Pediatric Nursing Care Plan

Priority Nursing Diagnosis__Activity Intolerence R/T Chronic Lung disorder, AEB pt tires easily.
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Goal___The pt will tolerate activity
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Outcome Criteria

Interventions

Scientific Rationale

Evaluation

1- The pt will demonstrate 3

energy saving techniques by
discharge.

1- Teach- teach pt to pace ADLs

throughout the day, QS.

1- Completing ADLs such

as bathing, brushing teeth,
getting dressed/undressed,
and making the bed can all
be tiring to the pt with CF.
By spreading out the tasks,
they learn to conserve
energy.

1- Met- Pt able to demonstrate 3

energy saving techniques.

1- Teach- teach pt to eat more

frequent meals in smaller portions
QS.

1- Teach- encourage pt to
ambulate short distances, multiple
times a shift.

1- Eating a large meal in

one sitting is great for
calorie consumption, but
usually will cause fatigue to
a pt with CF. by eating
more frequently, and in
small portions, the pt is
able to conserve energy.
1- Ambulation is crucial to
the CF pt for many reasons.
It helps mobilize
secretions, prevent
constipation, and increases

Outcome Criteria

Interventions

stamina. Ambulating long

.
Scientific Rationale

Evaluation

distances may increase

fatigue, therefore by
ambulating short distances
frequently, it is more well
tolerated.
1- Teach- encourage pt to take
frequent small naps QS.

1- Teach- encourage family

members to participate in care QD.

2- Pt will report no activity

intolerance Q day.

2- Assess- assess pt frequently for

activity intolerance QS.

2- Monitor- monitor pt for s/s SOB

QS.

1- Sleep is an essential part

of battling fatigue and
activity intolerance. Many
CF pts do not sleep well at
night due to coughing.
Small frequent naps, helps
to recharge the bodys
energy stores.
1- In times of exacerbation
of the pts CF, they may
need assistance with cares
to conserve energy. By
teaching and encouraging
family members to
participate in care, it helps
the pt conserve vital
energy and also promotes
bonding.
2- A pt, especially a
pediatric pt will not always
report feelings of activity
intolerance. It is important
for the nurse to assess the
pt frequently so

2- Partially Met- pt reports times of

activity intolerance some days.

interventions can be taken

promptly.

2- Monitor- monitor oxygen

saturation Q4hr and prn.

2- Medication- Give Orkambi (2)

200/125mg tabs PO BID

2- Independent- do not plan

activities after administration of
chest pt.

2- Signs of SOB in children,

such as retractions, nasal
flaring, tachypnea , and
stridor are all indicators
that the pt needs to take a
break from their current
activity and rest. And
further intervention may be
needed.
2- Oxygenation saturation
should remain above or
equal to 90% during
activity. If the saturation
drops, the pt will not feel
well, and will have
increased WOB and tire
easily.
2- Orkambi is a new drug
for CF that targets the
gene responsible for CF. It
helps increase the forced
expiratory volume in 1 sec.

3- Pt will not have altered

sleep during hospitalization.
3- Monitor- monitor pts sleep
quantity and quality QS.

2- Chest pt is necessary for

CF pts BID. It is often
accompanied by many
breathing treatments and
can be very tiring. Resting
for a time after the

3- Met- Pt had no sleep

disturbances.

treatment will help the pt

to regain some strength
and energy before doing
activities.
3- Monitor- apply apnea monitor
continuously @HS.

3- Teach- teach a sleep inducing

bedtime routine QHS.

3- Collaboration- try to schedule

meds/treatments around sleep
schedule Qd.

3- Independent- encourage family

members to spend the night if
possible QD.
4- Pt will be able to tolerate
progressive activities QD.
4- Assess- assess the pts ability to

3- Sleep quantity as well as

sleep quality is very
important. A 13 yo child
needs approx 8.5- 9.5
hours of sleep a night. Cf
kids also need naps inbetween. REM sleep is the
key to quality sleep.
3- An apnea monitor will
keep continuous track of
the pts O2 levels during
sleep as well as heart rate.
Low O2 sats or periods of
apnea can disrupt the
quality of sleep leaving the
pt tired upon waking.
3- Many pts c/o being
unable to fall asleep. Many
things such as a warm
beverage, decreasing
sugar, and turning off
electronics, as well as
turning the lights down low
all can help induce sleep.

4- Partially Met- pt tolerated most

activities with some fatigue noted.

tolerate progression of activities

QD.

4- Independent- encourage pt to
increase time out of bed QD.

4- Collaboration- collaborate with

PT to slowly increase PT exercises
QD.

4- Monitor- monitor pt for

tachycardia, tachypnea and WOB
QS.

5- Pt will be motivated to
participate in activities QD.

4- Independent- Keep room

temperature at or below 72F QS.

5- Assess- assess the pts likes and

3- Medications such as PO
meds, nebulizers, and
puffers all require the pt to
be woken up. IV therapies
can usually be
administered without
waking the pt.
3- Having a family member
in the room while they are
asleep gives the child a
sense of security
increasing the ability to
sleep.
4- Increasing physical
activities increases the
demand on the body. Close
monitoring of the pts
response provide
guidelines for optimal
activity performance.
.
4- Increasing the time
spent out of bed slowly and
progressively helps build
up tolerance at a rate the
child can adapt to.
4- The Physical Therapist
can adjust the therapy
goals and requirements
slowly to help achieve a
maximum level of activity

5- Met- Pt had motivation and would

ask to do more activities.

dislikes R/T activities QD.

5- Independent- Assess the pts

level of child development QD.

that the pt may tolerate.

4- Any change in baseline
vitals can be an indicator
that the pt is straining
themselves and is not
tolerating the activity.
Increased WOB will tire the
pt out quickly and may
indicate the need for
intervention.

5- Independent- encourage
visitors and family to play with the
child QD.

4- CF pts get warm easily

and will perspire more,
causing an excess loss of
sodium, and causing
hyponatremic dehydration.

5- Independent- offer frequent

rest periods QS.

5- Every pt enjoys different

activities. By discovering
what they enjoy and
dislike, you can create a
more individualized plan of
activities which will
promote participation.

5- Collaboration- collaborate with

activities staff, volunteers, and

5- Knowing what stage the

child is in developmentally
will help assist the nurse in
incorporating age
appropriate toys, games
and activities. If the
activities are too babyish or

child life specialist QD.

too advanced, the child will

not have an interest in
participating.
5- The child is much more
apt to be willing to
participate in activities with
friends, or family members.
This also gives them a
more home like
environment motivating
them to participate, and
taking their mind off the
fact they are being active.
Children with CF tire easily
and may have a hard time
recovering. By offering
frequent rest periods, it
keeps the activities fun and
not too exhausting.

5- Activities staff have a

variety of age appropriate
activities including group
activities for patients.
Volunteers are able to
come and play with the
child if no visitors are
present and if staff is busy.
And the child life specialist
is also a great resource for
the pt and can help

collaborate with all staff to

make the hospital stay
pleasant and fun. Fun is a
great motivator!