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Careplan

Self-Care Deficit, Pediatric

Oct.01.2020

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 Activity and 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.
  • Implement appropriate environmental modifications, such as reducing auditory and visual stimulation or adaptive seating for bathing.
  • Encourage active participation and independence in daily activity; provide level of assistance required for safety.
  • 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

  • (2018). Butcher, H. K.; Bulecheck, G. M.; Dochterman, J. M.; Wagner, C. M. (Eds.), Nursing interventions classifications (NIC). St. Louis: 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]
  • Gronski, M.; Doherty, M . Interventions within the scope of Occupational Therapy practice to improve activities of daily living, rest, and sleep for children ages 0–5 Years and their families: A systematic review. 2020;74(2), 10-33. doi:10.5014/ajot.2020.039545 [Systematic Review]
  • Haugen, N.; Galura, S. (2020). Ulrich and Canale's Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. St. Louis: Saunders, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019). Wong's nursing care of infants and children. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Palisano, R. J.; Orlin, M. N.; Schreiber, J. (2017). Campbell's physical therapy for children. St. Louis: Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • Registered Nurses' Association of Ontario. (2015). Person- and family-centred care. Source[Quality Measures,Clinical Practice Guidelines]
  • Swearingen, P. L.; Wright, J. (2019). All-in-One Nursing Care Planning Resource-E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health. Philadelphia: Elsevier Health Sciences. [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.

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