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pediatric nursing diagnoses

by carriblue

Mar 21, '08 | 45,752 Views | 7 Comments

0 i have to develop three nursing diagnoses for the following scenario

1.

and literally have been thrown into the fire with a do to learn it approach from
my instructor.. we have not even had peds yet!!!
the scenario is this
Pediatric Physical Assessment Case Study #1
Focus Assessment of the Musculoskeletal System
CC: Bonnie L. is a 6-year-old female who presents to the nursing clinic with a 5
day HX of generalized weakness, fatigue, and pains in her arms and legs.
Bonnie and her mother deny a history of fall or other injury. Bonnie is shy and
hesitant to get up on the exam table. She wants to sit on her mother's lap.

I must develop an actual, wellness and risk diagnoses complete with goal and
outcome...
Can anyone offer guidance or direct me to a good resource? I have been
working on this for what feels like hours and I am so discouraged
1

o
2.

3.

About carriblue
Joined Mar '08; Posts: 3.

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7 Comments so far...

4.

1
Mar 21, '08 by leslie :-D
pain?
act intolerance?
imp mobility?
knowledge deficit?
risk for self care deficit?
risk for alt family process?
(sorry, i don't have a list handy...but these dxs could be appropriate, regardless
of pt's age...except alt fam process)
don't let the peds part scare you.
leslie
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5.

3
Mar 21, '08 by Daytonite
hi, carriblue, and welcome to allnurses!
ok, i get that you haven't had peds yet, but did you read the title of this
assignment very carefully, it says:
pediatric physical assessment case study #1
focus assessment of the musculoskeletal system
have you had lecture(s) on the nursing process and care planning? assessment
is the first (and major) step of the nursing process. there are no such things as
"pediatric nursing diagnoses". the nursing diagnoses at their most simple
classification are either (1) actual problems, or (2) potential problems. gordon,
as in gordon's functional patterns, classified the nanda diagnoses into 11
classifications, none of them pediatric. the choice to use any nursing diagnosis
is based upon the symptoms that serve as evidence supporting the existance of
that problem (nursing diagnosis). any diagnosis can be used for a pediatric,
adult or geriatric patient as long as the person has the essential symptoms.
what you have to do to complete this assignment is to work the steps of the
nursing process in the sequence they occur.

o assessment (collect data from medical record, do a

physical assessment of the patient, assess adl's, look up
information about your patient's medical

diseases/conditions to learn about the signs and symptoms

and pathophysiology)
o determination of the patient's problem(s)/nursing
diagnosis (make a list of the abnormal assessment data,
match your abnormal assessment data to likely nursing
diagnoses, decide on the nursing diagnoses to use)
o planning (write measurable goals/outcomes and nursing
interventions)
o implementation (initiate the care plan)
o evaluation (determine if goals/outcomes have been met)
it seems obvious to me that your instructor wants you to focus your efforts on
the musculoskeletal system. you can find information on a musculoskeletal and
pediatric assessment on this thread of allnurses (part of your assessment
activity):

o http://allnurses.com/forums/f205/hea...ms-145091.html
- health assessment resources, techniques, and
forms (in nursing student assistance forum)
the scenario has given you some symptoms and developmental stage behavior
information which you do not want to ignore:

o 5-day history of generalized weakness

o fatigue
o pains in her arms and legs
o no history of fall or other injury

o shy and hesitant to get up on the exam table

o wants to sit on her mother's lap
if i were you i would do some reading and exploration of fatigue and weakness
in children to see what you come up with. muscle weakness can be due to heart
problems, myalgias, malnutrition, muscular atrophy, polio or a brain or spinal
tumor. a congenital condition that has weakness and fatigue as a symptom is
hypertrophic polyneuritis. these are also symptoms of diabetes and
hypothyroidism. since these are not a normal finding in a child, it may yield you
your at risk diagnosis. to use a "risk for" diagnosis you must have a specific
problem in mind. so, for example, let's say you think this kid is in danger of
having polio (really, not likely) and you are worried about her developing
pneumonia because of progressive paralysis of the lung tissue. you would
diagnose risk for infection and develop nursing interventions to monitor for
the signs and symptoms of pneumonia as well as do some preventative
measures. long-term goal: no pneumonia.
you need the symptom list going into step #2 of the nursing process. the first
three symptoms are evidence for at least one actual nursing diagnosis (pain)
and a potential one (see discussion above). there is a list of all the wellness
diagnoses on post #84 of this thread:

o http://allnurses.com/forums/f205/des...ns-170689.html
- desperately need help with careplans (in nursing
student assistance forum)
pick one. i think you can safely get away with making up supporting symptoms,
but ask your instructor if you want to be sure. also ask how creative you are
allowed to get with this assignment. what kind of data can you add to spice it
up?
goals/outcomes (they are basically the same thing) are intimately associated

with the nursing interventions. they are linked to the symptoms the patient has.
goals/outcomes are the results you expect to occur when the nursing
interventions you order for the symptoms are performed. i believe their is a
subtle difference between goals and outcomes. goals are the predicted results
of collaborative nursing actions; outcomes are the predicted results of
our independent nursing actions.
you can read about how to write a care plan which is basically what you are
being asked to do here on this thread:

o http://allnurses.com/forums/f50/help...ns-286986.html
- assistance - help with care plans (in the general
nursing discussion forum)
hope this has helped you. good luck with your assignment.
Last edit by Daytonite on Mar 21, '08
9livesRN, Annie09, and carriblue like this.

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Mar 21, '08 by carriblue
Leslie and Daytonite,
Thank you both for your help! :bowingpurI have read your postings and
searched the links... all I can say is wow! This is a great site, resource and

learning tool. I am grateful there are people out there who are willing got take
the time to help out people such as myself.
Actual
diagnosis:
Activity Intolerance r/t acute pain AEB pts report of pain of 6 out of 10 in arms
and legs
Goal:
reduction of pain
Outcome:
Will report reduction in pain level, on a scale of 1-10, of a 2 or less by April
1,2008
Wellness
Diagnosis
Readiness for enhanced sleep
Goal:
11-12 hrs sleep/day
Outcome
Will sleep, 11-12 hours total, each day for 1 consecutive week by April 1, 2008
Risk
diagnosis:
Risk for delayed growth and development r/t activity intolerance
Goal:
activity levels considered normal by pt
Outcome:
Will report levels of activity, consistent with those prior to illness, unassisted, for
3 consecutive days by April 1, 2008
o

#3

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Mar 22, '08 by Daytonite
Quote from carriblue

activity intolerance r/t acute pain aeb pts report of pain of 6 out
of 10 in arms and legs
"pts report of pain of 6 out of 10 in arms and legs" is a symptom of pain, not
activity intolerance. do you have a nursing diagnosis reference? every nursing
diagnosis has a set of signs and symptoms that nanda calls defining
characteristics. you cannot assign a nursing diagnosis to a patient unless they
had one or more of the defining characteristics. it would be more appropriate to
use acute pain r/t unknown musculoskeletal disorder aeb patient report
of pain in arms and legs of 6 on a scale of 10.
Quote from carriblue

risk diagnosis: risk for delayed growth and development r/t

activity intolerance
i'm not crazy about you using this. activity tolerance is not a risk factor for this
diagnosis. there is a nursing diagnosis for this: risk for activity
intolerance. use that instead.
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Mar 22, '08 by carriblue
per your earlier suggestion regarding being creative with this assignment, we
were told that we do not need to know what is wrong with the pt (medical
diagnosis) to determine what we as nurses need to do.... "what would you do as
a nurse."
Quote from daytonite

"pts report of pain of 6 out of 10 in arms and legs" is a symptom of pain,

not activity intolerance. do you have a nursing diagnosis reference? every
nursing diagnosis has a set of signs and symptoms that nanda calls
defining characteristics. you cannot assign a nursing diagnosis to a
patient unless they had one or more of the defining characteristics. it
would be more appropriate to use acute pain r/t unknown
musculoskeletal disorder aeb patient report of pain in arms and
legs of 6 on a scale of 10.
no, all i have is a nanda list of diagnoses with nothing else attached... no r/t or
defining characteristics.. nothing... one reason this is so hard. is there a
particular reference you would recommend over others?
i see why i cannot use the pt report of pain for activity intolerance .. i was just
thinking that the pain caused the activity intolerance. well, now i know i had it
backwards. if nothing else this is an incredible learning experience and i no
longer feel llike beating my head against a wall

is unknown musculoskeletal disorder really a related factor? wow, i had no

idea.
Quote from daytonite

i'm not crazy about you using this. activity tolerance is not a risk factor
for this diagnosis. there is a nursing diagnosis for this: risk for activity
intolerance. use that instead.

ok. thanks i will...

risk for activity intolerance r/t pt report of fatigue
? but if you can't tolerate activity wont that delay your muscular development
and coordination? or is this not relevant in writing these diagnoses
i see that once again i approached my goal and outcome statement from point
of the related factor. boy, i hope one day i can get these right.
goal: activity tolerance
outcome:will report levels of activity, consistent with those prior to illness,
unassisted, for 3 consecutive days by april 1, 2008

thanks again daytonite

o

#5

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Mar 22, '08 by Daytonite
Quote from carriblue

we were told that we do not need to know what is wrong with the
pt (medical diagnosis) to determine what we as nurses need to
do.... "what would you do as a nurse."
that is correct! go back to the nursing process and review what goes on in each
of the steps. we address and treat the patient's response to their disease,
situations and what is happening to them. the doctor's treat the disease.

Quote from carriblue

no, all i have is a nanda list of diagnoses with nothing else

attached... no r/t or defining characteristics.. nothing... one
reason this is so hard. is there a particular reference you would
recommend over others?
nanda, the north american nursing diagnosis association, publishes the nursing
diagnosis taxonomy. the taxonomy currently contains 188 nursing diagnoses for
which nanda has developed for each

o a definition (actually, this is a more descriptive

statement of the nursing problem)
o defining characteristics (actually, these are merely the
signs and symptoms that support the problem)
o related factors (the etiology, or underlying cause, of the
problem) - often you need to understand the
pathophysiology of the disease process going on to
choose the correct related factor connected with a
physiological nursing diagnosis
o risk factors - these are etiologies that are only listed
with the anticipated, or potential, (have yet to occur)
nursing problems. these are the nursing diagnoses that
begin with the words "risk for" and are used when the
patient is vulnerable to possibly developing a problem.
what you need to do is get a copy of it. where is the taxonomy? it can be
purchased from nanda. it is published in nanda-i nursing diagnoses: definitions
& classification 2007-2008. most of the taxonomy information only takes up one
page, two at the most, for each diagnosis. this is the reference i use the most
because it is compact and only about 340 pages long with just the information
listed above. it has no other nursing information (no interventions, no goals).
you can only purchase this book from nanda and the cost is about $25.

however, many authors of care plan and nursing diagnosis books have already
paid nanda a royalty in order to print the taxonomy information in their books.
they usually print this information right below the title of a nursing diagnosis. it
doesn't take up much space. in addition you are getting nursing interventions
and rationales for a variety of medical diseases in the care plan books along
with goals and other extra goodies. there are also two websites that have
information for about 75 of the most commonly used nursing diagnoses that
you can access for free:

o http://www1.us.elsevierhealth.com/ev...e/constructor/
o http://www1.us.elsevierhealth.com/me...ctor/index.cfm
Quote from carriblue

is unknown musculoskeletal disorder really a related factor?

the related factors that nanda lists for acute pain are "injury agents (biological,
chemical, physical, psychological)". it just seemed logical to me that an
unknown musculoskeletal disorder would be a biological injury agent, or illness.
i didn't want to say illness because that hasn't been established.
Quote from carriblue

? but if you can't tolerate activity wont that delay your muscular
development and coordination? or is this not relevant in writing
these diagnoses
i'm pretty confident in saying no. normally, i would tell you to research this
before making this claim. however, nanda has already done it and lists the risk
factors for this diagnosis (quite a long list, too) in the taxonomy. not tolerating
activity just isn't on the risk factor list of the risk for delayed
development nursing diagnosis (page 70, nanda-i nursing diagnoses:
definitions & classification 2007-2008).
Quote from carriblue

i see that once again i approached my goal and outcome

statement from point of the related factor.

you can do that. your goal might be to remove, neutralize or do away with the
element(s) causing the risk or potential danger. that's ok. that's well within the
spirit of these types of nursing problems. for example, if a patient's activity
intolerance is related to deconditioning (this is an actual risk factor of the
diagnosis of risk for activity intolerance), a goal of the patient can be to
"increase physical conditioning by the end of two weeks as measured by. . ."
this goal targets the related factor. other targets can be to prevent specific
symptoms. goals can also reflect the expected results of the nursing
interventions that are going to be performed as well.
when you get a chance to sit and think on all this information you will realize
that there is rationality to it all. it takes a little bit of time for it all to sink in and
the light bulbs to turn on. but once you get it, you'll be explaining it to others.
Last edit by Daytonite on Mar 22, '08
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Dec 24, '09 by KalynJohnson
I have the Nursing Diagnosis book by Ackley. It's very useful! As a nursing
student just completing my first semester I totally understand that Nursing
Diagnoses are hard to get a handle on.
o

#7

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