Grand Rounds By: Rebecca Berryman

Focus The focus of this presentation will be to introduce and discuss a patient I provided care for during clinical rotation at CHKD. Patient history and reason for admission Physical assessment Developmental Stage Nursing problems with expected outcomes Care interventions Teaching needs Application of current research

Patient Introduction N.M. is an 11 year old, African American, Female Birthday March 05, 2004 This is her 2 nd admission related to burns Diagnosis: Wounds not healing Pt lives with her family in North Carolina Siblings include 3 older brothers

Patient History First admission was on February 22, 2015 Came in with 20% Body Surface Area (BSA) Burns Partial and Full thickness burns Parents reported that the pt “fell into the stove and a pot of boiling water fell on her” While family were in the room they were yelling at each other while pt sat in her bed

Assessment Partial and Full thickness burns Face, neck, clavicles, shoulders, and back Patient was withdrawn and very depressed Did not allow me to physically assess her

Developmental Theories Erikson Pt is a school age child struggling with industry vs inferiority Needs to face the demands of social and academic demands so that she can either succeed or fail Pt will gain competence if she succeeds and feel more inferior if she fails. Important to give her small tasks she can complete to fuel her towards competence Piaget Pt is an adolescent Concrete Operational Struggles with abstract thinking Very rigid Should be less egocentric Should be thinking logically

Concept Map Nursing diagnosis Acute pain Imbalanced nutrition: Less than body requirements Fluid imbalance Constipation Dysfunctional family processes Ineffective coping (pt is depressed) Skin Integrity Infection

Interrelatedness Between Nursing Problems Pt’s pain was increased by depression Medications could be a cause of constipation Pt is not eating would could also be contributing to her constipation The mother’s and grandmothers actions caused pt’s infection Pt is depressed causing her not to eat Pt’s skin integrity was affected by improper care

Plan of Care The nurse and I tried to get the pt to eat but she refused MD did say if pt kept refusing to eat then they would have to place an NG tube Pt was receiving medications such as: Versed, Ibuprofen, Lactulose, Miralax, and Senna Dressing changes every 12 hours Child life was working with her Had a teacher working with her to keep her on track with her education Pt refused to work with Physical Therapy

Teaching Needs Patient Significant nutritional teaching NG tube Burns Unreceptive Family What isolation does to a child How to care for pt’s burn wounds Malnutrition Significance of nutrition after being burned Never came to the hospital

Discharge Planning Needs Wound care Social services Nutritionist Financial issues

Research Peadiatric Nurses’ Identification of Violence Against Children Sample size: 160 nurses This study was done in Poland Questionnaire form Largely focuses on nurses’ assessments, diagnostic skills, and interventions with child maltreatment 61.25% of the nurses reported working with a child that was maltreated 30% mentioned some form of child neglect Nurses need more specialized training on how to care for a maltreated child Pabiś, M., Wrońska, I., Ślusarska, B., & Cuber, T. (2011). Paediatric nurses' identification of violence against children. Journal Of Advanced Nursing, 67(2), doi: /j x

Summary Patient was introduced and discussed Patient history and reason for admission Physical assessment Developmental Stage Nursing problems with expected outcomes Care interventions Teaching needs Application of current research