Pediatric Nursing Rounds Presented by Marc Manucal Old

Pediatric Nursing Rounds Presented by: Marc Manucal Old Dominion University – Nursing Program

Trespasser VS Trains State of Virginia Casualties 2009 - 14 2010 - 13 2011 -15 2012 - 11 (Federal Railroad Administration, 2012)

Pertinent Past Medical History § § § § 10 year old African American male Born on 30 DEC 11 Normal delivery/birth history Vaccinations up to date No prior surgeries/hospitalizations Asthma -exercise induced -uses rescue Albuterol inhaler NKDA

Psychosocial History § § § Education -currently in 5 th grade -well rounded student Family -only child -lives one mother in 2 bedroom apartment Cultural Consideration -low socio-economic status -amputee

Circumstances Leading to Hospitaliation § § JH was playing with friends on railroad track near home He decided to run across tracks prior to oncoming train JH’s foot gets caught in the tracks Suffers a BKA of left leg

Admitting Diagnoses Primary v Traumatic below the knee amputation of left leg Secondary § Debridement and wound vac placement to left leg § PICC line insertion

Pathophysiology Amputations may be elective or traumatic. Elective amputations are related to peripheral vascular disease and arteriosclerosis. Complications result in ischemia in distal areas of the lower extremity. Traumatic amputations are most often the result of an accident from machinery, motor vehicle accidents, or industrial machinery. Traumatic amputations are also increasing during the wars in Afghanistan and Iraq due to roadside bombs (Ignatavicious & Workman, 2010).

Treatment Plan OCCUPATIONAL THERAPY PHYSICAL THERAPY

Expected Developmental Stage Erickson’s Industry VS Inferiority

Current Developmental Stage Industry VS Inferiority -growing sense of independence -building new skills -develops a sense of accomplishment -seeks extrinsic sources of reinforcement that provide encouragement and stimulation

Physical Assessment § § § § Neuro Skin Cardiovascular Respiratory GI GU Musculoskeletal

Concept Map 1. Acute Pain Below knee amputation 9/10 pain without meds Phantom pain Wound vac draining serosanguinous fluid TENS electrodes HR 115, BP 128/84 Pt Initials: JH Age: 10 Medical Diagnosis: Left below knee amputation Secondary Diagnosis: Debridement and wound vac placement Use walker, wheelchair Regular OT/PT visits Perform ADL’s without assistance Oxycodone Gabapentin 3. Risk for infection Debridement/wound vac placement PICC line Open wound Immobility 2. Impaired physical mobility Restricted movement of LLE Decreased ROM of LLE Pain with movement of extremity Wound vac attached to LLE Use of assistive devices (walker, wheelchair) 4. Ineffective Coping Inability to make decisions Lack of goal directed behavior Inadequate problem solving Poor concentration Nightmares of accident Fatigue 5. Disturbed body image Request for amputation site to be wrapped with acewrap Refusal to discuss amputation Actual change in structure of LLE Refusal to look at amputation site Covers site with blankets or clothing Child Life Social work Chaplain Child life Social work RBC-3. 23, WBC-6. 8, Plt-695

Expected Outcomes Acute Pain- patient will have pain controlled as evidenced by a pain level below 3/10 on pain scale. Impaired physical mobility- patient will maintain efforts in achieving optimal independence through therapy (OT/PT) during each session as evidenced by increased gait stability. Risk for infection- use of aseptic technique throughout shift. Patient and family will be able to verbalize signs and symptoms of infection by end of shift. Ineffective coping- patient will be able to demonstrate coping strategies such as expressing feelings, deep breathing exercises, and guided imagery. Disturbed body image- patient will verbalize concerns about body image throughout hospitalization.

Holistic Nursing Care Traditional- providing for basic healthcare needs Complimentary- OT, PT, Childlife Alternative- use of dry erase boards at bedside Collaborative- patient goal orientation with family members

Discharge Teaching

Transcutaneous Electrical Nerve Stimulation (TENS) Unit

TENS Unit

Nursing Research LIU, F. , WILLIAMS, R. , LIU, H. , & CHIEN, N. (2010). THE LIVED EXPERIENCE OF PERSONS WITH LOWER EXTREMITY AMPUTATION. JOURNAL OF CLINICAL NURSING, 19(15 -16), 2152 -2161. DOI: 10. 1111/J. 1365 -2702. 2010. 03256. X

Questions?

References Federal Railroad Administration Office of Safety Analysis. (2012). Trespasser Casualties (Deaths and Injuries). Retrieved December 4, 2012, from http: //safetydata. fra. dot. gov/Officeof. Safety/publicsite/Query/castally 4. aspx Ignatavicious D. D. , & Workman, M. L. , (2010). Medical-Surgical Nursing: Patient-Centered Collaborative Care (6 th ed. ). St. Louis, MO: Elsevier. Liu, F. , Williams, R. , Liu, H. , & Chien, N. (2010). The lived experience of persons with lower extremity amputation. Journal Of Clinical Nursing, 19(15 -16), 2152 -2161. doi: 10. 1111/j. 1365 -2702. 2010. 03256. x Tens. Unit. (2012). How does a TENS work? . Retrieved December 4, 2012, from http: //www. tensunits. com/INFO. html#1