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Concept Mapping
4832 Nursing Care of Children and Families

Rachael Huey

P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis

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Key Problem 1: Acute Pain Key Problem 2: Impaired Key Problem 3: Risk for
-Closed Fracture of Left comfort ineffective tissue Perfusion
femur -Muscle Spasms -Xray showing fracture of left
-4 on FLACC scale (d/t -Occasional fussiness femur
muscle spasms) - Patient stated she wanted to - use of soft cast
- Muscle spasms go home/misses her dog -future surgery- closed reduction
-administration of 1mg -keep leg elevated and use of of left femur, followed by use of
Diazepam po ice packs spica cast
-orders for analgesics
following surgery

Key Problem 7: Risk for

impaired skin integrity Key Problem 4: Parental
Reason For Needing Health Care: anxiety
-surgery followed by use of
spica cast
-Closed Fracture of the left femur -Parents never left bedside
-immobility -Closed reduction of left femur shaft -Parents stated feelings of
-repositioning Key assessments: guilt and worried for
Pain assessment patients ability to walk
Neurovascular assessment again
-Anxious facial expression
(cap refill- 2 secs, color, temp- warm)
- Anxious towards care of
child (such as diaper
change)

Key Problem 6: Immobility Key Problem 5: Caregiver

-Xray showing fracture of role strain
left femur -4 other children at home,
-use soft cast including a new born
-assist with comfort and -parents voiced concerns of
repositioning work schedule

Problem # __1_____: Acute Pain

General Goal: Relief of pain, maintenance of no pain
P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis
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Predicted Behavioral Outcome Objective (s): The patient will display a decrease in
pain related behaviors on the day of care
Patient will maintain no pain
Nursing Interventions Patient Responses

1. Assess pain using FLACC scale 1. 4 on FLACC scale due to muscle spasm

,reassesed, and patient was comfortable

2. Administer medications 2. Decrease in discomfort, patient relaxed

(1mg valium po, 120 mg ibuprofen)

3. Provide non pharmacological 3. Patient watched movie and played with toys

interventions (distraction/music)

Evaluation of outcomes objectives: Outcome met- patient pain was decreased and maintained,
relaxation was promoted

P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis

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Problem # _______2__________: Impaired Comfort

General Goal: Improve patients comfort

Predicted Behavioral Outcome Objective (s): The patient will maintain an acceptable
level of comfort on the day of care

Nursing Interventions Patient Responses

1. administer medication 1. Patient relaxed, muscle spams ceased

(1 mg valium po)

2. Enhance feelings of trust 2. Patient was trusting, but nervous when taking

vitals

3. Provide toys/distraction 3. Patient was played with toys/ watched

movies

4. Position patient comfortably 4. Patient stated more comfort

5. Provide ice pack for Left thigh 5. Patient kept ice pack on leg, lessened

swelling

Evaluation of outcomes objectives: Outcome met- Patients comfort was enhanced

P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis

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Problem # ___3____: Risk for ineffective peripheral perfusion

General Goal: Maintain adequate tissue perfusion

The patient will maintain adequate tissue

Predicted Behavioral Outcome Objective (s):
perfusion on the day of care, and after surgery

Nursing Interventions Patient Responses

1. Noted skin color and temperature 1. Skin was warm and color was appropriate

2. Assess for pain in left leg 2. Patient had no pain (once spasms resolved)

3. check capillary refill 3. Cap refill was 2 secs

4. Assess for edema 4. No edema present

5. elevate left leg to reduce swelling 5.Leg remained elevated with pillow during shift

Evaluation of outcomes objectives: Outcome met- patient maintained adequate perfusion to left
leg in a soft cast

P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis

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Problem # _______4__________: Parental Anxiety

General Goal: Display decreased anxiety

Predicted Behavioral Outcome Objective (s): The Parents will display decreased anxiety
on the day of care

Nursing Interventions Patient Responses

1. Educate parents on upcoming surgery 1. Parents expressed reduced anxiety

and outcomes/reassure towards surgery

2. encourage and answer questions 2. Parents asked questions about meds and

pertaining to treatment stated they felt their child was in good hands

3. Involve parents in care of the 3. Parents felt more comfortable and

patient competent with care (diaper change)

4. Teach stress reducing techniques 4. Parents expressed less anxiety

Evaluation of outcomes objectives: Outcome met- Parents anxiety reduced

P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis

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Problem # ___5____: Caregiver Role Strain

General Goal:

Predicted Behavioral Outcome Objective (s): The parents will feel supported by healthcare
professionals
Verbalize understanding of care situation
Nursing Interventions Patient Responses

1. Encourage parents to voice 1. Parents asked questions pertaining to care

concerns and feelings

2. Identify potential support and 2. Parents expressed interest

resources for caregiver

3. Arrange time for respite care 3. Parents never leave bedside

(offer to watch child for a short time)

4. Regularly monitor for signs of 4. Parents report anxiety towards care after

anxiety in the Parents surgery

Evaluation of outcomes objectives: Outcome met: Parents felt supported and expressed decreased
anxiety towards care

P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis

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Problem # _______6__________: impaired mobility d/t fracture of left femur

General Goal: mobility, ability to walk after surgery recovery. Keep leg stable until surgery

Predicted Behavioral Outcome Objective (s): The patient will keep leg stable prior to surgery
on the day of care
Parents verbalize understanding of use of adaptive equipment
Nursing Interventions Patient Responses

1. Assess patient for cause of 1. X-ray shows fracture of left femur,

immobility patients leg in a soft cast

2. Assist with postioning 2. Patient was comfortable

(use of pillows)

3. Stabilize affected leg until 3. Patient leg kept in soft cast and elevated

surgery with pillows

4. Educate parents of patients 4. Parents expressed less anxiety towards care

needs following surgery (brace, therapy

/additional equipment, learn to walk)

Evaluation of outcomes objectives: Outcome met: Parents verbalized understanding use of adaptive
equipment. Patient kept leg stable until surgery.

P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis

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Problem # __7_____: Risk

for impaired Skin Integrity
General Goal: Prevent alterations in skin integrity
Predicted Behavioral Outcome Objective (s):
Parents will verbalize understanding of
risk of and prevention of impaired skin integrity on the day of care.

Nursing Interventions Patient Responses

1. Inspect and monitor skin 1. Skin was warm with no lesions

at least once daily, post-op. could not assess left leg due to soft cast

2. Repositioning 2. Patient was repositioned and comfortable

3. Teach parents to monitor skin 3. Parents verbalized understanding of care

and prevention of skin breakdown needs following surgery

4. Assess patients nutritional status 4. Patient maintains adequate nutritional status

Evaluation of outcomes objectives: Outcomemet: Parents verbalized understanding of risk and

prevention of alterations in skin integrity. Skin intact on the day of care.

P. Schuster, Concept Mapping: A Critical Thinking Approach, Davis