Children with Developmental Delay Free Essay Example

Client Name:

Age: 14 Years

Sex:

Date Initiated:

End Date:

ASSESSMENT DATA List as much pertinent data that supports the Nursing Diagnosis . Subjective Data (S): Data client (or family) tells us (quotes OK). Objective (O): Data we measure, or “see,” or retrieve from client hx., procedures, diagnostics, labs, etc.	NURSING DIAGNOSIS NANDA DX Format: Use only approved NANDA Diagnoses, with "related to" and "AEB." Include pertinent evidence-based practice rationale/pathophysiology/definition with proper APA in-text reference after each	PLANNING (“What will be done?”) List 1 total short term and 1 long term client goal (STG/LTG) per nursing dx; preferably short-term goals that can be accomplished "by the end of shift" Must be measurable, realistic, and achievable client-centered goals Number and list planned interventions (minimum of 3) each with delegation (who can perform in parentheses at the end of each intervention).	NURSING IMPLEMENTATION (“What was actually done?”) Across from the corresponding number in the previous column, describe each implementation and who performed. List evidence-based practice rationale (R), and proper APA in-text reference for each rationale entry.	EVALUATION Evaluate each goal by stating either: Goal met/Partially met/Not met. For Partially Met/Not Met Goals, indicate your recommendations or revisions to care plan Pertinent Subjective (S) & Objective (O) Data for each goal evaluation.
S: The 14 years old patient complained of: Loss of awareness: the patient could momentarily not recognize their surroundings Instances of temporary confusion Uncontainable jerking of hands and legs A postictal state such as drowsiness, vomiting, and headache Instances of intense fear and anxiety History of falls O: While observing the patient, it was evident that: Rhythmic shuddering Gazing off expressionlessly Stiff contraction Difficulties in expressing themselves Repetitive behavior such as lip-smacking and being fidgety Low levels of self-care Suffocation	Nursing Diagnosis # 1 (Physiological): epileptic seizures: Probability of the patient related to the decline of the patient’s mental status Risk of aspiration related to the decline in the level of awareness Sickness manifested by showing the need to enhance their capacity to be independent especially in maintaining their health wellbeing Seizures are a result of abnormal activities in the brain, thus causing periods of unusual behavior, feelings, and loss of consciousness. The symptoms of epilepsy vary extensively, ranging from staring blankly, twitching of limbs, and losing consciousness completely. Also, in some instances, seizures are often evidenced by shaking and loss of consciousness in certain body parts ( Cámara, 2017).	STG#1: Help the patient understands the factors that contribute to the possibility of suffocation, anxiety, and loss of awareness. Each of these aspects will be scheduled independently LTG#1: In the long term, the nursing care aims at achieving a seizure-free status without adverse effects.	STG: The patient and their family were taken through the risk factors that are related to seizures. For this purpose, three nurses were each given one session per week to impart knowledge of causative factors to the patient and their family. Epilepsy is associated with falls, which might lead to fractures and burns (Willems et al., 2018). LTG: The patient will be placed under anti epileptogenesis medication, which will aim at preempting the progression of epilepsy, thus delaying the severity of attacks (Younus & Reddy, 2017).	STG #1: Goal Meet S: The patient was vomiting, experienced some headaches and was drowsy. Also, the patient explained to the nurse that he experiences some fear and was sometines anxious. The subjective data for the goal is to explain to the patient through a training on the possible causes of the loss of appetite and anxiety. O:Patient has verbalized relife and control of the rhythimic shuddering within the most appropriate time frame for sdministrative medication. LTG#1: Goal Meet S:Upon the intervention, the patient could not confortably state there is a reducton in the intense fear and anxiety. O: After several hour of nursing intervention, the patient was able to maintain core temperature thatcontributed to the sizure within the normal range.
Interventions (minimum of 3): Define factors related to the individual scenario as observed by the nurse (nurse) Note client's biodata such as age, sex, developmental progress and level of cognition and competence (nurse) Explore and illustrate seizure warning (if necessary) and common attack patterns. Teach the SO to evaluate and familiarize themselves with danger signals. Also, the SO will be shown how to care for the patient during and after a seizure (physiotherapist in conjunction with SO being trained) Evaluate the need for protective gear (nurse) Placing the patient under antiepileptogenesis medicines (clinicians)	Implementations: For this intervention, the responsible person ensured that factors related to each individual seizure activity were defined. This information was critical in preventing and managing future attacks (Stafstrom & Carmant, 2015). The nurse asked the client and their guardians to provide their details, which were then recorded accordingly. Having complete patients details is essential since they help enhance specialized care and influence healthcare outcomes ( Mathioudakis et al., 2016 ) The physiotherapist embarked on a process of identifying danger signs from the patient. Using the knowledge gained, they conducted an orientation program for the SOs. For example, the SO was shown how to advance care to the patient in the absence of the physiotherapist. According to (Male et al., 2018), providing updating healthcare teams with information concerning specific patients will help improve service delivery The nurse in charge evaluated the information collected by the rest of the nurse with a view of ascertaining the need for providing the patient with protective gear. Although uncommon, head injuries associated with epilepsy have serious repercussions (Jory et al., 2019). The clinical team prescribed antiepileptogenesis drugs to manage the patient's epileptic conditions. Research has shown that antiepileptic drugs are the backbone of treating epileptic seizures (Younus & Reddy, 2018)
S: Rolling over Problems with sitting and standing Has an issue with holding or clutching to objects Walking problems O: The patient unable to maintain the proper balance of his body Poor sitting posture	Nursing Diagnosis # 2 (safety): Check the patients home environment for aspects such as clutter, slippery floors and unstable chairs that are a threat to their safety Evaluate the overall status of the child-this is to define the conditions that may lead to injury Implementation of programs that aim at preventing injuries for children with developmental delays is crucial. Nurses will be able to set the needs of the child and educating their families and caregivers (Souza et al., 2018).	STG#1: Patient is able to explain techniques of preventing injury LTG#1: The child is able to maintain an injury-free status		STG #1: Partially Meet S: I would recommend the need to intensify the practive and intervention so as to enable the patient to better their experience in walking and holding objects which was a key challenge. O: I would recommend the patient to be taken to a therapist for further examination of the cause of the patient’s inability to properly balance the body and maintain an upright sitting position. LTG #1: Not Meet S: The patient being a child, there is a lot of engagement with vigorous activities that deters the patient from maintaining an injury free status. Thus, I would recommend the patients to assists in ensuring the activities that the child engages in are safe and would not cause any harm. O: There is need to determine the child’s posture vitality. I would recommend the need to determine the level of damage that a bad sitting position would cause to the child for effective approaches and implementation s to be put in place.
Interventions (minimum of 3): Completely orient the child to their environment (nurses) Avoid restraining the patient. There should be a certified order by a physician to restrain the patient Ensure that the patient does not engage in excessive activities (nurses).	Implementations: While in the hospital, the nursing team showed the different child areas such as the bathroom, their ward, and recreational areas. Also, the patient was educated on the different warning signs in the hospitals, such as a slippery floor. Since most of the time the patient spent in their room, there was no need to restrain him. The physician noted that by restraining would only increase the probability of getting injured. According to Pradhan et al., (2019), it is crucial for medics to have knowledge of how and when to execute patient restraining. The research found out that better patient restraining outcomes are attained when the nurses have a clear understanding of the practice. The nurses on duty were directed that they should limit the physical activities of the patient to avoid injuries. For example, excessive playing with other children in the ward was prohibited.
S: Incapacity to do daily activities such as using the restroom in the absence of help Challenges with logical thinking. The patient explained that they have difficulty with solving academic problems Difficulty in communicating and socializing O: Signs of withdrawal Difficulties in expressing themselves orally Esteem issues	Nursing Diagnosis # 3 (Psycho/social, spiritual, cultural: Understand the racial background of the patient Assess the significance of cultural beliefs and values on the understanding of the child’s risk to injury Help the child understand their character and abilities According to Souza et al. (2018), the NANDA guidelines aim at promoting the healthy development of individuals in spheres such as relationships, families, values, and cultures.	STG#1: Aid the patient to understand their predicament LTG#1: Help the patient develop self-esteem, self-awareness and minimize disrupting their social interactions		STG #1: Goal Meet S: The goal was meet by taking the patient through a training that increased the understanding of the ways to improve on the logical thinking and the inability to perform the daily human activities. O: program creation that will boost the child’s self-esteem such as public speaking and being outspoken. LTG#1: Goal not Meet S: improve on the communication ad socializing skills of the patient through providing a window of opportunity where they interact with their fellow children in a friendly and effective way. O: Introduce oral interventions that would assist the child improve on their oral speaking skills. Letters and symbols can be used to effectively increase the oral communication skills of the child.
Interventions (minimum of 3): Encourage the child to recognize and utilize their individual strengths (psychotherapist and nurses) Ensure that the child engages in activities especially with family and friends (pediatrician and close family members) Give positive feedback on the milestones achieved by the patient (All medical teams)	Implementations: The hospital counseling and nursing teams were mandated to help the patient identify their strengths and work on their weakness with the aim of boosting their social status. When a child with developmental delay is able to identify their strengths and weaknesses, they will have a better chance of having a healthy and gratifying life (Collins et al., 2017). The child was encouraged to engage in light exercises, which were facilitated by physiotherapists and family members. Exercises are crucial aspects of healthcare, especially for children with developmental delays. They will help such a child to better coordinate their movement and posture (Hocking, 2016) For every milestone, the child attained, all the teams were directed to provide positive feedback. This measure was meant to boost their confidence (Collins et al., 2017)

ASSESSMENT DATA

List as much pertinent data that supports the Nursing Diagnosis .

Subjective Data (S): Data client (or family) tells us (quotes OK).

Objective (O):

Data we measure, or “see,” or retrieve from client hx., procedures, diagnostics, labs, etc.

NURSING DIAGNOSIS

NANDA DX Format:

Use only approved NANDA Diagnoses, with "related to" and "AEB."

Include pertinent evidence-based practice rationale/pathophysiology/definition with proper APA in-text reference after each

PLANNING (“What will be done?”)

List 1 total short term and 1 long term client goal (STG/LTG) per nursing dx; preferably short-term goals that can be accomplished "by the end of shift"

Must be measurable, realistic, and achievable client-centered goals

Number and list planned interventions (minimum of 3) each with delegation (who can perform in parentheses at the end of each intervention).

NURSING IMPLEMENTATION (“What was actually done?”)

Across from the corresponding number in the previous column, describe each implementation and who performed.

List evidence-based practice rationale (R), and proper APA in-text reference for each rationale entry.

EVALUATION

Evaluate each goal by stating either:

Goal met/Partially met/Not met.

For Partially Met/Not Met Goals, indicate your recommendations or revisions to care plan

Pertinent Subjective (S) & Objective (O) Data for each goal evaluation.

S: The 14 years old patient complained of:

Loss of awareness: the patient could momentarily not recognize their surroundings

Instances of temporary confusion

Uncontainable jerking of hands and legs

A postictal state such as drowsiness, vomiting, and headache

Instances of intense fear and anxiety

History of falls

O: While observing the patient, it was evident that:

Rhythmic shuddering

Gazing off expressionlessly

Stiff contraction

Difficulties in expressing themselves

Repetitive behavior such as lip-smacking and being fidgety

Low levels of self-care

Suffocation

Nursing Diagnosis # 1 (Physiological): epileptic seizures:

Probability of the patient related to the decline of the patient’s mental status

Risk of aspiration related to the decline in the level of awareness

Sickness manifested by showing the need to enhance their capacity to be independent especially in maintaining their health wellbeing

Seizures are a result of abnormal activities in the brain, thus causing periods of unusual behavior, feelings, and loss of consciousness. The symptoms of epilepsy vary extensively, ranging from staring blankly, twitching of limbs, and losing consciousness completely. Also, in some instances, seizures are often evidenced by shaking and loss of consciousness in certain body parts ( Cámara, 2017).

STG#1: Help the patient understands the factors that contribute to the possibility of suffocation, anxiety, and loss of awareness. Each of these aspects will be scheduled independently

LTG#1: In the long term, the nursing care aims at achieving a seizure-free status without adverse effects.

STG: The patient and their family were taken through the risk factors that are related to seizures. For this purpose, three nurses were each given one session per week to impart knowledge of causative factors to the patient and their family. Epilepsy is associated with falls, which might lead to fractures and burns (Willems et al., 2018).

LTG: The patient will be placed under anti epileptogenesis medication, which will aim at preempting the progression of epilepsy, thus delaying the severity of attacks (Younus & Reddy, 2017).

STG #1: Goal Meet

S: The patient was vomiting, experienced some headaches and was drowsy. Also, the patient explained to the nurse that he experiences some fear and was sometines anxious. The subjective data for the goal is to explain to the patient through a training on the possible causes of the loss of appetite and anxiety.

O:Patient has verbalized relife and control of the rhythimic shuddering within the most appropriate time frame for sdministrative medication.

LTG#1: Goal Meet

S:Upon the intervention, the patient could not confortably state there is a reducton in the intense fear and anxiety.

O: After several hour of nursing intervention, the patient was able to maintain core temperature thatcontributed to the sizure within the normal range.

Interventions

(minimum of 3):

Define factors related to the individual scenario as observed by the nurse (nurse)

Note client's biodata such as age, sex, developmental progress and level of cognition and competence (nurse)

Explore and illustrate seizure warning (if necessary) and common attack patterns. Teach the SO to evaluate and familiarize themselves with danger signals. Also, the SO will be shown how to care for the patient during and after a seizure (physiotherapist in conjunction with SO being trained)

Evaluate the need for protective gear (nurse)

Placing the patient under antiepileptogenesis medicines (clinicians)

Implementations:

For this intervention, the responsible person ensured that factors related to each individual seizure activity were defined. This information was critical in preventing and managing future attacks (Stafstrom & Carmant, 2015).

The nurse asked the client and their guardians to provide their details, which were then recorded accordingly. Having complete patients details is essential since they help enhance specialized care and influence healthcare outcomes ( Mathioudakis et al., 2016 )

The physiotherapist embarked on a process of identifying danger signs from the patient. Using the knowledge gained, they conducted an orientation program for the SOs. For example, the SO was shown how to advance care to the patient in the absence of the physiotherapist. According to (Male et al., 2018), providing updating healthcare teams with information concerning specific patients will help improve service delivery

The nurse in charge evaluated the information collected by the rest of the nurse with a view of ascertaining the need for providing the patient with protective gear. Although uncommon, head injuries associated with epilepsy have serious repercussions (Jory et al., 2019).

The clinical team prescribed antiepileptogenesis drugs to manage the patient's epileptic conditions. Research has shown that antiepileptic drugs are the backbone of treating epileptic seizures (Younus & Reddy, 2018)

Rolling over

Problems with sitting and standing

Has an issue with holding or clutching to objects

Walking problems

The patient unable to maintain the proper balance of his body

Poor sitting posture

Nursing Diagnosis # 2 (safety):

Check the patients home environment for aspects such as clutter, slippery floors and unstable chairs that are a threat to their safety

Evaluate the overall status of the child-this is to define the conditions that may lead to injury

Implementation of programs that aim at preventing injuries for children with developmental delays is crucial. Nurses will be able to set the needs of the child and educating their families and caregivers (Souza et al., 2018).

STG#1: Patient is able to explain techniques of preventing injury

LTG#1: The child is able to maintain an injury-free status

STG #1: Partially Meet

S: I would recommend the need to intensify the practive and intervention so as to enable the patient to better their experience in walking and holding objects which was a key challenge.

O: I would recommend the patient to be taken to a therapist for further examination of the cause of the patient’s inability to properly balance the body and maintain an upright sitting position.

LTG #1: Not Meet

S: The patient being a child, there is a lot of engagement with vigorous activities that deters the patient from maintaining an injury free status. Thus, I would recommend the patients to assists in ensuring the activities that the child engages in are safe and would not cause any harm.

O: There is need to determine the child’s posture vitality. I would recommend the need to determine the level of damage that a bad sitting position would cause to the child for effective approaches and implementation s to be put in place.

Interventions

(minimum of 3):

Completely orient the child to their environment (nurses)

Avoid restraining the patient. There should be a certified order by a physician to restrain the patient

Ensure that the patient does not engage in excessive activities (nurses).

Implementations:

While in the hospital, the nursing team showed the different child areas such as the bathroom, their ward, and recreational areas. Also, the patient was educated on the different warning signs in the hospitals, such as a slippery floor.

Since most of the time the patient spent in their room, there was no need to restrain him. The physician noted that by restraining would only increase the probability of getting injured. According to Pradhan et al., (2019), it is crucial for medics to have knowledge of how and when to execute patient restraining. The research found out that better patient restraining outcomes are attained when the nurses have a clear understanding of the practice.

The nurses on duty were directed that they should limit the physical activities of the patient to avoid injuries. For example, excessive playing with other children in the ward was prohibited.

Incapacity to do daily activities such as using the restroom in the absence of help

Challenges with logical thinking. The patient explained that they have difficulty with solving academic problems

Difficulty in communicating and socializing

Signs of withdrawal

Difficulties in expressing themselves orally

Esteem issues

Nursing Diagnosis # 3 (Psycho/social, spiritual, cultural:

Understand the racial background of the patient

Assess the significance of cultural beliefs and values on the understanding of the child’s risk to injury

Help the child understand their character and abilities

According to Souza et al. (2018), the NANDA guidelines aim at promoting the healthy development of individuals in spheres such as relationships, families, values, and cultures.

STG#1: Aid the patient to understand their predicament

LTG#1: Help the patient develop self-esteem, self-awareness and minimize disrupting their social interactions

STG #1: Goal Meet

S: The goal was meet by taking the patient through a training that increased the understanding of the ways to improve on the logical thinking and the inability to perform the daily human activities.

O: program creation that will boost the child’s self-esteem such as public speaking and being outspoken.

LTG#1: Goal not Meet

S: improve on the communication ad socializing skills of the patient through providing a window of opportunity where they interact with their fellow children in a friendly and effective way.

O: Introduce oral interventions that would assist the child improve on their oral speaking skills. Letters and symbols can be used to effectively increase the oral communication skills of the child.

Interventions

(minimum of 3):

Encourage the child to recognize and utilize their individual strengths (psychotherapist and nurses)

Ensure that the child engages in activities especially with family and friends (pediatrician and close family members)

Give positive feedback on the milestones achieved by the patient (All medical teams)

Implementations:

The hospital counseling and nursing teams were mandated to help the patient identify their strengths and work on their weakness with the aim of boosting their social status. When a child with developmental delay is able to identify their strengths and weaknesses, they will have a better chance of having a healthy and gratifying life (Collins et al., 2017).

The child was encouraged to engage in light exercises, which were facilitated by physiotherapists and family members. Exercises are crucial aspects of healthcare, especially for children with developmental delays. They will help such a child to better coordinate their movement and posture (Hocking, 2016)

For every milestone, the child attained, all the teams were directed to provide positive feedback. This measure was meant to boost their confidence (Collins et al., 2017)

References

Cámara, M. P. (2017). Most frequent nursing diagnoses in patients admitted to the Epilepsy Unit. Revista Científica de la Sociedad de Enfermería Neurológica (English ed.) , 46 , 6-10.

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Collins, P. Y., Pringle, B., Alexander, C., Darmstadt, G. L., Heymann, J., Huebner, G., ... & Sretenov, D. (2017). Global services and support for children with developmental delays and disabilities: Bridging research and policy gaps. PLoS medicine , 14 (9).

Hocking, J. A. (2016). Physiotherapy interventions to improve gross motor skills in people with an intellectual disability aged six years and older: a systematic review (Doctoral dissertation).

Jory, C., Oak, K., Organ, C., Mclean, B., & Shankar, R. (2019). Headfirst–Review of epilepsy head injury risk and protection. Seizure .

Male, L. R., Noble, A., Snape, D. A., Dixon, P., & Marson, T. (2018). Perceptions of emergency care using a seizure care pathway for patients presenting to emergency departments in the North West of England following a seizure: a qualitative study. BMJ Open , 8 (9), e021246.

Mathioudakis, A., Rousalova, I., Gagnat, A. A., Saad, N., & Hardavella, G. (2016). How to keep good clinical records. Breathe (Sheffield, England) , 12 (4), 369–373. doi:10.1183/20734735.018016

Pradhan, N., Lama, S., Mandal, G., & Shrestha, E. (2019). Physical restraining: Nurses knowledge and practice in Tertiary Care Hospital of Eastern Nepal. Nursing Open , 6 (3), 1029-1037.

Souza, J. M. D., Cruz, D. D. A. L. M. D., & Veríssimo, M. D. L. Ó. R. (2018). Child Development: New Diagnoses for NANDA International. International journal of nursing knowledge , 29 (2), 112-116.

Stafstrom, C. E., & Carmant, L. (2015). Seizures and epilepsy: an overview of neuroscientists. Cold Spring Harbor perspectives in medicine , 5 (6), a022426. doi:10.1101/cshperspect. a022426

Willems, L. M., Watermann, N., Richter, S., Kay, L., Hermsen, A. M., Knake, S., … Strzelczyk, A. (2018). Incidence, Risk Factors, and Consequences of Epilepsy-Related Injuries and Accidents: A Retrospective, Single-Center Study. Frontiers in neurology , 9 , 414. doi:10.3389/fneur.2018.00414

Younus, I., & Reddy, D. S. (2017). Epigenetic interventions for epileptogenesis: A new frontier for curing epilepsy. Pharmacology & therapeutics , 177 , 108–122. doi:10.1016/j.pharmthera.2017.03.002

Children with Developmental Delay

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