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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