Pediatric Conceptual Care Plan
Medications (include Name & Indications of
all meds within your clinical day/timeframe)
Complete attached Medication Profile page
for all scheduled & prn medications
Scheduled:
 Augmentin: 125 mg tab BID
 Fluoxetine 10 mg daily
 Atenolol 25 mg tab nightly PO
 Morphine 6 mg IVP Q 6 hr
 Ondansetron: 8 mg IVP Q 8 hr
PRN:
 Toradol 15mg IVP Q 6h PRN pain
 Acetaminophen: 1-2 250 mg tab Q 6
hr PRN
 Heparin 10un/mL PRN Q 4 hr
IV Sites & Fluids Rate
 Below Right wrist IV SITE:
Discontinued—
Clindamycin IVPB 600 mg Q 8 hr with
Normal Saline,
Past Medical/Surgical History
--Marfan Syndrome
--Muscle Dysfunction: Lower extremity limb
weakness/gait abnormality
--Aortic Root Dilation and Mitral Valve Prolapse
--Bilateral Hydonephrosis
--Duane’s Syndrome of the Left Eye
--Depressive Disorder, PTSD, Goiter
--Nephrolithiasis
©Adapted
--Croup, Sinusitis, Otis Media, Streppharyngitis
Lab Values
Student Name: Courtney Wolf Date: 09/25/17
Patient Initials: D.R. Age: 14 Gender: Male 142 106 8 /87
Admission Date: 9/23 4.3 31 0.71 \
CODE Status: Full Allergies: Chloral Hydrate, Floxin
Diet: Peds Regular Activity: Ad Lib Braden Q Score : 26 7 \14/268
Humpty Dumpty Fall Score: 9 Caregiver at bedside? Yes /44\
Weight: 211 lb. (95kg) Height: 6’ 3’’ BMI: 26.4 Religion: LDS
Mormon
Micro:
Pt. needle aspiration showed gram + cocci in
History of Present Illness (include all diagnoses and brief right parotid abscess (9/24). Diagnosis of
pathophysiology) Suppurative Parotitis confirmed, occurs when the
salivary glands get obstructed by bacterial pus,
9/23—Pt. Admitted with Suppurative Parotitis (Acute thus causing facial swelling.
Sialadenitis) with facial swelling
Assessment Data Any other pertinent labs:
Vital Signs- 96.8 Temporal Temp, 109 HR, 22 RR, 109/66 BP, 10/10 Pain
Thyroid levels: TSH 1.9, T3 99
Neuro- AAA X 3, Distraught but Cooperative, Purposeful Movement, No
facial droop, Patient has cranial nerves grossly intact, macrocephaly
Diagnostic Tests & Results (X-Ray, CT, MRI, etc.):
Cardio- Patient had rounded and symmetric chest, no lifts, heaves or
pulsations. S1, S2, and S3 auscultated, patient has increased heart rate. --CT: nothing abnormal
Slight diastolic murmur heard on auscultation. Radial, carotid, and pedal --Urine Dipstick Negative
pulses all +2, capillary refill was ≤2 s in all extremities, pt. slightly pale --CBC: nothing abnormal
Resp- Chest is symmetric and expands bilaterally, has unlabored
breathing at rest, no use of accessory muscles, increased respirations Surgical/Invasive Procedures:
(22). No wheezes, crackles, or adventious sounds noted. Capillary refill
is ≤1 Patient sitting upright, bracing neck in pain, has dyspnea on --Needle Aspiration 9/24: Showed Gram + Cocci
exertion -- Right Laparoscopic Ear Puncture for Parotid
GI- Patient had distended abdomen, asymmetrical, last bowel
Gland Abscess 9/25
movement 3 days ago, flatulence present, normoactive bowel sounds
auscultated, Pt states lack of appetite Treatments (i.e. PT, RT, SLP, OT, Wound Care)
GU- Patient urinated 325 mL of yellow straw colored urine, non --Psychologist Appointment
malodorous. No bladder distention present
--Physical Therapy
MSK- Pt. can ambulate but has abnormal shuffling gait due to muscle
weakness. Patient presents with 5/5 upper extremity strength, 3/5 CONTINUED ASSESSMENT DATA:
lower extremity strength Developmental- Pt. is in Erikson’s Identity vs. Role
Confusion stage. His environmental influences are his peers
Integument- Patient’s skin was intact, warm, slightly pale, dry, and
and he is learning fidelity during this stage. Pt. may be
appropriate to ethnicity
struggling in this stage because of his depression and low
Psychosocial- Mom is attentive and participatory in D.R.’s care. Pt. self esteem from not looking like his peers (Marfan’s
from 2013, Linda Caputi, Inc. www.LindaCaputi.comSyndrome).
stated he felt safe at home, parents denied having any guns at home.
 Medication Profile (add additional pages as needed)

Scheduled Medications:

Name (generic): Classification: Route: Dosage Range for Route:

Augmentin Aminopenicillin PO 250-500 mg Q 8 hr

Pt. Ordered Dose: Frequency and administration times: Last date/time administered:
125 mg BID 0900 and 2100 9/25/17 0900

Indications: Why prescribed for your patient (assessment data)?

Treatment of a variety of infections
including: Skin and skin structure
infections, Otitis media, Sinusitis,
Respiratory tract infections, Genitourinary
tract infections.
Pt. diagnosed with suppurative parotitis, an acute bacterial infection that requires antibiotics to
treat. Because the medication binds to bacterial cell wall, it causes cell death and the infection to
cease.

Key Nursing Considerations:

Administer around the clock, assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC), monitor bowel function,
watch out for anaphylactic shock.

Name (generic): Classification: Route: Dosage Range for Route:

Fluoxetine Antidepressent PO 10-20 mg/day in morning

Pt. Ordered Dose: Frequency and administration times: Last date/time administered:
10mg daily Once daily in am (0900) 9/25/17 at 0900

Indications: Why prescribed for your patient (assessment data)?

Indications Major depressive disorder. Pt. diagnosed with moderate depression in August 2014. This medication will inhibit the reuptake
Obsessive compulsive disorder (OCD). of serotonin, helping the patient feel better.
Bulimia nervosa. Panic disorder. Acute
treatment of depressive episodes associated
with bipolar I disorder (when used with
olanzapine).

©Adapted from 2013, Linda Caputi, Inc. www.LindaCaputi.com

Key Nursing Considerations:
Monitor mood changes, assess for suicidal tendencies, monitor appetite and weigh weekly. Assess for serotonin syndrome and bulimia.

Name (generic): Classification: Route: Dosage Range for Route:

Atenolol Antihypertensive Beta Blocker PO 50-100 mg once daily

Pt. Ordered Dose: Frequency and administration times: Last date/time administered:
25 mg tab nightly Nightly once a day (2100) 9/24/2017 at 2100

Indications: Why prescribed for your patient (assessment data)?

Management of hypertension. Management Patient has history of Aortic Root Dilation and Mitral Valve Prolapse. Slowing of the heart rate
of angina pectoris. Prevention of MI. (like Beta Blockers work) will help prevent these problems.

Key Nursing Considerations:

Monitor BP, ECG, and pulse frequently during dosage adjustment period and periodically throughout therapy. Monitor intake and output ratios
and daily weights. Watch out for orthostatic hypotension.

Name (generic): Classification: Route: Dosage Range for Route:

Morphine Opioid Analgesic IVP Usual starting dose for moderate to
severe pain in opioid-naive patients—
0.05– 0.2 mg/kg q 3– 4 hr, maximum:
15 mg/dose.
Pt. Ordered Dose: Frequency and administration times: Last date/time administered:
6 mg Q 6 hr—0900, 1500, 2100, 0300 09/25/17 @ 1500

Indications: Why prescribed for your patient (assessment data)?

Severe pain. Management of moderate to
severe chronic pain in patients requiring use
of a continuous around-the-clock opioid
analgesic for an extended period of time.
Pulmonary edema. Pain associated with MI.
Patient experienced extreme 10/10 pain in his neck after Right Laparoscopic Ear Puncture for
Parotid Gland Abscess. Morphine will help combat this pain and will additionally help with the
patient’s anxiety.

Key Nursing Considerations:

Children are more sensitive to the effects of opioid analgesics and may experience respiratory complications, excitability and restlessness more
frequently. Monitor pain and assess bowels frequently.

©Adapted from 2013, Linda Caputi, Inc. www.LindaCaputi.com

Name (generic): Classification: Route: Dosage Range for Route:
Ondansetron Antiemetic IVP 16 mg 1 hr before induction
anesthesia or after
procedure
Pt. Ordered Dose: Frequency and administration times: Last date/time administered:
4 mg/2mL = 8 mg Q 8 hr Q 8 hr—0900, 1700, 0100 9/25/17 @ 0900

Indications: Why prescribed for your patient (assessment data)?

Prevention of nausea and vomiting Patient went under general anesthesia for right laparoscopic ear puncture for parotid gland
associated with highly or moderately abscess. To prevent postoperative nausea and vomiting, this medication was given to the patient.
emetogenic chemotherapy. Prevention of
nausea and vomiting associated with
radiation therapy. Prevention and treatment
of postoperative nausea and vomiting.
Key Nursing Considerations:
Give over 2-5 minutes. Assess patient for extrapyramidal effects (involuntary movements, facial grimacing, rigidity, shuffling walk, trembling
of hands) during therapy. Monitor ECG in patients with hypokalemia, hypomagnesemia, HF, bradyarrhythmias, or patients taking concomitant
medications that prolong the QT interval.

PRN Medications:

Name (generic): Acetaminophen Classification: Route: PO Dosage Range for Route:

Therapeutic: antipyretic, nonopiod 325mg-650mg q 6hr or 1g 3-
analgesics 4 times daily or 1300mg q
8hr
Pt. Ordered Dose: Frequency and administration Last date/time administered:
325mg / 2 tab times: N/A
q 6 hr PRN pain / fever
Indications: Treatment of mild pain and Why prescribed for your patient (assessment data)? It is prescribed as needed for this patient for
fever pain, which my patient may be having in his neck from his post-op recovery.
Key Nursing Considerations: It will be important to assess my patient’s pain level before and after medication administration. It will also be
important to assess for a fever as well and any other adverse reactions.
Adverse Reactions/Side Effects: Agitation, anxiety, fatigue, nausea, vomiting, dyspnea, and hypokalemia

©Adapted from 2013, Linda Caputi, Inc. www.LindaCaputi.com

Name (generic): Classification: Route: Dosage Range for Route:
Toradol Non-steroidal anti-inflammatory, non- IVP Single dose—0.4– 1 mg/kg
opioid analgesic (maximum: 15 mg/
dose).Multiple dosing—0.5
mg/kg q 6 hr.
Pt. Ordered Dose: Frequency and administration times: Last date/time administered:
0.4 mg/kg = 15 mg Q 6 hrs-- 0900, 1500, 2100, 0300 09/25/17 0900
Indications: Why prescribed for your patient (assessment data)?
Short-term pain (less than 5 days) Patient experienced extreme breakout neck pain after surgery, described as 10/10. Patient needed
pain medication stronger than Tylenol.
Key Nursing Considerations:
Assess for rash, may cause delayed hypersensitivity reaction. Administer undiluted. Frequently monitor pain levels. May increase BUN/Creat
levels.

Name (generic): Classification: Route: Dosage Range for Route:

Heparin Therapeutic: anticoagulants IVP Intermittent bolus—50– 100
units/kg, followed by 50– 100
units/kg q 4 hr.

Pt. Ordered Dose: Frequency and Last date/time administered:

55 units/kg = 5000 units administration times: N/A
Q 4 hours—0900, 1300,
1700 2100, 0100, 0500
Indications: Why prescribed for your patient (assessment data)?
Prophylaxis and treatment of: Venous thrombosis, Patient is on heparin PRN in order to prevent any clots for occurring. If any signs
Pulmonary embolism, and Atrial fibrillation with of DVT/clots are suspicious, this medication should be administered to thin his
embolization. Management of myocardial infarction: blood and make sure no clots occur. This is especially important because my
Decreases risk of death, Decreases risk of subsequent MI, patient is post-op and is bedridden.
Decreases risk of future thromboembolic events. Prevention
of thrombus formation and embolization after prosthetic
valve placement.
Key Nursing Considerations:
 Assess for signs of bleeding and hemorrhage (bleeding gums; nosebleed; unusual bruising; tarry, black stools; hematuria; fall in
hematocrit or BP; guaiac-positive stools, urine, or nasogastric aspirate)..
 Instruct patient not to drink alcohol or take other Rx, OTC, or herbal products, especially those containing aspirin or NSAIDs, or to start
or stop any new medications during heparin therapy without advice of health care professional.
©Adapted from 2013, Linda Caputi, Inc. www.LindaCaputi.com
  Because of the large number of medications capable of significantly altering heparin’s effects, careful monitoring is recommended when
new agents are started or other agents are discontinued.
Nursing Diagnosis #1
Acute Pain r/t right posterior laparoscopic
puncture for parotid abscess from suppurative
parotisis as evidenced by 10/10 neck pain,
lack of appetite, and neck guarding
Interrelated Concepts
Gas Exchange, Infection, Perfusion,
Inflammation, Fluids/Electrolytes
Desired Outcome (Goal)
Short term: Patient will state post procedural
pain is a 4 out of 10 or less on a 0 to 10 scale
by 1200 on 9/25/17.
Long term: Patient will not experience
breakout pain (pain > 8 out of 10) and will be
able to ambulate by himself by 1500 on
9/26/17.
Interventions
1. Manage D.R.’s acute pain using a
multimodal approach. (using both Toradol
and Tylenol) (ONLY RN)
2. Administer analgesics around-the-clock
for continuous pain (expected to be
present approximately 50% of the day,
such as postoperative pain) and PRN (as
needed) for intermittent or breakthrough
pain. (ONLY RN)
3. Support D.R.’s nonpharmacological
methods to supplement pharmacological
analgesic approaches to help control pain,
such as playing his favorite music, simple
©Adapted from 2013, Linda Caputi, Inc. www.LindaCaputi.com
Nursing Diagnosis #2
Decreased cardiac output r/t aortic root dilation
and mitral valve prolapse as evidenced by diastolic
heart murmur, decreased CVP, and slightly low
blood pressure
Interrelated Concepts
Perfusion, Infection, Acid/Base balance, Gas
Exchange, Fatigue
Desired Outcome (Goal
Short term: Patient will demonstrate adequate
cardiac output as evidenced by blood pressure,
pulse rate and rhythm and skin color within
normal parameters for client by the end of my shift
at 1500 on 9/25/17.
Long term: Patient will be able to ambulate
without dyspnea or chest pain by 9/26/17 at 1500.
Interventions
1. Check blood pressure, pulse, and condition
before administering D.R.’s cardiac
medication (beta-blocker). Notify health
care provider if heart rate or blood pressure
is low before holding medication. (ONLY
RN)
2. Monitor pulse oximetry (especially when
D.R. ambulates) and administer oxygen as
needed per health care provider's order.
(RN and UAP)
3. Gradually increase activity when D.R.’s
condition is stabilized by encouraging
slower paced activities, or shorter periods
Nursing Diagnosis #3
Risk for Falls r/t muscle dysfunction, lower
limb weakness, and gait abnormality from
advanced Marfan Syndrome as well as
increased risk for orthostatic hypotension
from beta blockers
Interrelated Concepts
Safety, Perfusion, Gas Exchange, Mobility,
Pain, Fatigue
Desired Outcome (Goal)
Short term: Patient will verbalize and explain
methods to prevent injury and promote a safe
environment by 1000 on 9/25/17.
Long term: Patient will remain free from
injury and demonstrate behaviors that
decrease the risk for injury by 9/26/17
Interventions
1. Review drug profile for potential side
effects and interactions that may
increase risk of injury, such as the
D.R.’s beta blocker. This can cause
orthostatic hypotension, cause the
patient to get dizzy and fall. (RN)
2. Involve family (especially mom) in
helping to provide a culture of safety.
(RN, UAP, FAMILY)
3. Provide a safe environment
--Use one fourth– to one half–length side
rails only, and maintain bed in a low
position. Ensure that wheels are locked
 massage by mom, relaxation, and
application of heat. (RN, UAP, FAMILY)
4. Assess D.R. at regular intervals and
include frequent assessment of pain level,
assessment of respiratory status (including
rate, rhythm, noisiness, depth), and
systematic assessment of sedation level
using a sedation scale. Especially since
D.R. is a child, respiratory depression is
more common with opiod pain
medications and should be monitored
frequently. (ONLY RN)
Rationale – Citation/EBP
1. A multimodal approach (combining two
or more drugs that act by different
mechanisms for providing analgesia)
enhances pain relief and allows the lowest
effective dose of each drug to be
administered, resulting in fewer or less
severe side effects, such as nausea,
sedation, and respiratory depression.
2. If pain is present most of the day, the use
of PRN medications alone will lead to
periods of undermedication and poor pain
control and periods of excessive
medication and adverse effects (Pasero,
2010).
3. Although more evidence is needed to
conclude effectiveness,
nonpharmacological methods (which are
low cost and low risk) can be used to
complement pharmacological treatment of
pain (Gelinas & Arbour, 2009;
Ignatavicius, 2013).4
4. Opioid induced respiratory depression
occurs with the greatest frequency in
postoperative clients during the first 24
hours after surgery, and factors
contributing to postoperative respiratory
©Adapted from 2013, Linda Caputi, Inc. www.LindaCaputi.com
of activity, with frequent rest periods
following exercise prescription; observe
for symptoms of intolerance. (RN, RT)
4. Observe D.R.’s cardiac monitor for
hemodynamically significant arrhythmias,
ST depressions or elevations, T-wave
inversions and/or q-waves as new signs of
ischemia or injury. Report abnormal
findings. (ONLY RN)
Rationale – Citation/EBP
1. It is important that the nurse evaluate how
well the client is tolerating current
medications before administering cardiac
medications; do not hold medications
without health care provider input. The
health care provider may decide to have
medications administered even though the
blood pressure or pulse rate has lowered.
2. Supplemental oxygen increases oxygen
availability to the myocardium and can
relieve symptoms of hypoxemia. Resting
hypoxia or oxygen desaturation may
indicate fluid overload or concurrent
pulmonary disease.
3. Exercise-based cardiac rehabilitation is
effective in reducing total and
cardiovascular mortality and hospital
admissions (Heran et al, 2011).
4. Arrhythmias and electrocardiogram (ECG)
changes indicate myocardial ischemia,
injury, and/or infarction. Note that left
ventricular hypertrophy, ventricular pacing,
and bundle branch blocks can mask signs
of ischemia or injury (Amsterdam et al,
2014).
on bed and commode. Keep dim light
in room at night.
-- Remove all possible hazards in
environment such as medications, room
clutter, and wet floors.
--Place at risk for injury client in a room
that is near the nurse's station. (RN,
UAP, FAMILY)
4. Refer D.R. for physical therapy for
strengthening as needed; evaluate use
of his leg braces. (ONLY RN)
Rationale – Citation/EBP
1. The use of polypharmacy is the sole
most significant factor in risk injury.
A mix of medications can cause a
reduction in physical function, raise
the risk of falls, and cause delirium
and other geriatric syndromes, and is a
known factor in hospital admissions
and death (Scott et al, 2014).
2. A client-centered approach to care
should include the family, in both
planning and decision-making
(Wrobleski et al, 2014).
3. According to Wang et al (2014), when
clients' safety culture is improved,
there is a decrease in client adverse
events. A client-centered environment
of care is not just the care provided at
the client's side. It is seen throughout
the facility.
4. Exercise training supervised by a
physiotherapist was found to have
positive outcomes on physical
function and quality of life, and to
reduce incidence of falls (Kwok &
Tong, 2014).
 depression include the intervention of
multiple prescribers (33%), concurrent
administration of nonopioid sedating
medications (34%), and inadequate
nursing assessments or response (31%)
(ASA, 2012; Jarzyna et al, 2011; Lee et al,
2015).
Evaluation (Goal Met, Not Met, Partially Met) Evaluation Evaluation
– Re-evaluation?
Patient’s short-term goal was met. After Patient’s short-term goal was met. By 1000
Patient’s short-term goal of having a pain administering pain medications, patients HR, BP, on 9/25/2017, patient was able to verbalize
score of less than or equal to 4 was met. At and pain levels returned to normal. Additionally, how to maintain a safe environment. He
1200, pt. stated pain was a 3 out of 10. When patient’s skin color was no longer pale and now is stated he would dangle his feet on the side of
combining toradol with acetaminophen, using appropriate for ethnicity. Patient’s long-term goal the bed before getting up. Mom stated she
non-pharmacologic methods such as the heat was partially met as patient was discharged home would help keep the room clutter free and
packs, music, and massage, patient’s pain on 9/26. However, he experienced some dyspnea watch him closely when he ambulates. Both
became controlled. Patient’s long-term goal on exertion so we took our time and slowly walked mom and patient were receptive to the idea of
was additionally met. Patient was actually downstairs. Upon discharge, the nurse and I went having a full time physical therapist and were
discharged home on 9/26/17 at 1100, so over some exercises D.R. could do in order to help willing to explore the possibility of other
therefore he was able to manage his pain. I improve his activity level without having dyspnea. mobility aids. Patient’s long-term goal of
walked with the patient out to the car with his remaining accident-free was additionally met.
mom. By the time the patient was discharged, the
patient was ambulating at his own pace,
utilizing his leg braces, and stopping when he
felt tired.

References:

 Ackley, Betty J., MSN, EdS, RN, Gail Ladwig, MSN, RN and Mary Beth Makic, RN, PhD, CNS, CCNS. (2017). Nursing Diagnosis Handbook: An
Evidence-Based Guide to Planning Care, 11th Edition. Mosby, 032016. VitalBook file.

 Giddens, Jean F. (2017). Concepts for Nursing Practice (with Pageburst Digital Book Access on VST), 2nd Edition. Mosby, 022016. VitalBook file.

 Potter, Patricia A., RN, MSN, PhD, FAAN, Anne Perry, RN, EdD, FAAN, Patricia Stockert, RN, BS. (2017). Fundamentals of Nursing, 9th Edition.
Mosby, 022016. VitalBook file.

 Vallerand, A. H., Deglin, J. H., & Sanoski, C. A. (2017). Davis’s Drug Guide for Nurses Fifteenth Edition. Philadelphia: F. A. Davis Company

©Adapted from 2013, Linda Caputi, Inc. www.LindaCaputi.com