Peds+Care+Plans

Really are your friends...
 * Nursing Paperwork: **
 * Concept maps and Care plans **
 * APA, Teaching-Learning, Evaluations... **

Now, I did not used to feel this way either. It was all so global and confusing. Right now simply caring for your patients, introducing yourselves, remembering to get their name and date of birth (verifying), assessing, wrapping your brain around their diagnosis and treatment is hard enough. Please understand that this is to be expected ;) However, it will not always be this way and it will get easier. I promise!

How many of you have ever had the English exercise where you were told to write directions on how to do something. (Actually, I hated this exercise. It seemed so pointless).

Example: Write directions on how to make a peanut butter and jelly sandwich....OK...

First, I get the bread, Then, I get the peanut butter and jelly...and a knife. Next, I put the bread on a plate. Then, <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">I open the peanut butter, put the knife in, get peanut butter on the knife, take it out and spread it on the bread...

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">And so forth and so on... <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Oh so tedious....

<span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 22px;">*In essence when we ask for a care plan, we are saying give me directions on how you plan to care for your patient... <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 22px;">A care plan is just a plan of care!

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Where do I start? The six steps!

media type="custom" key="21338912" width="560" height="560"


 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">First: **
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Identify problems from your assessment, the database may or may not be up to date **
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Then prioritize the problems with the use of a concept map... **

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Define your nursing diagnosis...Check out NANDA. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">A nursing diagnosis is not a medical diagnosis. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Nursing diagnoses can be grouped in various ways:
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Second: **
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Turn problems into Nursing Diagnoses: **

<span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Maslow's hierarchy of needs: <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">> physiological needs <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">>safety and security needs <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">>love and belonging <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">>self esteem <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">>self actualization

<span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Gordon's Functional Health Patterns: <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Health perception/health management <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Nutritional-metabolic pattern <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Elimination pattern <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Activity-exercise pattern <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Sleep-rest pattern <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Cognitive-perceptual pattern <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Self perception self concept patterns <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Role relationship pattern <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Sexuality-reproductive pattern <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Coping-stress tolerance pattern <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Value-belief pattern

<span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Doenges and Moorhouse's diagnosis framework <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Activity/rest <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Circulation <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Ego Integrity <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Elimination <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Food/Fluid <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Hygiene <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Neurosensory <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Pain/Discomfort <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Respiration <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Safety <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Sexuality <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Social Interaction <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Teaching/Learning

<span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">NANDA's domains of nursing diagnosis <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Health Promortion <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Nutrition <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Elimination/exchange <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Activity/rest <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Perception/cognition <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Self-perception <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Role relationships <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Sexuality <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Coping/stress tolerance <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Life principles <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Safety/protection <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Comfort <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">> Growth/development

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">***Use modifiers,** decreased, ineffective, altered, impaired, at risk for...

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">*Expand upon for nursing diagnosis - is related to (r/t) as evidenced by (aeb) <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">For example, Pain related to a surgical incision as evidenced by grimacing, crying, FACE =8/10, ...

<span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Related to, r/t <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">...pathophysiological, environmental, psychosocial, spiritual, cultural, situation, developmental level...Note these must be modifiable by a //nursing// intervention.

<span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">As evidenced by, aeb, <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;"> often the answer to this was noted in your interview or assessment. <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Examples: <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Pain r/t surgery aeb grimacing, flacc, face or number = 8, immobility, crying... <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Ineffective oxygenation r/t constricted airways aeb SOB, tachypnea, tripoding, retractions, O2 sat<94%

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">This is one of your care goals for your patient. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">After you have your nursing diagnosis, determine an outcome or goal for your patient. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">The outcome must be measurable...if the child has had a procedure which causes pain, a measurable goal could be that before I leave today I want to have maintained his pain at a level of < 3. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">At the end of the day you will evaluate this outcome... <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Was I able to keep the pain level down below 3? <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">I like to do it in this order so that the care I provide has meaning.
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Third: **
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Outcome: **

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">If for example, the child is 4 days post-op and no longer in p <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px; line-height: 25px;">ain but bored or afraid, then the goal I set is pointless.

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">The goal will determine my interventions. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">If my child is in pain I am going to assess the pain using the appropriate measure, then provide distraction, possibly warm or cool compresses, and later I will try medication... and so forth and so on. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">You need at least 3 interventions per nursing diagnosis.
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Fourth: **
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Intervene: **

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">If my child is in respiratory distress, I will intervene in appropriate ways to maintain oxygenation i.e. assessing respiratory status: rate, rhythm, ease, O2 sat readings. I may then intervene with position changes, O2 via nasal canula, etc.

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">I need to be able to explain why I intervened like I did. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Why did I use a FLACC or FACE pain assessment scale (age). <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">I need to provide a reason I tried distraction. Did I try sweetease or a movie? Was it age appropriate? <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Why did I then administer a pain medication? <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">If I assessed the respiratory status, this is to maintain homeostasis. Respiratory distress can lead to....
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Fifth: **
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Rationale/explanation: **

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Lastly, I will evaluate my care. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">The patient and family are evaluating your care; this is no different. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Did I make sure to focus on the main <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px; line-height: 25px;">problems? (Pick the most important diagnoses) <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Did I set a measureable goal? (< 3 on FLACC, FACE or Number pain scale, O2 sat >94%) <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">If I performed patient teaching, I can still measure the results by having the patient acknowledge understanding through a return demonstration.
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Sixth: **
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Evaluate: **

<span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">More and more in our documentation insurance companies are going to evaluate outcomes. <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">If I teach a client, it is not billable unless I include that the patient acknowledged understanding and returned a demonstration. See, returning an accurate demonstration indicates understanding; it is measurable.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">An excellent video which details how to write a Care Plan/Map

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 26px;">media type="youtube" key="onnoPvwJ8SM" height="479" width="606"

<span style="color: #0000ff; font-family: 'Times New Roman',Times,serif; font-size: 26px;">Links for nursing diagnoses, outcomes classification and interventions

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Link to the U.S. National Library of Medicine, Institute of Health concerning nursing diagnoses: <span style="background-color: initial; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Nursing diagnoses

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Link to U.S. National Library of Medicine, Institute of Health concerning nursing outcomes classification: <span style="background-color: initial; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Nursing outcomes classification

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Link to U.S. National Library of Medicine, Institute of Health concerning nursing interventions classification: <span style="background-color: initial; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Nursing interventions outcomes


 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 23px;">The PowerPoint below addresses much of the other required paperwork for the nursing program. **
 * <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 23px;">APA, Teaching-Learning and Clinical Evaluations **

media type="custom" key="21338958" width="598" height="598"


 * <span style="color: #cd2d2d; font-family: 'Times New Roman',Times,serif; font-size: 23px;">This is a link to an amazing resource by the American Psychological Association about APA formatting. It is a brief voice over PowerPoint tutorial with several examples. **
 * @http://www.apastyle.org/learn/tutorials/basics-tutorial.aspx **

<span style="color: #cd2d2d; font-family: 'Times New Roman',Times,serif; font-size: 160%;">The Owl of Purdue for excellent guidance on APA @http://owl.english.purdue.edu/owl/

<span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 26px;">SBAR... <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 16px;">Did you know that if you are leaving the floor, going to post conference, or changing patients you must report off, even as a student, to the nurse in charge or it could be considered patient abandonment? SBAR provides an excellent way to give a quick, relevant report to the nurse. Also, did you know that more and more end of shift reporting is being done at the bedside?

<span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 26px;">A breakdown of SBAR... <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 26px;">Situation <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Tell the person you are reporting to who your are, who you are reporting about, why you are reporting and what is going on... <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 26px;">Background <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">What has lead up to this... <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 26px;">Assessment <span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Current data, why are we calling him...description of status, not diagnosis <span style="color: #cd1818; font-family: 'Times New Roman',Times,serif; font-size: 26px;">Recommendation <span style="color: #000000; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Suggestion for care related to labs, medications, care

media type="youtube" key="8N_JQbARxps" height="408" width="546"

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Just for fun, be careful what you write... <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chart and Documentation Bloopers!

media type="youtube" key="dsw7uNZiJcI" height="377" width="504"

<span style="color: #df3a3a; font-family: 'Times New Roman',Times,serif; font-size: 14pt;">References:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Hockenberry, M. J., & Wilson, D. (2009). Wong's essentials of pediatric nursing (8th ed.). St. Louis, MO: Mosby Elsevier.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 17px;">Potts, N. L., & Mandleco, B. L. (2012). Pediatric nursing: Caring for children and their families (3rd ed.). New York, NY: Delmar Cengage Learning.

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Schuster, P. M. (2012). Concept Mapping: A critical thinking approach to care planning (3rd ed.). Philadelphia, PA: F. A. Davis Company.

<span style="color: #d33131; font-family: 'Times New Roman',Times,serif; font-size: 17px;">Videos located at:

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Care Plans <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/onnoPvwJ8SM

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">SBAR <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/8N_JQbARxps

<span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">Chart and Documentation Bloopers <span style="font-family: 'Times New Roman',Times,serif; font-size: 130%;">http://youtu.be/dsw7uNZiJcI