CARING CORNER
PEDIATRIC DAY HEALTH CENTER
Day Care for medically fragile, technology dependent children, Caring Corner is a
nursing center. Caring Corner is a private, for profit nursing service which is a division
of Optimal Health Service. Children that meet the criteria of medically fragile,
technology dependent qualify for nursing services under MediCal guidelines. Thus
funding for Caring Corner is the hourly rate of pay for actual care provided. We are
currently licensed for 35 children at one time with our average daily attendance around
25 children. We currently have more than 35 children on service.
We are staffed with three full time and three half time Licensed Vocation Nurses.
Our administrator is Joey Buehler, RN,MN. Joey received her BSN from CSUB and a
Master’s degree in Maternal-Child Health Nursing from UCLA. She has extensive
experience in pediatric nursing in both acute and home health care. Edee Ellenberger,
MS,RN,CRRN-A received her BSN from the Medical College of Georgia and a MS
degree in Rehabilitation Nursing from Boston University. She is certified as an advanced
practice nurse by the Association of Rehabilitation Nursing. Our staff also includes a
receptionist/administrative assistant, Care Assistants who have a minimum of a CNA
certification, and an Activity Assistant who works with the children on activities to
promote socialization and skills which are intergrated into the plan of care.
Each child is under the care of their own physician. A plan of treatment which
includes both physician orders and nursing care is developed by the Clinical Nurse
Manager in consultation with the child’s caregivers. This is translated into a care plan, a
procedure list, and a medication administration record.
Caring Corner provides Pediatric Rehabilitation Nursing. Rehab nursing is
defined as “the diagnosis and treatment of human responses of individuals and groups to
actual and potential health problems relative to altered functional ability and lifestyle.”
Things to look for while at Caring Corner:
Nursing diagnosis vs. Medical diagnosis
Examples of family centered care, empowering families
Role of advanced practice nurse
Teaching of families and clients
Actual completion of procedures vs. critical thinking surrounding procedures
Activities to promote “normalization”
Nursing in a community setting
Consultation with other expert nurses.
Medical diagnosis seen at Caring Corner include:
Cerebral palsy
Cornelia de Lange syndrome
Rubenstein Tabys syndrome
Dandy Walker syndrome
Hydrocephalus with ventriculo-peritoneal shunt
Spina Bifida
Pierre Robin syndrome
Microencaphly
Seizure Disorder
Neuromuscular Respiratory failure
Cleft palate
Diabetes insipitus
Adrenal insufficiency
The most common nursing diagnoses include:
- Alteration in nutrition R/T: dysphagia
-Alteration in MobilityR/T spasticity, developmental delay, hemiparesis, paraparesis,
contracture, scoliosis
-Alteration in cognition/communication R/T developmental delay, impaired vision,
impaired hearing
-Alteration in elimination R/T developmental delay, R/T neurogenic bowel and bladder
dysfunction
-Ineffective airway clearance R/T dysphagia
-Risk for injury R/T seizure disorder.
Examples of nursing care plans:
Risk for injury R/T seizure. 1. Has partial complex seizures characterized by upper
extremity jerking with facial grimace to left. May be preceded by laughter or vomiting.
Give routine seizure meds as ordered, observe for seizures and record all seizure activity
and report to care giver. Make seizure record available to physician.
For non-convulsive seizure without loss of consciousness lasting more than 15 minutes
administer Diastat 10 mg. by rectum and call 911. For convulsive seizure with loss of
consciousness lasting more than 2 minutes administer Diastat 10 mg. and call 911.
(Diastat is a gel form of diazepam.)
2. Has implanted vagal nerve stimulator in left sub clavian area. Use magnet for any
observed seizure activity, may repeat q minute.
Alteration in nutrition R/T dysphagia. Nothing by mouth. 1. Has gastrostomy tube
Mickey button14 Fr. 1.8 cm. Is changed by family, may be changed by nurse prn
dislodgement, plugging, leaking. Child to have spare G tube with him at all times. Site
is cleaned with soap and water at bath time and prn. Is fed Jevity with fiber (1cal/ml) 240
ml via Gtube bolus by gravity every three hours. Follow with 120 ml of water. Weight
every month.
2.Infant has 14 Fr. 0.8 Mickey button. Offer Similac Neosure Advance formula by
mouth using pigeon nipple on demand. Titrate g-tube feeding to equal no less than 6 oz.
formula every three hours while awake. Feed continuous by pump to G tube at 30 ml per
hour for ten hours at night. Weigh weekly.
Ineffective airway clearance R/T neuromuscular respiratory clearance and tracheostomy
Has 4.5 mm Shiley pediatric trach. Is changed every two weeks by parents. May be
changed by nurse prn plugging, dislodgment. To have extra 4.5mm and 4.0 mm. trach
with child at all times. Trach ties changed daily and as needed to keep clean and dry.
Trach site cleaned with normal saline. Is at risk for skin breakdown under trach ties R/T
history of pressure ulcer in that area. Use only wide padded trach ties. Inspect skin with
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each tie change. Trach is suctioned prn using 8 Fr. Sleeved catheter and sterile technique,
cath advanced no more than 7 cm. May lavage with normal saline 1 ml. at a time prn
thick secretions.
Alteration in mobility R/T cerebral palsy
Has random, non-purposeful motion of all extremities with increased flexor tone. Does
not have head control, does not sit. Uses custom wheelchair with head support and lateral
trunk supports with shoulder harness. Upper extremity extension splints to be worn on 2
hours, off two hours. Hip abduction brace to be worn to tolerance as evidenced by
confort and no skin changes due to pressure. Range of motion exercises with stretching
to all extremities prior to application of splints and brace. Prone on mat with upper torso
supported on bobby pillow at least one hour daily. May be in highchair, may be in
beanbag, may be in recliner. Position change every thirty minutes.
Medications:
Tegretol, Keppra, Clonopin, Depakote, Depakene, Topamx, Diastat, Lorazepan,
Diasapam, Baclofen, Reglan, Robinal, Captopril, Revation, Lasix, Digoxin