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#1 Key Problem/ND: #2 Key Problems/ND: #3 Key Problem/ND:

Impaired gas exchange Ineffective airway clearance Thermoregulation
Supporting Data: r/t increased nasal secretions Supporting Data:
Nasal flaring Supporting Data: Temperature: 100.8
Intercostal/subcostal Meds Flushed/pale skin
retractions O2 saturation = 90-92 Irritability in all positions
Respiratory rate: 44 Increased fatigue when Clammy extremities
HR: 138 feeding Lethargic
O2 saturation: 90-92 Suctioning order before and
HOB elevated after feedings
Restlessness Isolation

#7
#4
Key Problem/ND:
Care giver role strain Reason For Needing Health Care: Key Problem/ND
Supporting Data: RSV Activity intolerance related
Older sibling at home, 3-year-old Key Assessments: to difficulty breathing
Father not involved in care Pulse oximetry Supporting Data:
Immediate family lives over an Lung sounds Intercostal/subcostal
hour away Respiratory rate retractions increased with
Difficulty getting a sitter and still Skin color feeding
visiting child Capillary refill Multiple short naps
Change in health status of child Heart rate throughout day
Hydration/ I&O Flushed/pale skin
Irritability in all positions

#8
Key Problem/ND
Key Problem/ND: #6 Parental anxiety
Transition Readiness Supporting Data:
Supporting Data: Anxious facial expression
Older child did not have RSV Increased apprehension
through infant years that condition might
Unsure of diagnosis and treatments worsen
upon arrival at hospital Continuous questioning
Unsure of worsening S&S or when in room providing
complications care, always asking to
Anxiety of parent speak to doc
Expressed concern about
need for IV therapy
Verbalized lack of
understanding about RSV
#5
Key Problem/ND
Risk for dehydration
Supporting Data:
Urinalysis results
Capillary refill 2-3 sec.
Slight depression in fontanels
Little to no tearing
Increased irritability
Dry mucous membranes
Slight weight loss since
diagnosis
Lethargic
Difficulty feeding

Daniel Macinga Concept Map

Problem # ___1___:
General Goal: Improve oxygenation of child
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Predicted Behavioral Outcome Objective (s): The patient will……

Maintain a pulse oximetry of >94% throughout duration of shift
on the day of care.

Nursing Interventions Patient Responses

1. Attached continuous pulse oximetry to left 1. Mother reported relief to continuous monitoring.
foot.
2. Suctioning before and after meals. 2. Patient appeared in less distress after suctioning.
3. Scheduled activities together to provide rest 3. Patient was able to rest easier following activities,
afterwards. and held a great 02 saturation.
4. Applied nasal mask when supine 4. Patients 02 saturation stayed above 96%.
5. Instructed mother on proper positioning for 5. Mother understood that upright/bent forward
feedings, holding, burping, etc. positioning would improve diaphragm contraction.
6. Explained complications of hypoxia 6. Mother was able to identify brain death and
paralysis as complications of prolonged hypoxia.
Evaluation of outcomes objectives:
Patient was able to maintain pulse oximetry of greater than 94% while under my care.

Problem # ___2____:
General Goal: Improve breathing/comfort of child by reducing nasal secretion buildup

Predicted Behavioral Outcome Objective (s): The patient will……

Demonstrate clear breath sounds; be free of cyanosis, dyspnea, and nasal secretions
on the day of care.

Nursing Interventions Patient Responses

1. HOB elevated to >30 degrees. 1. Patient exhibited fewer S&S of dyspnea.

2. Thorough handwashing and precautions 2. Mother expressed appreciation that care was taken
conducted and demonstrated. to prevent further spread of infection.
3. Suctioning before and after meals with NS 3. Clear/white secretion removed. Mother reported easier
feeding and rest after suction done.
4. Provided education to mother on importance 4. Mother understood that hydration facilitates easier
of fluid intake even after discharge. elimination of secretions.
5. Room kept in low lighting with minimal 5. Mother understood that reduced stimulation would lead
noise. to reduced nasal secretion buildup
6. Use of vibrating chair/bouncer when home. 6. Mother understood that vibrations would help break up
secretions.
7. Encouraged mothers’ involvement in care. 7. Seeing mothers face was soothing to child and eased care.
Evaluation of outcomes objectives:
Patient was relieved of nasal secretions before and after each meal, which eased breathing ability and
improved respiratory/peripheral vasculature assessment data.

Problem # ___3____:
General Goal: Maintain patient temperature within normal limits (97-99 degrees)
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Predicted Behavioral Outcome Objective (s): The patient will……

Maintain temperature of less than or equal to 99 degrees F
on the day of care.

Nursing Interventions Patient Responses

1. Provided education to mother on importance 1. Mother understood that hydration status is an

of fluid intake even after discharge. early indicator of temperature alteration.
2. Ensured rest period after any care provided. 2. Patient appeared less agitated and was able to rest.
3. Hourly temperature taken. 3. 100.8, 100.3, 99.7, 98.9. Mother was appreciative.
4. Instructed mother to limit activities during 4. Mother understood that activity and play increased
daytime. temperature. Infant appeared calm.
5. Suctioning before/after meals with NS. 5. Patient appeared in less distress. Temperature decreased.
6. Nasal mucosa/lips continuously moistened. 6. Patient appeared comfortable, in less distress.
7. Room kept in low lighting with minimal 7. Mother understood that reduced stimulation would lead
noise. to a temperature decrease.
Evaluation of outcomes objectives:
Patient’s temperature was reduced from 100.8 to 98.7 during shift. Mother was taught and described methods
to decrease temperature (thin clothing, oral rehydration, limiting stimulation).

Problem # ___4____:
General Goal: Improve energy level of patient, restore to pre-hospitalization level

Predicted Behavioral Outcome Objective (s): The patient will……

Exhibit tolerance during physical activity as evidenced by a normal fluctuation of vital signs
during physical activity on the day of care.

Nursing Interventions Patient Responses

1. Involved mother in routine care. 1. Patient responded better, seemed more willing to allow
assessment conduction and suctioning therapy.
2. Established goals/guidelines with mother. 2. Mother appreciative of being included in goal making.
3. Discussed passive ROM activities. 3. Mother understood this was an appropriate way to increase
activity while building stamina.
4. Prioritized most involved care first upon 4. Patient was able to execute activities before fatigue set in.
entering room. Mother reported easier resting following activities.
5. Applied nasal mask when supine/for care. 5. Patient was able to perform activities with better perfusion.
6. Provided emotional support to mother. 6. Mother expressed fear of overexertion but felt
7. Created a plan of care throughout day with 7. Mother understood importance of prioritizing activities
mother. during times when child had the most energy.

Evaluation of outcomes objectives:

Patient was able to participate in activity with frequent rest periods through clustering of activity and
prioritization. Mother was able to create a plan for care following discharge to prevent overexertion.

Problem # ___5____:
General Goal: Improve hydration status of patient
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Predicted Behavioral Outcome Objective (s): The patient will……

Maintain vitals that indicate normal hydration (cap. Refill <2sec, normal BP, normal RR, HR,
pulse strength, mucous membranes, no nostril flaring) on the day of care.

Nursing Interventions Patient Responses

1. Assessed mucous membranes, skin turgor, 1. Skin turgor good, mucous membranes moist, no nostril
tearing each time room was entered. flaring present.
2. Ensured strict I&O orders followed. 2. Mother understood importance of I&O, oral rehydration.
3. Emphasized to mother oral hygiene efforts. 3. Mother understood that mouth care promotes drinking interest.
4. Hourly vital signs taken. 4. BP 87/55, HR 128, RR 33. Mother understood vital changes
were an indicator of dehydration.
5. Thorough inspection of diapers. 5. No diarrhea present. Mother aware diarrhea is a method of
fluid loss.
6. Encouraged mothers involvement in care. 6. Patient was more willing to take bottle, fluid, care.
7. Room kept in low lighting with minimal 7. Mother understood that reduced stimulation would prevent
noise. further fluid loss.
Evaluation of outcomes objectives:
Patient maintained BP, RR, HR, pulse strength within normal limits. Capillary refill was <2 seconds, mucous
membranes were moist, and no nostril flaring was exhibited.

Problem # ___6____:
General Goal: Reduce anxiety of mother

Predicted Behavioral Outcome Objective (s): The parent will……

understand patient’s diagnosis and be relieved of anxiety by end of shift
on the day of care.

Nursing Interventions Patient Responses

1. Mother involved in suctioning 1. Mother stated being more confident for transition care
2. Explained disease process to parent 2. Stated that she was more understanding of disease
3. Offered to provide informative 3. Mother declined but was appreciative of offer. Asked
documentation to mother if doctor would be able to come in for additional questions
4. Updated mother on lab results/treatments 4. Mother stated that being “in the know” was helpful
5. Explained that care was being provided 5. Mother apologized for being overbearing and just
with the best intent and practice for child wanted her child to be okay
6. Allowed mother to speak freely about 6. Mother stated being very stressed and concerned with
situation and express emotions being major provider and filling two roles without father
7. Told mother to go get dinner while I 7. At first was reluctant but eventually left and was very
stayed with child appreciative of being allowed time to self

Evaluation of outcomes objectives:

Mother reported being less anxious and having a better understanding of the disease process of her child as
well as the treatments currently used.

Problem # ___7____:
General Goal: Be aware of current stressors in daily life and how to reduce them
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Predicted Behavioral Outcome Objective (s): The parent will……

Explain at least 3 methods of decreasing stress that are practical within daily life
on the day of care.

Nursing Interventions Patient Responses

1. Openly asked mother about current 1. Mother disclosed she would smoke or drink wine at
methods for dealing with stress. end of night to cope.
2. Offered to watch child while mom 2. Mother was very appreciative of offer and left to get
went to dinner or rest. food.
3. Discussed several positive ways to 3. Mother explained benefits of exercise and meditation
reduce stress. back to me.
4. Discusses potentially negative ways 4. Alcohol and smoking as well as lashing out at child do
to reduce stress currently being used. not solve the problem and potentially create a rift.
5. Reinforced need for mother to main- 5. “Being the only parent caring for my children, it is
tain her health as well as children. extremely important I stay healthy to care for them.
6. Offered to put aside time after care 6. “Thank you for offering, but I have a friend I usually
to discuss current stressors. can call and talk to.”
Evaluation of outcomes objectives:
Mother was able to describe the use of exercise, meditation and having a nonjudgmental conversation with a
friend or counselor as potential ways to reduce daily stress. Mother also described her current stressors and
how previous methods to reduce stress were not effective.

Problem # ___8____:
General Goal: Transition from hospital care to home care

Predicted Behavioral Outcome Objective (s): The parent will……

Describe disease process, demonstrate new health regimen incorporation into daily life, and
shows motivation to learn on the day of care.

Nursing Interventions Patient Responses

1. Offered to move to different room to 1. Mother felt comfortable moving to quiet setting with less
discuss home care. distractions to discuss home care.
2. Discussed RSV diagnosis with mother. 2. Mother reported better understanding of disease process.
3. Involved mother in creation of care plan. 3. Mother was appreciative and felt her “opinion mattered”
4. Openly asked mother about concerns with 4. Mother expressed concern with providing care for sick child
home care of patient. while preventing possible transmission to older child.
5. Offered to provide brochures, literature. 5. Mother accepted literature and discussed use of websites.
6. Assessed mothers education level and 6. Mother stated she was unsure of some of the terminology used.
comfortability with medical terminology. After further discussion she reported feeling more knowledgeable.

Evaluation of outcomes objectives:

Mother was able to discuss care in the home, how to prevent spread of infection to other child, and what
complications could present with other S&S of RSV disease.