Pediatric Grand Rounds Presentation Intro Page

Pediatric Nursing Grand Rounds Presentation NUR 421- Clinical Management of Infants and Children Purpose of Assignment To provide the student an opportunity to integrate knowledge from the sciences, developmental theory and physical assessment data to the care of a pediatric client and family in the acute care setting. The student will utilize critical thinking and independent judgments in presenting a holistic plan of care in a formal oral presentation. Student Approach to Assignment The patient chosen for this oral presentation was a 3-year-old boy diagnosed with Midgut Volvulus and Short Bowel Syndrome. The patient was initially admitted to the hospital after complaining of stomach pains and experiencing frequent emesis episodes. However after his admission, a physical assessment determined the patient had symptoms of a Midgut Volvulus. The patient was immediately taken to surgery where he received a bowel resection and an ileostomy. However, the patient remained hospitalized for four months due to several complications. The patient underwent numerous surgeries including an appendectomy, and a bowel resection. As a result of the multiple surgeries, the patient was diagnosed with Short Bowel Syndrome. The patient continued to remain hospitalized due to complications associated with reoccurring Midgut Volvulus. Reason for Inclusion of this Assignment in Portfolio This assignment is included in the portfolio because it highlights the care I gave to a pediatric patient in a pediatric setting at the Children’s Hospital of King’s Daughter in Norfolk, VA. This assignment demonstrates my capability to thoroughly develop a plan of care for a pediatric patient. This assignment illustrates my capability to conduct a thorough physical assessment, formulate nursing diagnoses, as well as focus on the psychological aspects of my patient.  Critical Thinking  Uses nursing and other appropriate theories and models to guide professional practice.  Example: In this oral presentation, I included Erikson’s Initiative vs. Guilt developmental stage theory. The theory states a child will begin to take initiatives to exert control over his or her environment through play, such as make up games, or other activities. This theory helped develop a plan of care that included a form of play when implementing certain nursing tasks for my patient. Before performing any interventions, I made sure to introduce the medical equipment in

an interactive way. For example, during my physical assessments, I let the patient play with my stethoscope listening to his heart and lung sounds before I auscultated them.  Nursing Practice  Demonstrates an awareness of complementary modalities and their usefulness in promoting health.  This oral presentation included the complementary and alternative medical intervention of Child Life activities, such as direct play. The patient’s age categorized him in the developmental stage of Initiative Vs. Guilt. This stage focuses on the child’s ability to take control over their environment though play. However since my patient had been hospitalized for four months, it was important to incorporate a time where the patient was able to express his feelings, and explore his surroundings. Because the patient was in a stable condition during my clinical time, I engaged in various child life activities with the patient, including visiting the play room, and engaging on a nature’s walk.  Establishes and/or utilizes outcome measures to evaluate the effectiveness of care  This oral presentation included nursing diagnoses accompanied by measurable outcome measures to evaluate the effectiveness of the provided care. For example: I found the patient to have a primary nursing diagnosis of a risk for infection related to multiple broken skin barriers. The patient had a PICC line in his left Basilic vein, a gastrostomy tube in his left upper quadrant, and ileostomy in his right lower quadrant, and he had a past medical history of Methicillin-resistant Staphylococcus aureus (MRSA). Based upon his primary nursing diagnosis, I established the expected outcome that the patient would remain free from any signs of infection, as evidenced by a temperature less than 37.4 degrees Celsius, a lack of redness or purulent discharge from the stoma site or his PICC area, and vitals signs within the normal ranges, including respirations between 22-34 and a heart rate between 80-120 bpm. Throughout the time of my care, the patient was able to meet these outcome measures, ensuring the effectiveness of his planned care.

 Communication  Adapts communication methods to patients with special needs.  This oral presentation demonstrated my ability to accommodate communication methods in regards to my patient’s age and developmental stage. I considered his age of 3 years and his developmental stage of

Initiative Vs. Guilt when communicating with the patient, or preparing to provide a nursing intervention. For example: I used the method of play to introduce medical equipment to the patient. By doing so, I was able to establish a sense of rapport with the patient in a non-verbal way.  Expresses oneself and communicates effectively with diverse groups and disciplines using a variety of media in a variety of contexts.  This oral presentation of my patient’s case was presented to my classmates and clinical instructor. I used a PowerPoint presentation, and a visual board to help explain Midgut Volvulus, Short Bowel Syndrome, and his nursing diagnoses.  Teaching  Provides teaching to patients and/or professional about health care procedures and technologies in preparation for and following nursing or medical interventions.  During this oral presentation, I addressed the teaching that was implemented with the mother. Because the patient is very young, most of the teaching regarding his care is directed towards his mother. During the patient’s hospilization, the mother would participate in suctioning and changing his ileostomy bag. It was during these times, that I noticed the mother would not perform proper hand hygiene, including washing her hands prior or donning gloves during this intervention. I provided teaching on how a clean technique is needed when manipulating gastrostomy tubes since the patient is at a higher risk for infection. The mother was very receptive of the teaching, and started performing adequate hand hygiene before performing the procedure.  Research  Applies research-based knowledge from nursing as the basis for culturally sensitive practice.  In this oral presentation, I included a research article that discussed the complications associated with gastrostomy tubes in children. The research article was a descriptive study that investigated the main complications with gastrostomy tubes. The study found that 35 out of the 94 patients studied had infections, and the 64 out of the 94 had granulation tissue. The study also revealed that the major complications were leakage from the stoma, infected fistula, and reoccurring granulation tissue. I used this information in my nursing care during each of my physical assessments. I made it a priority to frequently assess the stoma site for any sign of leakage or infection.

 Shares research findings with colleagues  The findings of this research study were shared with my nursing peers and my nursing instructor during the presentation of my grand rounds on this particular patient.  Culture  Articulates an understanding of how human behavior is affected by culture, race, religion, gender, lifestyle, and age.  During this presentation, I presented information about my patient, a 3year-old boy diagnosed with both Midgut Volvulus and Short Bowel Syndrome. The patient had been hospitalized at the Children’s Hospital of King’s Daughter in Norfolk, VA for four months due to complications. His long period of continued hospitalization affected the normal behavior that should be illustrated at his specific age. According to Erikson’s developmental theory, the patient should be in the Initiative vs. Guilt stage that consists of the individual exploring and taking control of his surroundings. However, because of the patient’s lifestyle of being hospitalized and requiring frequent surgical procedures, the patient was unable to explore his surroundings and take control of his environment.