Student: Alyssa Van Vark

Date of Experience: 10/1/12

University of Saint Francis

Leach College of Nursing
JOLIET, ILLINOIS
PEDIATRIC
PATIENT DATA BASE

BASIC CONDITIONING FACTORS:

Client Initials: T.B.
Age: 5
Sex: Male
Allergies: NKA
__________________________________________________________________________________
Medical Diagnosis:
Stage 4 Chronic Kidney Disease (GFR 15-29 mL/min)
Anemia
Hypercalcemia
Secondary hyperparathyroidism of renal origin
Acidosis
___________________________________________________________________________
Surgical Procedure / Treatment: None
__________________________________________________________________________________C
lient Profile: (reason for hospitalization, chief complaints and/or presenting symptoms)
T.B.s reason for hospitalization was for a routine kidney follow up visit due to elevated BUN/Creatinine
levels related to his stage 4 Chronic Kidney Disease. Patients typical BUN is in the 30s, but upon
hospitalization it was 57. Patients typical Creatinine levels are 1.5-1.6, but upon hospitalization was
2.84.
__________________________________________________________________________________
Past Medical History: (including previous hospitalizations)
Upon birth, T.B. was admitted to the neonatal intensive care unit for ventilatory management with a
presumed diagnosis of posterior urethral valve based upon antenatal hydronephrosis. Renal was very
poor and was on maintenance on catheter drainage. T.B. has a cystoscopy with a transurethral incision of
the posterior urethral valve on 5/17/07. Patient is currently up to date on all vaccinations including most
recent, DTap-HEPB-IPV on 7/6/07 and 6/25/07, HIB (3 dose) on 6/25/07 and the Pneumococcal vaccine
on 6/25/07.
__________________________________________________________________________________
Support Systems: (family, friends, coworkers etc.)
T.B. is one of two children with him being the oldest, leaving his 3 year old brother to be the youngest.
He lives at home with his mom, maternal grandmother, maternal step-grand-father and cousin. Patients
mom is the predominant caregiver, but it was also reported that the maternal grandmother also assists in

Health Care System: Ann & Robert H.

Lurie Childrens Hospital of Chicago
Instructor: Lori Jones

POWER COMPONENTS:
The client has actual or potential self-care deficits in
the following areas: (Indicate A for actual and P
for potential). Comment when appropriate.
_A__ Attention Span
Due to the clients age and being in the hospital,
the clients attention span was in deficit.
_A__ Energy Level
Considering that the patient is hospitalized, it
decreases his energy level in that he cannot do his
normal activities that keep him active and energized.
Although the patient seemed to have some energy,
patients mom reported that he is less energized than
normal due to his illness and being in the hospital.
_A__ Control of body movements
Although the patient can control his body
movements, his ability to do so is limited. It is
limited in that the patient is hooked up to IVs and
other medical equipment that makes it challenging for
him to control and move his body. Considering the
patient is only 5, it is normal for him to want to move
around and be active, but in this circumstance he is
unable and therefore creates a deficit.
_A__ Ability to reason
Considering that the patient is only 5 years old,
his reasoning skills are not fully developed, therefore

his care. T.B. mentions that he has many friends, as evidenced by a lot of cards and balloons that were in
the patients room and windowsill. T.B. stated that his cousin is also his best friend, and they also attend
the same school.
__________________________________________________________________________________
Sociocultural and daily patterns of living:
T.B. is young African-American, English speaking male. T.B. lives around the Chicago area in a private
residence in a safe neighborhood. The patient attends kindergarten at Building Blocks Leaning Academy
where he states he is very happy and has a lot of friends. T.B. attends kindergarten five times a week from
8:30 am-2:30 pm. T.B. also states that he has a pet turtle and he makes sure that he washes his hands very
well after every exposure to avoid Salmonella. T.B. relies mostly on his mother and maternal grandmother
to assist with his care and activities of daily living. It was also noted that the patient previously
underwent clean, intermittent catheterization every four hours, but during school, he is going eight hours
without catheterization. Patients mom has not discussed this medical need with the school nurse due to
being scared to talk with the school about it. Patients mom is also unsure if the patient would allow this
to be done at school. Other options are currently being discussed as a solution is trying to be found.
Social work is involved in trying to help come up with a solution.

creating a deficit in the ability to reason.

__A_ Ability to make decisions
The patient has a deficit in making decisions due
to his young age as well as the intimidating factors of
being in the hospitalized which may make it more
difficult for him to make decisions.
_A__ Motivation
The patient has a deficit in motivation related to
his age of only 5. He does not fully understand the
seriousness of his disease and therefore is not
motivated by that to get better.
_A__ Knowledge of health problem
Considering that the patient is only 5 years old, he
is not in primary care of his health and therefore,
does not have a full knowledge of his health problem.
He is also too young to fully comprehend the extent
and the details of his health problem, creating a
deficit.
_A__ Ability to provide for self care
Due to being only 5 years old, the patient is not
able to provide for full self-care quite yet. He still
needs supervision for certain tasks and needs
guidance for others.
__A_ Skills needed to adapt self-care needs
The patient has a deficit in the skills needed to
adapt self-care needs in that he does not fully
understand the extent of his illness and the care that
it requires. He is also still too young to possess all
the skills that would be needed to adapt to his selfcare needs, and therefore relies on his mother to
provide these skills.
_A__ Ability to adapt self-care needs to A.D.L.
Due to the patient being only 5 years old, he has a
deficit in this category, as he is not fully capable of
adapting self-care needs to activities of daily living.
He relies a lot still on his mother and other caregivers

to assist him with these tasks.

Student:
Date of Experience:

LEACH COLLEGE OF NURSING

JOLIET, ILLINOIS
PEDIATRIC
PATIENT DATA BASE

UNIVERSAL / HEALTH DEVIATION

SELF-CARE REQUISITE ASSESSMENT:
Air: (Respiratory, Cardiovascular)

Pulse-87 and regular. Capillary refill of 2 seconds. Heart sounds heard throughout chest cavity at a
regular rate and rhythm with normal S1/S2 with physiologic splinting. No murmur heard upon
auscultation. No chest pain reported. Normocephalic, no facial edema or fullness in cheeks, sclerae
white, nares clear, lips dry and mucus membranes tacky. Skin was of normal texture, normal turgor
with no rash or edema present. Respiratory rate of 18 per minute at a regular pattern, effortless and
clear, bilateral breath sounds. No cough or secretions present. Oxygen saturation of 95% on room
air.
Water: (Renal, F & E)

IV (22 gauge) site on left hand, in tact and continuous as 100 mL/h. Intake during shift of 500 mL
and output during shift of 1040 mL. Urine output clear with a slight yellow tinge. No edema
noted. Normal skin turgor with tacky mucus membranes. No JVD present. Foley in tact, no
redness or swelling or drainage at the site. No ascites present. Electrolytes: Sodium 138 (normal
134-146 mEq/L), Potassium 4.1 (normal 3.7-5.5 mEq/L), Chloride 107 (normal 98-108 mEq/L),
Calcium 9.8 (normal 8.8-10.8 mEq/L).
Food /Elimination: (Gastrointestinal)

Abdomen was soft and non-tender with good bowel sounds in all quadrants. Patient height 107.5
cm, patient weight: 16.6 kg. No NG tube present. Patient on a general diet, with good appetite.
Ate 100% of breakfast and lunch. Estimated energy needs per dietician are 65 cal/kg, 1g protein/kg
and 80 mL/kg/day of fluids. No nausea or vomiting reported. No known food allergies. Foley
catheter present and in tact. Regular stool habits of about 1-2 stools per day of a firm, regular
consistency.
Activity & Rest: (Musculoskeletal, Neurological)

T.B. was alert and oriented times three (person, place, and time). Muscles of good strength and
normal for patients age. Equal handgrip and intact tactile sensation. Patient is able to ambulate
well and is steady in gait. Range of motion was in full range for all extremities. Patient reports that

Health Care System:

Instructor:

DEVELOPMENTAL SELF CARE REQUISITES:

Clients Age: 5
Stage of Development:
Erickson Initiative vs. Guilt
Piaget Preoperational
Explain each stage
In Initiative vs. Guilt, children like to pretend and
try out new roles. Fantasy and imagination allow
children to further explore their environment.
They are also developing their superego, also
known as their conscience. Conflicts often arise
between the childs desire to explore and the limits
that often times, the parents have placed on the
child. These and other conflicts, sometimes
usually lead to frustration and feelings of guilt
from the child. It also isnt uncommon for the
child of this age to feel guilt if the parents
responses are too harsh. Preschoolers such as
T.B. are learning to maintain a sense of initiative
without imposing on the freedoms of others. It is
recommended to teach impulse control and
cooperative behaviors during this stage to avoid
the risks of altered growth and development in
later stages.
In preoperational, the children in this stage learn
to think with the use of symbols and mental
images. The children in this stage are still
egocentric and only see things from their own
point of view and believe that everyone
experiences the world exactly as they do. Play
becomes a primary means by which children
foster their cognitive development and learn about
the world. The use of play with this age of a child

he sleeps through the night and feels rested when he wakes up in the morning. Mom reports that
patient has a regular bedtime and is good about sticking to it. Patient reports to have a good
activity tolerance to sports and activities. Patient is involved in many sports such as basketball and
football. PERRLA: pupils are equal, round and reactive to light and accommodation, extra ocular
movement is intact.

is very important, even in the healthcare setting.

Language develops and broadens possibilities for
thinking about the past of future also during this
time frame. Children in this stage can now
communicate about events with others as
language now fits into a logical form for the child
(Potter & Perry, 2009, pp. 139-142).

Solitude & Social Interaction: (Sensory Perception, Psychosocial)

T.B. does not have glasses or hearing aids. Patient was calm but playful during the assessment and
reported to be close with his mom, grandmother and friends. No communication difficulties present How might this illness interfere with the clients
at the time of assessment. No previous psychological behavior noted. T.B. reported no pain or
developmental tasks: How might the clients stage
uncomfort.
of development impact his/her adjustment to the
illness?
Prevention of Hazards: (Endocrine Autoimmune, Chemical)

T.B. does not smoke and lives in a smoke free environment. He has never been assessed for
alcohol or drug use due to his young age. He has no history of seizures. Unable to assess the
patients home environment, but T.B. and his mother state its a private residence in a nice
neighborhood where they feel safe and comfortable. Patients temperature was 98.9 (37.2). Patient
is not currently a fall risk. No restraints were present nor were SCDs or Ted hose. T.B. is not a
diabetic, but his blood glucose level was 104 (normal 70-110). Patient is not in any pain and is not
taking pain medications currently. Patients call light was in his bed by his side, his bed was in low
position and the side rails were up.
Promotion of Normalcy: (Personal Hygiene/Self Concept/Sexuality, Skin)

Patient appeared to be clean and have good hygiene. Patients mom reported to having to still
assist T.B. with some of his activities of daily living, whereas other things he is able to do himself.
T.B. seemed to have a good self-concept and seemed playful and up to beat. Patient was shy at
first, but warmed up quickly after performing the morning assessment. Patients skin was dry and
intact without any lesions or rashes present.

T.B.s illness might interfere with his

developmental tasks in that he wont be at home
and in his normal environment that allows his to
flourish and grow normally. T.B. wont have the
luxury to try out new roles at home and to explore
things as his peers are doing, which places limits
on his behavior. He isnt allowed to practice
initiative as he should be, which can lead to him
having feelings of guilt, which can be difficult for
him developmentally. T.B. also wont be able to
use play as he should be and as his peers are
doing, which might set him back and make
cognitive development a little more challenging
for him. Being in and out of the hospital for a
long period of time will alter how T.B. grows and
develops and can even set him back in his
developmental milestones. The clients
developmental stage might impact his adjustment
to the illness in a few ways. He might think that
the illness was caused for a certain reason, or
wonder why it happened to him as he is still in the
egocentric view of the world. He might think that
everything is about him and then get irritated or
frustrated when the nurse or his family isnt able
to play with him at a certain moment or be with
him all the time. He might not understand that
since people are busy, they must finish their work
before the play and T.B. might take that as an

insult and view it as negative. The patients stage

of development might also affect his illness in that
if he isnt able to do certain things by himself or
isnt given the opportunity to experience initiative,
he might experience the sense of guilt, which can
also be detrimental to his development. As
mentioned previously, conflicts often occur
between the childs desire to explore and the limits
placed on his/her behavior. Keeping this in mind,
it is more than likely that a conflict might arise in
that T.B. isnt allowed to explore all the time
while in the hospital.

PEDIATRICS GROWTH AND DEVELOPMENT ASSESSMENT

Height

NORMS
When plotted on a grown chart, the average (50th
percentile) 5-year-old boy should be about 110 cm tall.

Weight

The average child in the 50th percentile for growth charts is

about 19 kg.

Head Circumference (if applicable)

Not applicable

Vital Signs/Norm Variations

Blood pressure in a 5-year-old boy should be between 104116 for the systolic and then between 63-74 for the
diastolic. The pulse rate should be between 80-125. The
temperature should be between 97.5-98.6 (36.4-37) axillary.
The respiratory rate should be between 20-30 breaths per
minute.

Gross Motor
(List representative tasks)

Preschoolers should be able to hop on one foot or alternate

feet. They should also be able to walk heel to toe, balance
on each foot for longer time; begin to ride a bike with
training wheels. They also should be able to throw and
catch a ball, and walk downstairs using alternate feet.

Fine Motor

Fine motor skills are improving during this age period,

which allows for intricate manipulations. They learn to
copy crosses and squares but triangles and diamonds are
usually mastered between the ages of 5 and 6. Scribbling
and drawing help to develop fine muscle skills and eye-hand
coordination needed for the printing of letters and numbers.
They should also be able to draw a person with several body
parts with drawing resembling familiar objects or people.
The child should also be able to tie shoelaces.
The world of the preschooler expands beyond the family
into the neighborhood where the child might meet other
children and adults. Their curiosity and developing sense of
initiative lead to the active exploration of the environment,

Socialization

CLIENT DATA
T.B. when plotted on a growth chart is in the 25th
percentile, which means he is shorter than the average
5-year-old boy.
T.B. when plotted on a growth chart is in the 10th
percentile, which means that he is under weight for his
age.
Not applicable
T.B.s blood pressure was 96/60, which is a little lower
than expected for his age group. T.B.s pulse rate was
87 beats per minute, which is right where it should be.
T.B.s temperature was 98.9 (37.2), which is just .9
degrees (.2 Celsius) higher than it should be, but is not
worrisome. T.B.s respiratory rate was 18 breaths per
minute, which is a little lower than expected, but is also
not worrisome.
T.B. was able to walk and move around as well as hop
on one foot or alternating feet as expected for his age
group. He reported being able to ride a bike and stated
that he loves the play basketball and football, which
implies that, he can run and move well as expected for
his developmental level.
T.B. was painting and drawing pictures during my
experience with him and seemed to be able to
manipulate and control his fine motor movements well.
He was able to draw well-represented pictures that
resemble realistic things and was able to color within
the lines.

T.B. seemed to be well socialized, in that he stated he

had many friends both in school and around the
neighborhood. This was obvious by the pile of cards
that were stacked on his windowsill that were from his

the development of new skills, and making new friends. It is

normal for a child of this age to have a surplus of energy
that permits them to plan and attempt many activities that
are beyond their capabilities, which often results in the sense
of guilt from the child. Sources of stress for preschoolers
can include things such as starting school, the birth of a
sibling, relocation or an illness. During stressful times, the
child in this stage sometimes reverts to bed-wetting or
thumb sucking and wants to be dependent on their parents
again. Play is very important to a child in this stage and is
an excellent way for preschoolers to vent frustration or
anger and is also a good way for the child to deal with
stress.
(Potter & Perry, 2009, p. 160-161).
(McKinney et al, 2009, p. 817).

classmates. T.B. loved to play and wanted to play all

day during my experience with him. He was talkative
and very playful and seemed to have plenty of energy
as expected for his age.

PEDIATRICS
Research of the Medical Diagnosis/Surgical Procedure
Chronic Kidney Disease in children is caused by congenital malformations, inherited disorders, acquired
diseases and metabolic syndromes. It has been discovered that the underlying cause correlates closely with the
age of the child. In children younger than 5, such as T.B., CKD is commonly associated as the result of
congenital malformations such as renal dysplasia or obstructive uropathy as T.B. also had. The states for
progression of CKD in children are based on the glomerular filtration rate. A mild stage is a GFR of 60-89
mL/min, a moderate stage is a GFR of 30-59 mL/min, a severe stage is a GFR of 15-29 mL/min and kidney
failure is classified as a GFR of less than 15 mL/min. T.B. was in severe chronic kidney failure as evidenced by
his glomerular filtration rate of 15-29 mL/min. Certain features of CKD are manifested in children. These consist
of severe growth impairment, developmental delays, bone abnormalities, and development of psychosocial
problems. The most common condition seen in children is high-bone-turnover bone disease caused by secondary
hyperparathyroidism. (Porth & Matfin, 2009, p. 871). As for diagnostic evaluation, chronic renal failure may
manifest nonspecifically. Physical examination may be one method of diagnosis as it may reveal short stature,
failure to thrive and hypertension. A blood work up might also be done which might show electrolyte
abnormalities, calcium and phosphorus abnormalities and anemia. A creatinine clearance test might also be done
which measures the ability of the renal system to excrete metabolic products. The child who has chronic kidney
failure may have normal fluid volume, be dehydrated or may have fluid overload. (McKinney et al., 2009, p.
1164).
The diet of a child with chronic renal failure is often times modified due to the decreased ability of the
kidneys to regulate fluids, electrolytes, minerals and waste products. Such restrictions or modifications of the
diet may include salt and fluid, protein, phosphorous and potassium. Often times, diuretics are indicated to
control fluid balance, and antihypertensive are given for hypertension. Sodium bicarbonate may be necessary to
maintain acid-base balance and Vitamin D and phosphorous binding medications may also be helpful in
preventing bone disease. As for health promotion, the child with chronic renal failure should receive all
childhood immunizations and yearly influenza vaccines unless the vaccines are consisted of live viruses. Advances
in the treatment of CKD in infants and children such as recombinant erythropoietin and recombinant growth
hormone have shown to improve the quality of life in some of these children (McKinney et al., 2009, p. 1164). As
with other diseases processes and treatment plans, each treatment plan should be tailored to each and every
patient.

Diagnosis Tests (Include lab, x-ray, etc. Provide purpose of test and significance of results)
Tests

Renal Ultrasound was performed due to a history of posterior urethral valve and then used as a comparison of
prior renal ultrasounds. The impression was that T.B. had moderate to severe bilateral hydronephrosis with
associated cortical thinning, which decreases slightly after catheterization, but is not resolved. The overall
impression and finding from the test was bilateral hydrouretr.
AP Supine View of the Abdomen was performed due to worsening creatinine levels. The findings associated
where that there was bowel gas in a non-obstructed pattern. There was no supine evidence of free air as well as
no masses seen or abnormal calcifications.
Cystogram with Urodynamics was performed with the indication of posterior urethral valves. The impression
was that there is a right, grade five vesicoureleral reflux.

Labs
Osmolality, Urine 184 (Range 50-1400 mOsm/kg) Osmolality is the measurement of the number of dissolved
particles in a solution. It is a more exact measurement of urine concentration than specific gravity, because
specific gravity depends on the number and prcis nature of the particles in the urine. Osmolality is used in the
precise evaluation of the concentration and diluting abilities of the kidney. This test is also used to monitor fluid
and electrolyte balance. (Pagena & Pagena, 2011, p. 711).
Sodium 138 (Range 134-146 mEq/L) The sodium content of the blood is a result of a balance between dietary
sodium intake and renal excretion. An average dietary intake of about 90 mEq/day to 250 mEq/day is needed to
maintain sodium balance in adults. (Pagena & Pagena, 2011, p. 902).
Potassium 4.1 (Range 3.7-5.5 mEq/L) Considering the serum concentration of potassium is very narrow,
minor changes in concentration can have significant consequences for this patient. Serum potassium
concentration depends on many factors including aldosterone, sodium reabsorption and acid/base balance.
Potassium has profound effects on the heart and contractility, and therefore should be monitored carefully.
(Pagena & Pagena, 2011, pp 775-776).
Chloride 107 (Range 98-108 mEq/L) Chloride is a major extracellular anion and its main purpose is to
maintain electrical neutrality. This test does not provide much information when looked at alone, but when
compared with other electrolyte values, chloride can give an indication of acid-base balance and hydration status.
Certain drugs can decrease chloride levels, whereas others can raise it. (Pagena & Pagena, 2011, p. 258).
CO2 20.6 (Range 23-30 mmHg) The CO2 test is usually included with other assessments of electrolytes. It is
also often done with a multiphasic-testing machine that also measures sodium, potassium, chloride, BUN, and
creatinine. As with chloride, certain drugs can cause increase or decrease carbon dioxide levels. (Pagena &
Pagena, 2011, p. 220).
Glucose Plasma 104 (Range 70-110 mg/dL) Blood glucose levels are within range for the patient and his age
considering he is not diabetic.
BUN 26 (Range 7-18 md/dL) The BUN measures the amount of urea nitrogen in the blood. BUN is directly
related to metabolic function of the liver and the excretory function of the kidney. It therefore serves as an index
of the function of these organs. Patients who have an increase in their BUN, as does T.B., are said to have
azotemia. Nearly all renal diseases cause inadequate excretion of urea which causes the blood concentration to
rise above normal which is most likely the case for T.B. BUN levels can also increase with certain conditions.
(Pagena & Pagena, 2011, p. 995).
Creatinine 2.71 (Range 0.25-0.74 mg Creatinine, as with blood urea nitrogen, is excreted entirely by the
kidneys and therefore, is directly proportional to renal excretory function. The serum creatinine test is used to
diagnose impaired renal function. (Pagnea & Pagena, 2011, p. 327).
Albumin 2.6 (Range 3.3-4.3 mg/dL) Albumin is a protein that is formed in the liver. The major effect of
albumin in the blood is to maintain colloidal osmotic pressure. Albumin is synthesized in the liver and is
therefore, a measure of hepatic function. When disease affects the liver cell, the hepatocyte loses its ability to
synthesize albumin.
Calcium 9.8 (Range 8.8-10.8 mg/dL) The serum calcium test is used to evaluate parathyroid function and
calcium metabolism by directly measuring the total amount of calcium in the blood. This test is particularly
useful when monitoring patients with renal failure, renal transplantation, hyperparathyroidism, and various
malignancies. T.B. is at risk for hypocalcemia due to his renal failure and hypoalbuminemia and therefore, his
levels should be monitored carefully and frequently. (Pagena & Pagena, 2011, p. 216).

PEDIATRICS
Medical Technologies: Treatments/Medications
(List and describe specific purpose for client. Indicate calculation of dosage and if appropriate.)
Epoetin alfa (Procrit) 2, 000 units subcutaneous daily for anemia in chronic kidney disease
Citric Acid Sodium Citrate 25 mL orally twice daily for treatment of metabolic acidosis
Ferrous Sulfate 65 mg orally once daily for iron deficiency anemia
Oxybutynin (Ditropan) syrup 2.5 mg orally twice daily for relief of symptoms associated with uninhibited
neurogenic bladder, reflex neurogenic bladder

Prioritized Nursing Diagnoses: (List all that apply and utilize PES format)
Impaired urinary elimination related to effects of disease AEB Foley catheter insertion.
Impaired oral mucus membranes related to irritation from nitrogenous waste products AEB tacky mucus
membranes and dry lips.
Interrupted family processes related to situation transition AEB changes in communication patterns, changes in
patterns and changes in rituals.
Compromised family coping related to prolonged over concern for child AEB an expressed concern about
patients response to health problem.
Ineffective health maintenance related to deficient knowledge regarding medications AEB young age.
Risk for electrolyte imbalance related to renal dysfunction.
Risk for imbalanced nutrition: less than body requirements related to gastrointestinal manifestations of
hypercalcemia.
Risk for ineffective renal perfusion related to renal disease.
Risk for anxiety related to cause of disease.

Area of Concern
A
Activity

M
Medication

E
Environment (home)

T
Treatment

H
Health Teaching
(Include anticipatory
guidance)

O
Outpatient Referral

D
Diet

Discharge Preparation Needed

T.B. will continue on achieving his highest level of functioning and mobility prior to discharge by
keeping active and performing ROM exercises daily. T.B. will continue his ROM exercises and
activity post-discharge on a regular basis. T.B. will continue playing football and basketball upon
discharge and will practice safe techniques by using safety gear while playing. T.B.s mom will
provide transportation to and from activities as well as any follow-up appointments.
T.B. will continue taking his medications as prescribed and currently taking once discharged. T.B.
will be aware of his medications, their side effects, and when to take them. T.B.s mom will also be
in the room during the education and will be required to describe what will be expected of her in
giving T.B. his medications. T.B. and his mother will be informed not to start or stop any
medications prior to talking to their physician as it could cause serious side effects or counteract
with other prescribed medications. T.B.s caregivers will assist the patient with his medications.
Patients home will be evaluated prior to discharge, looking for any actual or potential hazards
within the home. It is recommended that the patients house contain adequate lighting, no throw
rugs or clutter, side rails on both sides of the stairwell, as well as easily accessible access into and
out of the shower. T.B. will return home with his mother, grandmother, step grandmother and
cousin as well as his younger brother. T.B. and his mom report feeling safe in their home
environment and state that it is in a good neighborhood.
T.B. and family will be aware and fully educated on the patients condition, prescribed medications
and treatment plan prior to discharge. T.B. will continue being active through sports and play upon
discharge as well as practice ROM exercises. Follow up care will be provided both to the patient
and family as well as given any information on when the physician should be called.
Patient and family will be taught how and when to administer medications, any side effects or
adverse reactions as well as contraindications. Patient and family will also be knowledgeable
about T.B.s medical condition, what it consists of as well as any follow up care and procedures
that will be required. The patient and family will also receive both written and verbal information
about the patients medical conditions, what to expect and when to seek care. It is important for
the patient and all caregivers to fully understand the patients condition in order to provide proper
care and treatment.
Follow up care will be arranged and provided to the patient prior to discharge. The patient will be
provided with phone numbers, addresses, and emergency contacts for any questions, concerns or
problems. It is also suggested that the family and caregivers of T.B. join a support group as it
might help to better understand and empathize with the patient. T.B. and his family will be given
and explained a written discharge plan for his care.
T.B. will continue a general diet post discharge. Information will be provided to him and the mom
about proper nutrition, and fluid intake.

References:

Ackley, Betty & Ladwig, Gail. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care.
(9th edition). St. Louis: Mosby Inc.
Hodgson, B. Barbara & Kizior, J. Robert. (2012). Nursing drug handbook 2012. St. Louis: Saunders Inc.

McKinney, E., James, S., Murray, S., & Ashwill, J. (2009). Maternal-child nursing. (3rd edition). St. Louis:
Saunders Inc.
Pagena, Kathleen Deska & Pagena, J. Timothy. (2011). Diagnostic and laboratory test reference. (10th edition).
St. Louis: Mosby Inc.
Porth, Carol Mattson & Matfin, Glenn. (2009). Pathophysiology: Concepts of altered health states. (8th edition).
Philadelphia: Lippincott Williams & Wilkins.
Potter, A. Patricia & Perry, G. Anne. (2009). Fundamentals of nursing. (7th edition). St. Louis: Mosby Inc.