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Careplan

Self-Care Deficit, Pediatric

Jul.10.2018

Self-Care Deficit (Pediatric Inpatient)

Clinical Description

  • Care of the hospitalized child experiencing limitations in the safe and independent performance of activities of daily living.

Key Information

  • It is important to consider the child’s and family’s cultural norms, along with individual priorities and preferences when promoting self-care performance.
  • Early rehabilitation and care aimed at increasing self-care abilities are important to help prevent loss of independence and associated negative health outcomes.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Improved Ability to Complete Activities of Daily Living

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: Overview
  • Education: Self Management
  • Education: When to Seek Medical Attention

Correlate Health Status

  • Correlate health status to:

    • history, comorbidity, congenital anomaly
    • age, developmental level
    • sex, gender identity
    • baseline assessment data
    • physiologic status
    • response to medication and interventions
    • psychosocial status, social determinants of health
    • barriers to accessing care and services
    • child and family/caregiver:
      • health literacy
      • cultural and spiritual preferences
    • safety risks
    • family interaction
    • plan for transition of care

Self-Care Deficit

Signs/Symptoms/Presentation

  • ability to perform developmentally-appropriate functional activity impaired
  • active movement limitation
  • bathing ability limited
  • dressing ability limited
  • grooming ability limited
  • inability to complete BADLs (basic activities of daily living)
  • inability to complete IADLs (instrumental activities of daily living)
  • limited endurance
  • muscle weakness
  • pain limits activity
  • reluctance to perform self-care
  • requires assistance with self-care
  • requires prompting to perform self-care
  • self-feeding ability limited
  • shortness of breath
  • toileting ability limited

Problem Intervention

Promote Functional Independence

  • Evaluate ability to perform and complete age-appropriate BADLs (basic activities of daily living) and IADLs (instrumental activities of daily living) safely and independently.
  • Identify patient’s preferences for clothing, food and personal care items; offer and honor patient choice when possible.
  • Provide therapeutic interventions, such as modifications or adaptations to personal care tasks or routines; individualize interventions to developmental need.
  • Encourage active participation and independence in daily activity; provide level of assistance required for safety.
  • Implement appropriate environmental modifications, such as reducing auditory and visual stimulation or adaptive seating for bathing.
  • Promote use of recommended adaptive equipment, devices and orthoses.
  • Maintain child or parent/caregiver’s preferred routines and habits; respect privacy and personal space.
  • Schedule self-care activities when pain and fatigue are at a minimum to encourage optimal performance.
  • Pace activity; allow adequate time and rest periods to conserve energy.
  • Provide frequent encouragement, along with prompting and assistance as needed.
  • Provide set-up of items if patient is unable to retrieve; store personal care items in accessible location.
  • Individualize instructions and prompts to patient’s cognitive status to promote effective communication; simplify verbal directions, give encouragement and provide demonstrated cues as needed.
  • Position the patient for optimal performance, such as sitting in a chair for meals or performing hygiene at sink.

Associated Documentation

  • Activity Assistance Provided
  • Adaptive Equipment Use
  • Self-Care Promotion

Education

CPG-Specific Education Topics

Overview

  • risk factors

  • signs/symptoms

Self Management

  • self-care

When to Seek Medical Attention

  • unresolved/worsening symptoms

General Education Topics

General Education

  • admission, transition of care

  • orientation to care setting, routine

  • advance care planning

  • diagnostic tests/procedures

  • diet modification

  • opioid medication management

  • oral health

  • medication management

  • pain assessment process

  • safe medication disposal

  • tobacco use, smoke exposure

  • treatment plan

Safety Education

  • call light use

  • equipment/home supplies

  • fall prevention

  • harm prevention

  • infection prevention

  • MDRO (multidrug-resistant organism) care

  • personal health information

  • resources for support

References

  • Boyt Schell, B. A.; Gillen, G.; Scaffa, M. E. (2014). Willard & Spackman's occupational therapy. Baltimore: Lippincott Williams & Wilkins. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Bulechek, G. M.; Butcher, H. K.; McCloskey-Dochterman, J. M.; Wagner, C. (2013). Nursing Interventions Classification (NIC). St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Campbell, S. K.; Palisano, R. J.; Orlin, M. N. (2012). Physical therapy for children. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Case-Smith, J.; O'Brien, J. C. (2015). Occupational therapy for children and adolescents. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Hoeman, S. P. (2008). Rehabilitation nursing prevention, intervention, and outcomes. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Kreider, C. M.; Bendixen, R. M.; Huang, Y. Y.; Lim, Y. Review of occupational therapy intervention research in the practice area of children and youth 2009-2013. American Journal of Occupational Therapy. 2014;68(2), e61-e73. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • National Guideline Clearinghouse (NGC). (2015, May). Guideline summary: Person- and family-centred care. (Summary of a guideline by the Registered Nurses’ Association of Ontario) In: National Guideline Clearinghouse (NGC) [Web site]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ). [Quality Measures,Clinical Practice Guidelines]
  • Polatajko, H. J.; Cantin, N. Exploring the effectiveness of occupational therapy interventions, other than the sensory integration approach, with children and adolescents experiencing difficulty processing and integrating sensory information. American Journal of Occupational Therapy. 2010;64(3), 415-429. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Rahman, T.; Basante, J.; Alexander, M. Robotics, assistive technology, and occupational therapy management to improve upper limb function in pediatric neuromuscular diseases. Physical Medicine and Rehabilitation Clinics of North America. 2012;23(3), 701-717. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]

Disclaimer

Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.