2. OBJECTIVES To present a plan of care for a previous patient through introduction, physical assessment and history, nursing problems with plan of care, with research.

4. No health history on file Born healthy Youngest sibling out of 5 No prior hospitalizations No psychosocial history on file No visits from social work

5. Culture Young parents with multiple children Living in a large family with many siblings First time hospitalizations

7. Chief reason for admission Abscess on neck Primary medical diagnoses Infection as evidence by abscess in need of incision and drainage

8. Patho-physiology What is an abscess? An abscess results from pus gathering in a tissue of the body that has formed a cavity due to an infection. How does it start/form? A series of immune responses beginning with the migration of white blood cells to the infection and the separation of a fluid-filled cavity from the surrounding, healthy tissue.

9. Patho-physiology Why? Immune system compensates creating the pus that forms the abscess What is the pus? Mixture of dead cells and the chemical mediators of immune response, fills the area around the site, which is separated from healthy tissue by the formation of an abscess wall.

10. Treatment plan Antibiotic Clindamycin to treat infection and surgery to remove the puss (incision and drainage) There is no secondary diagnosis

11. Developmental Stage What ‘s expected psychosocialy? In using the psychosocial developmental theory by Erickson this child should be in the initiative vs guilt stage. In this stage it is important for the child to have exploration and play in order to gain accomplishment Were expectations met? YES

12. Developmental Stage How were expectations met? Through observation How did this effect care? Did not try to limit the amount of time of child time. We adjusted our schedules. Praise for simple task completed so that he would that he was being “a good boy.”

13. Developmental Stage What ‘s expected cognitively? In using the cognitive developmental theory by Piaget this child should be in intuitive part of the preoperational stage. There is a shift from totally egocentric thought to somewhat understanding others view points. Able to think and talk about what is going on inside their head without having to stop to act out their thinking Were expectations met? YES

14. Developmental Stage How were expectations met? Through observation How did this effect care? Communication was adjusted. More active listening. Encouraged trial and error before teaching.

15. Other Developmental Manifestations Personal Takes frustration out on parents Understands do’s and dont’s Speech Knows simple songs Uses sentences of 5 words or more

16. Other Developmental Manifestations Fine Motor Copies Drawings Plays video games reliably Gross Motor Catches ball reliably Skips on one foot

17. Abnormal Physical Assessment Cardiovascular IV in right antecubital in infusing with 10mL/hr of Clidamycin Blood pressure increased to 119/65 when norms are 70-106/42-63 because of anxiety and fear of unknown Skin Bandage of incision site with 4x4 gauze and hypafix dressing Fluid Balance Output > Input because of infection (insensible fluid loss)

22. General Nursing Care Interventions Assessing site of incision when saturated change dressing and use aseptic technique Infection Administering continuous infusion of Clindamycin Comfort Checking vital signs q 4 hrs including pain and bowel sounds

23. Holistic Care Interventions “Pain” due to previous NPO status Encourage small light foods first Comfort Position on non-affected side Communication Behavior Understanding regressed behavior

24. Collaborative Care Interventions Comfort Child life, Parents

25. Alternative Care Interventions Comfort Dog Therapy

26. INCLUDES…. General Nursing Care Interventions Holistic Care Interventions Collaborative Care Interventions Alternative Care Interventions

27. Fear -> Comfort Knowledge Deficit of Parents-> Fear Comfort Knowledge Deficit of Parents-> Comfort Knowledge Deficit of Parents-> Fear -> Comfort Impaired Skin Integrity/Infection-> Comfort Impaired Skin Integrity/Infection-> Fear Impaired Skin Integrity> Fear -> Comfort Impaired Skin Integrity/Infection -> Further Infection

28. Teaching Parameters surrounding hospital stay Assessing Child Discharge Planning Clindamycin information because of newly diagnosed med, may need pamphlet Signs of Infection, may need pamphlet

29. NURSING SUPPORT FOR PARENTS OF HOSPITALIZED CHILDREN Background: Having a child in hospital is a stressful experience for most parents. Support from nurses can assist parents to maintain their parenting role and promote quality pediatric nursing care. Aims and objectives: The aim of the study is to describe the quality of nurse-parent support in Iranian parents of hospitalized children in pediatric sites. Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130.

30. NURSING SUPPORT FOR PARENTS OF HOSPITALIZED CHILDREN Methods: This was a descriptive study using a convenience sample. 230 parents (183 mothers and 47 fathers) with hospitalized children took part in this survey. There was 250 the others opted out. They were notified of what was going on and wanted to sign. Eliminated if they could not speak Farsi. Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130.

31. NURSING SUPPORT FOR PARENTS OF HOSPITALIZED CHILDREN Tool: The NPST is a 21-item questionnaire that was developed by Miles, Brunssen, & Carlson to assess the type of nursing support that parents received during the hospitalization of their child. The tool is classified into groups : Information Giving and Communication Support (nine items); Emotional Support (three items); Appraisal Support (four items) and Instrumental Support (five items). Scores range from 1 to 5 with higher scores showing a greater amount of support provided by the nursing staff. Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130.

32. NURSING SUPPORT FOR PARENTS OF HOSPITALIZED CHILDREN Discussion/Result: Based on the results, it can be said that the parents in this study received a high level of support (4.1 ± 0.7) from the nurses. Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130.

33. How does this relate to my patient? Nurses have an important role in assisting parents to define their role in the relationship between them and their critically ill child. A child is in the care of the parent, once the parent is reached, care of the child may be easier. Interrelatedness of Knowledge Deficit of Parents in treatment regimen.

34. Summary Presented a plan of care for a previous patient through introduction, physical assessment and history, nursing problems with plan of care, with research.

35. REFERENCE Caramenico, G. (n.d.). Retrieved from http://www.wisegeek.com/what-is-the- pathophysiology-of-an-abscess.htm Google media images Hockenberry, M. J., & Wilson, D. (2011). Wong's essentials of pediatric nursing (9th ed.). St. Louis, MO: MosbyElsevier. Sanjari, M. (2009). Nursing Support for Parents of Hospitalized Children. Issues In Comprehensive Pediatric Nursing, 32(3), 120-130.