You are on page 1of 17

PEDIATRIC CONSIDERATIONS

Encompasses problems related to childhood through adolescence.

CARE SETTING
Any setting in which nursing contact with children occurs/care is provided.

ASSESSMENT FACTORS (IN ADDITION TO ROUTINE ASSESSMENTS)
Age and gender
Developmental level
Patterns of communication with SOs
Perception of body and its functions: in health and illness
Behavior when anxious, afraid, withdrawn, angry

SIGNIFICANT OTHERS
Nuclear family, extended family
Family developmental cycle
Child’s role in family tasks and functions
Peer group, friends

SOCIOECONOMIC
Social class, value system
Social acceptability of current situation

CULTURAL
Ethnic background, heritage, and residence

DISEASE (ILLNESS)
Condition requiring treatment and response of patient/family to situation
Nature of condition—acute, chronic, recurrent
Emotional response to current treatments
Past experience with illness, hospitalization, and healthcare providers
If illness is terminal, what do patient and family expect?
Availability/use of resources

NURSING PRIORITIES
1. Enhance level of comfort/minimize pain.
2. Reduce anxiety/fear.
3. Provide growth-promoting environment for child and parent(s).
4. Prevent/minimize complications.

DISCHARGE GOALS
1. Reports/indicates pain relieved.
2. Child/family dealing appropriately with current situation.
3. Safe environment maintained.
4. Plan in place to meet needs after discharge.

or color scale). music. change with acute pain not chronic pain. chemical.g. tension. NURSING DIAGNOSIS: Pain. e. Influences degree/severity of pain manifestations. . Encourage diversional activities. expressions. Note: Autonomic responses normals/variations. rigidity. quality. physical. pulse and respiratory rates. characteristics. Manifest decreased restlessness/irritability. onset/duration. blood pressure (BP) (using correctly Changes in autonomic responses may indicate increased sized cuff). Nonverbal expressions may signal pain or changes in pain severity. may require enlisting the aid of parent/caregiver to clarify frequency. Assessment of children involves observational skills and including location. Provide comfort measures. Pain is subjective and cannot be experienced by others. Demonstrate age-appropriate blood pressure. restlessness.. irritability Autonomic responses DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Pain Level (NOC) Report pain is relieved/controlled. Note location/type of surgical incisions.. may reduce level of pain and enhance coping. relaxation. acute May be related to Injuring agents (biological. facial cues and verbalizations. noting age-appropriate pain before child verbalizes. and restlessness. injuries/trauma. May signal worsening of condition or development of complications. e. sleep pattern Guarded/protective behavior. Helps distract patient’s attention from pain and reduces playing quiet games. repositioning. Investigate changes in frequency or description of pain. Observe for guarding. reading. psychological) Possibly evidenced by Verbal cues Changes in appetite and eating. Review procedures/expectations and tell patient when it Reduces concern of the unknown and helps patient deal will hurt. ACTIONS/INTERVENTIONS RATIONALE Pain Management (NIC) Independent Perform routine comprehensive pain assessment. Accept child’s description of pain. Nonpharmacological pain management promotes use of heat/cold. moaning. severity (using 0–10 scale. Monitor heart rate. crying. with the reality of the anticipated pain. TV. back rub.g. and respiratory rate.

Use Accurate communication promotes trust and creates an terms familiar to child (e. loss of physical support) Separation from support system in potentially stressful situation (e. withdrawal. impending separation from SO). shy. Calmness is important because anxiety is easily transmitted from one person to another and children are often adept at sensing changes in the moods of adults around them. sleep disturbances/nightmares Avoidance or attack behaviors..g. advancing to a prn schedule may be sufficient. instead of “ambulate”. trust. interpersonal transmission/contagion Threat to/change in health/role status Natural/innate origin (e. ineffective May be related to Situational/maturational crisis. Coping. restlessness. hospital procedures) Learned response (e.. Administer medications as indicated. Anxiety/Fear.g. and genuine Trust and unconditional acceptance are necessary for positive regard.. satisfactory nurse/child/family relationship. Provide explanations in language appropriate for age. reports of being scared. withdrawn demeanor DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Anxiety Control (NOC) Appear relaxed and report/demonstrate relief from somatic manifestations of anxiety. Engage in age-appropriate activities in absence of parent/primary caregiver without fear or distress noted. conditioning.g. crying.g. .ACTIONS/INTERVENTIONS RATIONALE Pain Management (NIC) Collaborative Encourage rest periods.. pain. hospitalization. procedures—”take a picture” Promotes understanding/accurate expectations. expressed concerns about changes Social inhibition. ACTIONS/INTERVENTIONS RATIONALE Anxiety Reduction (NIC) Independent Establish an atmosphere of calmness. lack of eye contact. As condition resolves. A regular schedule may be required to manage pain effectively. Demonstrate a decrease in somatic complaints and physical symptoms when faced with stressful situations (e. Note: instead of “fluoroscope”). Helps reduce fatigue and enhances coping ability. Children may become frightened of things they cannot articulate.g. modeling from or identification with others) Possibly evidenced by Excessive psychomotor activity. NURSING DIAGNOSIS.. care activities—”walk” atmosphere where child feels free to ask questions.

Provide honest anxiety responses when separation occurs. clay. May stimulate release of endorphins. Children may believe that situation is punishment for some wrongdoing (imagined or real) on their part. . or failing to include child in conversations child to overhear partial or unrelated conversations may regarding him or her. pictures/posters. e.” nurse/caregiver. be available for support). and release tension. Provide consistency of caregivers. doll house. when child or adolescent is hospitalized or in treatment familiar toys. puppets. Use play materials (e.e. Maintain home routines whenever possible. and lessens anxiety. releasing tension. child and family contact.ACTIONS/INTERVENTIONS RATIONALE Anxiety Reduction (NIC) Independent Ensure child of his or her safety and security (e. skills. Family involvement in activities promotes continuity of Encourage parents to participate in care planning and care family unit. control in situation create anxiety and can be very frightening. Promote family interaction. sand tray). decreasing anxiety and enhancing child’s ability to deal with illness/situation. music) if hospitalized. fairy tale stories. Promotes sense of control. listen Strange surroundings. Play therapy enables child to explore conflicts. cope with situation.g. setting.. Help family support child emotionally by being available. Be honest with child and parents.. changes in routine. i. Becoming acquainted with caregiver enhances sense of security. etc. Provides physical outlet for energy. Encourage Use of age-appropriate object enhances sense of security child/parents to bring transitional object from home (e. facilitates communication. Refrain from conversations unrelated to child in his or her Ignoring the child/talking about (not to) them or allowing presence. say “Yes. Provide child with choices when possible.g.. Schedule ample time for play and age-appropriate Promotes normalcy and helps divert attention from diversions. Engage in exercise program as appropriate to situation. Providing information. doctor/nurse kits. being available can be reassuring. identify needs. information about leaving and returning. and enhances coping skills.. and loss of to child. express fears. special pillow/blanket. this will Promotes trust and enhances relationship with hurt and I will help you manage it. situation. Conveys acceptance of child and confidence in ability to Active-Listening.. Emphasize importance of staff/family giving verbal Avoidance of these issues increases the likelihood of prompts in anticipation of absences. provides opportunity to learn/practice new provision.g. demonstrates regard for individual. be very stressful and result in child imagining things that are incorrect.g.

living(ADLs) and promote exercise as indicated. periods. abnormal heart rate or blood pressure response to activity DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Endurance (NOC) Participate in customary activities at desired level. interventions and to assess progress of recovery. in order to determine needed account age and developmental level. extreme stress Possibly evidenced by Report of fatigue or weakness. recreational and diversional activities. reduce intensity level or discontinue Protects patient from injury and enhances ability to activities as needed. Assist with activities of daily participate in activity to improve strength. ACTIONS/INTERVENTIONS RATIONALE Activity Therapy (NIC) Independent Ascertain child’s usual level of activity. use of restraints. exertional discomfort or dyspnea. Note how present situation is affecting level of activity: Presence of certain disease processes/trauma. NURSING DIAGNOSIS: Activity intolerance [specify level] May be related to Generalized weakness. bedrest or immobility Imbalance between oxygen supply and demand Pain. cancer. Report absence of fatigue.ACTIONS/INTERVENTIONS RATIONALE Anxiety Reduction (NIC) Collaborative Administer medications as indicated. Determine usual sleep/rest routine and bedtime Attempting to maintain usual sleep routines promotes rest rituals/security objects. Mild sedation can be effective in ameliorating symptoms of anxiety and enhancing child’s receptiveness to therapeutic regimen. casts or traction. treatments. Promote participation in individually appropriate Enhances sense of well-being. treatment immobilization. and usual/desired level of activity. Adjust activities. modalities have potential for interfering with patient’s presence of heart or respiratory impairment. Plan care with adequate rest and maximizes energy and endurance. . taking into Establishes baseline.

activity and exercise programs. and/or expressive skills typical of age group within scope of present capabilities. peer group Environmental and stimulation deficiencies. genetic complications.ACTIONS/INTERVENTIONS RATIONALE Activity Therapy (NIC) Independent Monitor response to activity including BP. anomalies. presence of signs and symptoms establishes an actual diagnosis. . Provides comparative baseline and basis appropriate tests such as the Denver Developmental for choosing developmentally appropriate interventions. pulse. Refer to physical/occupational therapists to develop Helpful in creating a plan to meet individual needs. and so forth. social. complications. risk for delayed Risk factors may include Separation from parents and family. ACTIONS/INTERVENTIONS RATIONALE Development Enhancement: Child/Adolescent (NIC) Independent Determine existing factors/condition(s) that could Plan of care will be based on individual factors present. Note reported losses/alterations in functional level. Marfan’s syndrome. Screening Test. and behavior. prolonged. of the same age. Collaborative Provide/monitor response to oxygen therapy and May be needed to improve tolerance to activity. underlying cause for fatigue. Determine child’s birth weight and length and compare Identifies the child’s status compared with other children present growth. including familial history immediacy of threat. and potential long-term of pituitary tumors. Measure developmental level using age.] DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Child Development: (specify age)] (NOC) Perform motor. Helps identify/monitor degree of fatigue and potential for respiratory rate. treat medications. effects of physical disability/confinement Inadequate care. NURSING DIAGNOSIS: Growth and Development. Demonstrate weight/growth-stabilization or progress toward age-appropriate size. multiple caretakers. skin color. contribute to growth deviation. painful treatments Possibly evidenced by [Not applicable.

Although this unsupported. setting.g. including pertinent reference current illness/problem.. Determine occurrence/frequency of significant stressful Lack of resolution or repetition of stressor can have a events. Identify realistic goals with child/parents. genetic/intrauterine growth retardation. imbalanced [specify]. Provide information regarding normal growth/ Helps parents understand potential changes in relation to development as appropriate. relocation). important developmental milestones. functional level. deterioration of. e. growth hormone abnormalities). Identify nature and effectiveness of parenting/caregiving Assessment of parenting and potential for conflict and activities (e. e. Review expectations for current height/weight percentiles and degree of deviation. Nutrition. grooming..g. losses. divorce. play. abandonment. separation.g. situational disruption or inadequate resources during period of crisis or transition). familial factors (body Aids in determining growth expectations. withdrawal/aggression) reaction to environment and chronic/recurrent conditions may delay acquisition of stimuli..g. unrealistic/ negative interaction between parent/caregiver and child insufficient expectations.g. Collaborative Assist with therapy to treat/correct underlying conditions Illness. or (e.g. Increases probability of to take to avoid/minimize preventable complications. mellitus.. feeding.. inadequate. Note behavioral (e. and separation from (e. hospitalization. Note severity/pervasiveness of situation (e. reaching goals. cardiac problems. materials. infant ability to roll over or sit dependency/decline in functional level.) . managing situation more effectively. infant feeding problems. inconsistent. responsiveness).. may not be of major concern for the short term. Determine child’s cognitive/perceptual level. and environmental changes cumulative effect over time and result in regression in. aging. individual Problems existing over a long period may have more showing effects of long-term physical/emotional severe effects and require longer course of treatment to abuse/neglect versus individual experiencing recent onset reverse. Encourage self-care activities as appropriate. build/stature). death of parent/sibling. Promotes independence and maintenance of self-esteem. lack of stimulation.. nutritional deficits. parents/family have a negative effect on endocrine problems (e.g.g. (Refer to ND. treatments. grade Illness/injury can lead to a temporary increase in level of level in school. or renal disease). hypothyroidism.ACTIONS/INTERVENTIONS RATIONALE Development Enhancement: Child/Adolescent (NIC) Independent Note chronological age. Crohn’s disease. Discuss actions Provides anticipatory guidance. type 1 diabetes physical/psychological growth and development. limit identifies interventions needed to maximize care..

Determine ability to chew. and metabolic demands. nutritionists. such as WIC. intestinal Provides opportunity for early intervention. specialists in endocrine problems/genetics). diabetes. or economic factors Increased metabolic demands Possibly evidenced by [Not applicable.] DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Nutritional Status (NOC) Ingest nutritionally adequate diet for age.g. build. activity level.g. presence of signs and symptoms establishes an actual diagnosis. taste. . activity level. surgery. cystic fibrosis. potential of patient and family. or conditions such as lactose nutrients. substance abuse conditions require many resources to maximize growth programs. chronic/recurrent equipment supplies.g.ACTIONS/INTERVENTIONS RATIONALE Development Enhancement: Child/Adolescent (NIC) Collaborative Include nutritionist and other specialists (e. medical limited support and few ill effects. intolerance. inflammatory bowel diseases. presence of These factors can affect ingestion and/or digestion of mechanical barriers. and specific dietary choices. prior nutritional deficiencies).. risk for less than body requirements Risk factors may include Inability to ingest or digest food or absorb nutrients because of biological. hypermetabolic states. restricted intake. Identifies individual nutritional needs and provides appropriate measurements. strength. including weight and body comparative baseline. Determine child’s current nutritional status using age. ACTIONS/INTERVENTIONS RATIONALE Nutrition Management (NIC) Independent Identify children at risk for malnutrition (e. psychological. Refer to available community resources as appropriate Although acute situations may be readily resolved with (e. swallow. sleep/rest cycles. public health programs. Demonstrate stable weight/progressive weight gain toward goal. physical/ Use of multidisciplinary team increases likelihood of occupational therapist) in developing plan of care. developing a well-rounded plan of care that meets child’s special and varied needs.. NURSING DIAGNOSIS: Nutrition: imbalanced..

indirect calorimetry). Review drug regimen. Consult dietitian/nutritional team as indicated. Clarify family/caregiver access to/use of resources such May be necessary to improve child’s intake and/or as food stamps. type and amounts of solid foods an infant/young toddler eats. Provide information regarding individual is counterproductive.. serum Indicators of nutritional health and effects of nutrients in albumin/prealbumin. malabsorption syndrome. needs. nutritious Although nutritious intake is important. Collaborative Establish a nutritional plan that meets individual needs Corrects/controls underlying causative factors (e. and so on). Emphasize importance of well-balanced. digestion/absorption of nutrients. food. and anorexia). liver function. side effects. iron. regarding typical daily food intake. community food availability of food to meet nutritional needs. budget counseling. incorporating specific food restrictions. transferring.g. nitrogen balance studies. Auscultate bowel sounds. bank. Discuss with parent what types of candy. can affect desires/influences on dietary choices. determining foods Knowledge of child’s specific likes/dislikes may be and beverages normally consumed. may affect choice/timing of feeding. blood urea nitrogen [BUN]. amount. opportunity for identifying and providing healthy snacks. Identifies what child eats in a typical day. Note characteristics of stool Provides information about digestion/bowel function and (color. electrolytes. Note well-being and early growth. Determine psychological factors. Provide food without comment. total lymphocyte count. such as vegetarianism. and/or other appropriate assistance programs. organ function.. helpful in meeting child’s nutritional needs during a time Discuss eating habits and food preferences (likes and when appetite is suppressed or child has no interest in dislikes). Note types of snacks. . may help them in making healthy choices. arguing over food intake. Avoid arguing over food intake. amino acid profile. special dietary diabetes. Ethnic food choices can improve a child’s intake when appetite is poor. frequency.ACTIONS/INTERVENTIONS RATIONALE Nutrition Management (NIC) Independent Elicit information from child/parent of younger child Baseline information to determine adequacy of intake. interaction with certain interactions with other medications/over-the-counter foods can alter effect of medication or drugs. Providing age-appropriate nutritional needs and ways to meet these needs within guidelines to children as well as to parents/care provider financial constraints. Review indicated laboratory data (e. Determine whether infant is breastfed or formula-fed and Providing usual and typical feedings is important to infant typical pattern of feedings during a 24-hr period. WIC.g. cultural or religious Dietary beliefs. nutritional intake. and sodas child eats/drinks. and potential Timing of medication doses. cancer. glucose. Useful in determining individual nutritional needs and therapeutic diet. other sweets. Provides snacks.

ACTIONS/INTERVENTIONS RATIONALE Nutrition Management (NIC) Collaborative Refer for dental hygiene/professional care. narrow therapeutic margin of safety of some drugs. . presence of fractures. allows for timely intervention. Take steps to correct identified risks and protect patient from hazards. exposure to latex products. tobacco. invasive factors that place child at risk..g. seizure activity. and family therapy as direction for meeting nutritional needs not only in the indicated. Provides opportunity to modify environment/eliminate therapeutic use of potentially toxic medications. CAREGIVER/PARENT—WILL: Verbalize understanding of individual risk factors that contribute to possibility of injury. use of restraining device Use of pharmaceutical agents. risk for (specify: trauma. exposure to safety hazards.] DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Risk Control (NOC) Be free of injury. therapy when used. May be needed to provide assistance. Provide appropriate level of supervision. fluid deficit/excess. malnutrition. airway patency. Permits monitoring of patient’s well-being. present but for achieving long-term goals as well. ACTIONS/INTERVENTIONS RATIONALE Risk Surveillance (NIC) Independent Identify individual risk factors.g. exposure to nosocomial agents Possibly evidenced by [Not applicable.. alcohol. Refer to home care resources and so on when indicated To assist with initiation/supervision of home nutrition by specific condition/illness. exposure to substances (e. Release restraints periodically Skin/tissues are more fragile and at greater risk for per protocol. e. damage. immobility/use of restraints. support. poisoning) Risk factors may include Developmental age. NURSING DIAGNOSIS: Injury. lines/procedures. impaired neurological status. suffocation. and counseling/psychiatric care. street drugs) Lack of safety or drug education/precautions Immune/autoimmune dysfunction. malnutrition. Handle infant/child gently. presence of signs and symptoms establishes an actual diagnosis. cognitive or emotional difficulties Disease or injury process.

infection responsibility of parents and caregivers. precautions. mask/hood. properly Prevents treatment-related injuries and ensures sized BP cuffs. parent/caregiver knowledge of safety needs. padded side rails. parenting skills. etc. obtaining necessary equipment. warming devices. e. Preventing injuries and complications is a prime e. Encourage parent/caregiver to learn cardiopulmonary Being prepared for emergencies promotes confidence for resuscitation (CPR) and individually appropriate adults and children in their own ability to deal with their procedures or emergency interventions/responses. sensitivity/adverse reaction to latex products. etc.g. Collaborative Refer to community education programs and resources as Can provide additional opportunities for improving indicated. especially Provides for effective therapeutic management. substance use. including information about learning. prevents dosage measurements and conversions. smoking.ACTIONS/INTERVENTIONS RATIONALE Risk Surveillance (NIC) Independent Initiate safety precautions as individually appropriate. Review home situation for safety hazards. and reduces risk for toxic reactions. carrying an EpiPen. Repeat exposure increases risk of developing catheters/tubing.. .g. Monitor medication administration closely. airway adjuncts. such as situation. ventilator bag. Ascertain recurrent exposure to latex gloves.. and oxygen availability of life-saving equipment. suction equipment. Ascertain Promotes a safe environment. concentrations of medications when available. and safer sex practices. injury prevention in home setting. medications in childproof containers. eczema. Have age-appropriate equipment available. IV catheters. Note history of allergies. Use pediatric overdose. Provide bibliotherapy/written resources for Provides information for later review and self-paced parent/caregiver and child. bed in low position. low-flow IV pump.

urinary and gastric output.g. Determine whether child has problems with urination. conditions such as diabetes. burning. hemodynamic measurements. ACTIONS/INTERVENTIONS RATIONALE Fluid Management (NIC) Independent Note potential sources of fluid loss/intake. e. diarrhea. use of total parenteral nutrition (TPN). Note uses of drainage devices such as nasogastric tube. NURSING DIAGNOSIS: Fluid volume. Promote adequate age-appropriate fluid intake.g. child is in diapers. Note: Hypotension turgor. burns. amount indicative of developing shock may not be readily of blood draws. and suppositories. wound drain. enemas. presence of Causative/contributing factors for fluid imbalances. Children often do not take in enough oral fluids to meet hydration needs. Note child’s age. Affects ability to tolerate fluctuations in fluid level and ability to respond to fluid needs. cause and treatment of underlying problem.] DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Hydration (NOC) Demonstrate adequate fluid balance as evidenced by stable vital signs. fistulas Rapid/excessive fluid replacement Possibly evidenced by [Not applicable. presence of signs and symptoms establishes an actual diagnosis. etc. vomiting. If whether child is toilet trained. normal skin turgor. output may be determined by weighing diapers. fever Rapid/sustained loss. mucous membranes. and Provides information for baseline and comparison. weight. Monitor vital signs. and absence of edema. lack of excessive weight fluctuation (loss/gain). Review child’s intake of fluids. risk for imbalance Risk factors may include Lack of adequate intake. skin Indicators of hydration status. hemorrhage. e. size. use of laxatives. May increase fluid and electrolyte losses. increase in fluid needs. moist mucous membranes.. breath sounds. palpable pulses/good quality. observed in pediatric patients until very late in the clinical course. burns. individual appropriate urinary output. holding. . bed-wetting. and cognitive abilities. Evaluation of these issues is important for determining such as urine retention. Determine child’s normal pattern of elimination. PARENT/CAREGIVER WILL: Verbalize understanding of child’s fluid needs. weight.

interventions. lack of support between or from significant other(s) Interruption in bonding process. Because smaller volumes are administered. child. inability to care for/discipline child Lack of parental attachment behaviors Growth and/or developmental lag in child DESIRED OUTCOMES/EVALUATION CRITERIA—PARENT/CAREGIVER WILL: Family Functioning (NOC) Verbalize positive feelings about parenting abilities. BUN. unrealistic expectation for self. NURSING DIAGNOSIS: Family Processes. Be involved in problem-solving solutions for current situation. often safer and better tolerated when given orally if time/condition allows.ACTIONS/INTERVENTIONS RATIONALE Fluid Management (NIC) Collaborative Administer IV fluids via control device/pump. close monitoring and regulation is required to prevent fluid overload while correcting fluid balance. Replace electrolytes as indicated by oral route whenever Oral replacement solutions formulated for children are possible. e. interrupted/Parenting. urine osmolality/specific gravity. trauma. Strengthen parenting skills. modification in family finances. participation in decision making.. Arrange with laboratory to combine common tests and Excessive/repetitive blood draws may markedly reduce draw smallest amount of blood that is necessary to Hb/Hct levels in pediatric patients. partner Possibly evidenced by Changes in communication patterns. family social status Lack of/ineffective role model. disabling/expensive treatments). shift in health status of a family member Developmental transition. .g. lack of appropriate response of child to parent/parent to child Lack of knowledge. impaired May be related to Situational transition and/or crises (illness. Monitor laboratory results. resentment toward child. perform required tests. hemoglobin/hematocrit Indicators of adequacy of hydration/therapeutic (Hb/Hct). Develop skills to deal with present situation. expressions of conflict within family Frequent verbalization of disappointment in child.

Identifies relationships. important. Note: Role models may be negative and/or controlling. psychiatric/physical illness. communication skills. and the family is important. going to a movie or out to self. situational/chronic low).. Encourage parent(s) to identify positive outlets for Parent often believes it is “selfish” to do things for own meeting own needs (e. their coping abilities are enhanced and they are better parents. disabilities of child or parent. Encourage parent(s) to problems. sense of success/failure. and feelings about one another. parents are dinner). maintaining a Helping parent(s) to feel accepting about self and positive attitude toward parent’s capabilities and potential individual capabilities will promote growth. considering intellectual. (Refer to Self-Esteem.. However. training. Note attachment behaviors between parent and child(ren). that children are primary. Observe interactions between parent(s) and child(ren). skill emotional. preconceived ideas can be counterproductive. Identify developmental stage of the family (e. and develop a treatment plan that meets its specific needs. Identifies areas of need for further education. Lack of eye contact and touching may indicate bonding recognizing cultural background. Assess parenting skill level. own style of parenting. Stress the positive aspects of the situation. newborn/infant. problems and choices of solutions. As a rule. for improving. and factors that might interfere with ability to assimilate new information. Learning new skills is enhanced when everyone is participating and interacting. Note presence/effectiveness of extended family/support Provides role models for parent(s) to help them develop systems. children are important. noting presence of specific factors such as interventions and establishing a realistic plan of care. particularly subsequent parent-child interaction. when parents take care of themselves.ACTIONS/INTERVENTIONS RATIONALE Family Support (NIC) Independent Determine existing situation and parental perception of Identification of the individual factors will aid in focusing the problems.) Determine cultural/religious influences on parenting This information is crucial to helping the family identify expectations of self/child. school-age/adolescent children.g. Discuss issues of step-parenting and ways to achieve Blending two families can be a very demanding task. first These factors affect how family members view current child/new infant. stepfamily.g. Failure to bond effectively is thought to affect hold and spend time with child. and positive relationships in a blended family. . Involve all members of the family in learning activities. and physical strengths and limitations. enhancing likelihood of success.

presence of signs/symptoms establishes an actual diagnosis. dehydration. risk for imbalanced Risk factors may include Extremes of age/weight. hot environment. with rectal measurement being on average approximately one degree higher than oral. and axillary being one degree lower than oral.] DESIRED OUTCOMES/EVALUATION CRITERIA—CHILD WILL: Thermoregulation (NOC) Regain/maintain appropriate body temperature for age/size. Providing information/role models can help people learn to negotiate and develop skills for parenting and living together.. Inaccurate functioning thermometer. support groups. child and where temperature is measured. and at the axillary space. NURSING DIAGNOSIS: Body Temperature. dehydration. using properly All children experience fever at some time. Temperature may be measured orally. Discuss variables in temperature measurements for age of Knowledge of normal ranges for age of child (e.ACTIONS/INTERVENTIONS RATIONALE Family Support (NIC) Collaborative Refer to resources such as books. measurement can result in inappropriate treatment. Measure/monitor child’s temperature. Infection. newborn through adolescent) is critical to knowing when a fever requires treatment. PAENT/CAREGIVER WILL: Risk Control (NOC) Provide proper environmental controls and safeguards. classes. ACTIONS/INTERVENTIONS RATIONALE Temperature Regulation (NIC) Independent Note conditions promoting fevers. exposure to cold/hot environments.g. illness/trauma affecting temperature regulation Possibly evidenced by [Not applicable. . inflammation. rectally.

environment.] DESIRED OUTCOMES/EVALUATION CRITERIA—PARENT/CAREGIVER WILL: Health Seeking Behavior (NOC) Identify necessary health maintenance activities. Apply cool Limiting linens. environmental issues such as childcare setting. Develop plan to meet specific needs. Verbalize understanding of factors contributing to current situation. nutrition. can help lower body cloth to head. children. excessive levels may have adverse effects and require intervention. Provide safety precautions as Higher fevers may trigger febrile seizures in susceptible indicated. Adjust bedclothes and linens. Some degree of fever may be useful for fighting infection. Collaborative Administer antipyretics as indicated. Observe for seizure activity. risk for ineffective Risk factors may include Unachieved developmental tasks Perceptual or cognitive impairment Ineffective individual/family coping Lack of material resources. may reveal problems requiring maintained. higher metabolic rate. sleep/rest. immediate intervention. homelessness. and sensitivity to environmental conditions. . presence of signs/symptoms establishes an actual diagnosis.g. however. Newborn is more vulnerable to heat loss than older child because of body surface area. etc. e. NURSING DIAGNOSIS: Health Maintenance. use of room fan. psychosocial supports Possibly evidenced by [Not applicable. immunization status. bathe in lukewarm bath.ACTIONS/INTERVENTIONS RATIONALE Temperature Regulation (NIC) Independent Be aware of heat loss related to age/body mass. exercise. temperature. ACTIONS/INTERVENTIONS RATIONALE Health System Guidance (NIC) Independent Explore with parents how child’s health status is Identifies strengths.

skilled nursing care. monitoring by primary care provider. healthcare facility team and community healthcare providers. (e. as well as self-care ADLs. or legal concerns. illness/ long-term health problems occur. Refer to social services as indicated.ACTIONS/INTERVENTIONS RATIONALE Health System Guidance (NIC) Independent Discuss mother’s health status when pregnant with child.g. Information and support is vital for maintaining and and identify ways parent can adapt when progressive managing effective health practices. Develop plan with parent/caregiver for child’s care. . Provide information about individual healthcare needs. and follow-up. Provides for prevention of complications and early Identify signs and symptoms requiring further evaluation intervention in times of illness. complications of pregnancy/birth. Provide for communication and coordination between the Promotes continuation of care. Collaborative Make referral as needed for community support services Provides for childcare and parental support. need to be monitored/care provided for optimum health. Provide anticipatory guidance for periods of wellness. Provide time to listen to concerns of parent/caregiver. eye and dental care. their own care may have areas of need. and financial resources. and provides parents with information about areas that and immunizations. Arrange for hospice services if needed. Plan of care can be altered as needed. either because of illness or other stressors. homemaker/home attendant. and health status. Long-term care for chronically ill child or acute care to a child can be very challenging to parent’s physical. Helps identify issues that may arise in child’s future e.. Allows for incorporating existing strengths or limitations. May be indicated when illness is terminal. Monitor adherence to prescribed medical regimen. emotional. substance use. assistance in adapting and organizing care as necessary. Ascertain frequency of routine health exams. well-baby clinic).g. May need assistance with financial. Note desire/level of ability to meet health maintenance Care providers and children who can provide much of needs.. housing. exposure to toxic agents. including Identifies areas of child’s healthcare that may be lacking.