Trishana
Wallace
N. L.
https://www.youtube.com/watch?vJsJ
RSTfGzeM&list=PLXIC8aFFVDk2ibtatLQl0
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 Full
term
gestation
 “Normal” finding
in ultra sounds
during
pregnancy
 Multiple
Congenital
anomalies
 Feeding
Difficulties
 Sleep Apnea
Health History
Developmental
Stage
Assessment findings
Morgnani Hernia
Morgnani
Hernia
Chromosomal
Deletion
Failure to Thrive
Failure to
Thrive
Difficult to eat
Cleft Palate
Not enough
Calorie Intake
Nutrition
Imbalance:
Less than…
Impaired
skin
integrity
Risk for
Infection
Pain
Umbilical
hernia
Failure to
Thrive
Anxiety
Pain
Related to recent surgical
procedures as evidenced by
constant crying with no
consolibitly, and arched rigid
posturing
Nutrition
Imbalance:
Less then Body
Requirements
RDA for age(kcal/kg) x ideal wt for ht
Actual weight
Anxiety
Related to unfamiliar
surroundings multiple
medical staff
Impaired Skin
Integrity
Risk For
Infection
Interventions
Pain
• . Administer Hycet 2ml by mouth every 6 h for signs of severe pain.
• Pain assessment FLACC q4hours
• Allowed her to stay in the recliner with mom, minimal handling
• Ask mother about how her child generally expresses pain.
Nutrition Imbalance
• Pediasure 5 cc Po ad lib Postop day 4
• Allow mom to feed her
• NPO post op day 5 r/t abd distention
• Subsequent use of G tube placement for night feedings
Anxiety
• Allow mom to hold pt during procedures
• Allow pt and family uninterrupted time alone fro rest and bonding
• Explain every procedure to pt using appropriate communication
• Use distraction techniques during potentially uncomfortableprocedures
Interventions
Impaired Skin Integrity
• Assess surgical wound dressing, Iv access, Gtube
placement for dislodgment, bleedings, inflammation
• Vitals q 4 hours
Risk for infection
• Vitals q 4 hours
• Assess Iv access for inflammation
Other
• Focused assessment for GI, girth measurement, weight,
i/o
• Monitor 02 sats r/t sleep apnea
• r/t asthma, assess BS, Nebulizer treatment
Relationships
•Surgical
procedure
•wounds
Anxiety
•Associate pain
with environment
and medical staff
•Parent’s response
Nutrition:
Less
Pain
•Iv access
•Gtube
•NG tube
Risk for Infection
•Pain and anxiety
effect on appetite
Nutrition
Imbalance: Less
•Body can not
fight infection
•Easier to
damage with
poor nutrition
Impaired Skin
Integrity
Teaching/dicharge
Pain
Medication admin Tylenol,
Motrin
Nutrition Imbalance
Follow doctors orders for Gtube feedings over night
30ml/hour 12 hours
Daytime feeding: PO pureed
food only, no more than 45ounces
Use of feeding pump
Risk for infection
• Report temp
101.5,decrease eating, n/v
• Redness, swelling at gtube
picc site
• Care of Gtube site
Feeding instructions
Teaching/discharge
Anxiety
Impaired skin Integrity
Explain post operative
expectations
Child Life specialist
Explain care equipment to child in
method she understands
ER immediately for
dislodgment
The steri-strips associated
with surgical incision will
fall off on their own
Cleaning of G tube site
Other
• Follow up appt surgeon
• Nutritionist referral
• Home health care support
• Child development specialist
referral
Cultural
Considerations
Research
Coping Kits
In Summary