Pediatric Nursing Grand Rounds Presentation
NUR 421- Clinical Management of Infants and Children
Purpose of Assignment
To provide the student an opportunity to integrate knowledge from the sciences,
developmental theory and physical assessment data to the care of a pediatric client and family in
the acute care setting. The student will utilize critical thinking and independent judgments in
presenting a holistic plan of care in a formal oral presentation.
Student Approach to Assignment
The patient chosen for this oral presentation was a 3-year-old boy diagnosed with Midgut
Volvulus and Short Bowel Syndrome. The patient was initially admitted to the hospital after
complaining of stomach pains and experiencing frequent emesis episodes. However after his
admission, a physical assessment determined the patient had symptoms of a Midgut Volvulus.
The patient was immediately taken to surgery where he received a bowel resection and an
ileostomy. However, the patient remained hospitalized for four months due to several
complications. The patient underwent numerous surgeries including an appendectomy, and a
bowel resection. As a result of the multiple surgeries, the patient was diagnosed with Short
Bowel Syndrome. The patient continued to remain hospitalized due to complications associated
with reoccurring Midgut Volvulus.
Reason for Inclusion of this Assignment in Portfolio
This assignment is included in the portfolio because it highlights the care I gave to a
pediatric patient in a pediatric setting at the Children’s Hospital of King’s Daughter in Norfolk,
VA. This assignment demonstrates my capability to thoroughly develop a plan of care for a
pediatric patient. This assignment illustrates my capability to conduct a thorough physical
assessment, formulate nursing diagnoses, as well as focus on the psychological aspects of my
patient.
 Critical Thinking
 Uses nursing and other appropriate theories and models to guide professional
practice.
 Example: In this oral presentation, I included Erikson’s Initiative vs. Guilt
developmental stage theory. The theory states a child will begin to take initiatives
to exert control over his or her environment through play, such as make up games,
or other activities. This theory helped develop a plan of care that included a form
of play when implementing certain nursing tasks for my patient. Before
performing any interventions, I made sure to introduce the medical equipment in
an interactive way. For example, during my physical assessments, I let the patient
play with my stethoscope listening to his heart and lung sounds before I
auscultated them.
 Nursing Practice
 Demonstrates an awareness of complementary modalities and their usefulness in
promoting health.
 This oral presentation included the complementary and alternative medical
intervention of Child Life activities, such as direct play. The patient’s age
categorized him in the developmental stage of Initiative Vs. Guilt. This
stage focuses on the child’s ability to take control over their environment
though play. However since my patient had been hospitalized for four
months, it was important to incorporate a time where the patient was able
to express his feelings, and explore his surroundings. Because the patient
was in a stable condition during my clinical time, I engaged in various
child life activities with the patient, including visiting the play room, and
engaging on a nature’s walk.
 Establishes and/or utilizes outcome measures to evaluate the effectiveness of care
 This oral presentation included nursing diagnoses accompanied by
measurable outcome measures to evaluate the effectiveness of the
provided care. For example: I found the patient to have a primary nursing
diagnosis of a risk for infection related to multiple broken skin barriers.
The patient had a PICC line in his left Basilic vein, a gastrostomy tube in
his left upper quadrant, and ileostomy in his right lower quadrant, and he
had a past medical history of Methicillin-resistant Staphylococcus aureus
(MRSA). Based upon his primary nursing diagnosis, I established the
expected outcome that the patient would remain free from any signs of
infection, as evidenced by a temperature less than 37.4 degrees Celsius, a
lack of redness or purulent discharge from the stoma site or his PICC area,
and vitals signs within the normal ranges, including respirations between
22-34 and a heart rate between 80-120 bpm. Throughout the time of my
care, the patient was able to meet these outcome measures, ensuring the
effectiveness of his planned care.
 Communication
 Adapts communication methods to patients with special needs.
 This oral presentation demonstrated my ability to accommodate
communication methods in regards to my patient’s age and developmental
stage. I considered his age of 3 years and his developmental stage of
Initiative Vs. Guilt when communicating with the patient, or preparing to
provide a nursing intervention. For example: I used the method of play to
introduce medical equipment to the patient. By doing so, I was able to
establish a sense of rapport with the patient in a non-verbal way.
 Expresses oneself and communicates effectively with diverse groups and
disciplines using a variety of media in a variety of contexts.
 This oral presentation of my patient’s case was presented to my classmates
and clinical instructor. I used a PowerPoint presentation, and a visual
board to help explain Midgut Volvulus, Short Bowel Syndrome, and his
nursing diagnoses.
 Teaching
 Provides teaching to patients and/or professional about health care procedures
and technologies in preparation for and following nursing or medical
interventions.
 During this oral presentation, I addressed the teaching that was
implemented with the mother. Because the patient is very young, most of
the teaching regarding his care is directed towards his mother. During the
patient’s hospilization, the mother would participate in suctioning and
changing his ileostomy bag. It was during these times, that I noticed the
mother would not perform proper hand hygiene, including washing her
hands prior or donning gloves during this intervention. I provided
teaching on how a clean technique is needed when manipulating
gastrostomy tubes since the patient is at a higher risk for infection. The
mother was very receptive of the teaching, and started performing
adequate hand hygiene before performing the procedure.
 Research
 Applies research-based knowledge from nursing as the basis for culturally
sensitive practice.
 In this oral presentation, I included a research article that discussed the
complications associated with gastrostomy tubes in children. The research
article was a descriptive study that investigated the main complications
with gastrostomy tubes. The study found that 35 out of the 94 patients
studied had infections, and the 64 out of the 94 had granulation tissue. The
study also revealed that the major complications were leakage from the
stoma, infected fistula, and reoccurring granulation tissue. I used this
information in my nursing care during each of my physical assessments. I
made it a priority to frequently assess the stoma site for any sign of
leakage or infection.
 Shares research findings with colleagues
 The findings of this research study were shared with my nursing peers and
my nursing instructor during the presentation of my grand rounds on this
particular patient.
 Culture
 Articulates an understanding of how human behavior is affected by culture, race,
religion, gender, lifestyle, and age.
 During this presentation, I presented information about my patient, a 3year-old boy diagnosed with both Midgut Volvulus and Short Bowel
Syndrome. The patient had been hospitalized at the Children’s Hospital of
King’s Daughter in Norfolk, VA for four months due to complications.
His long period of continued hospitalization affected the normal behavior
that should be illustrated at his specific age. According to Erikson’s
developmental theory, the patient should be in the Initiative vs. Guilt stage
that consists of the individual exploring and taking control of his
surroundings. However, because of the patient’s lifestyle of being
hospitalized and requiring frequent surgical procedures, the patient was
unable to explore his surroundings and take control of his environment.