Grand RoundsBy: 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 2nd 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• Patient was withdrawn and very depressed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 childPabiś, M., Wrońska, I., Ślusarska, B., & Cuber, T. (2011). Paediatric nurses' identification of violence against children. Journal Of Advanced Nursing, 67(2),

384-393. doi:10.1111/j.1365-2648.2010.05473.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