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Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Day of care: 7/28/2017 Student Name: Jeanine Diaz Clinical site: LVH CC Pediatric Unit Pt initials: J.D.
Day of hospitalization: Day 1 Age: 11 Allergies: NKA

Admitting medical diagnosis and brief explanation of pathophys: Osteomyelitits of right radius. Osteomyelitits is an infection of the bone or
joint most commonly caused by direct infection of pyogenic bacteria and mycobacteria such as Staphylococcus aureus or Staphylococcus
epidermidis into an open fracture, or from joint replacement surgery. Osteomyelititis can result in local bone destruction, necrosis and opposition of
new bone (Birt, Anderson, Toby & Wang, 2017).

Additional diagnosis: None

Pertinent past medical/surgical history: None

Likes/Dislikes/Comfort measures: (Ask nurse or patient/family) Patient prefers elevating wrist above head and applying ice for comfort. Patient
also preferred Motrin for pain until it was discontinued.

Current treatment/Complementary health practices:

Current treatment includes Clindamycin (cleocin) 408mg IV q 8 hrs for infection. Patient was prescribed Ibuprofen (400mg) or acetaminophen
(500mg) PRN for pain, however orders were updated to morphine 7.5mg IV q 6 hrs PRN for pain to not mask any fevers. Additionally, ice and
elevation are being used for comfort measures. Other orders include strict observation of temperature and output, as well as an orthopedic consult.
Nursing Assessments Related to Diagnosis and Treatments (IV, dressings & wounds care, feeding tubes, etc.)
Tubes, lines, drains or treatments: Purpose Nursing assessment/documentation
Peripheral IV line- single lumen. Left 22 IV is in place for administration of IV site is free from any redness, swelling,
gauge median cubital vein (antecubital fossa). antibiotics, pain medication and possible irritation or pain as evaluated q 1 hr of shift.
Saline locked. need of fluids.

Lab and diagnostic data (normal that pertain to Dx and/or abnormal findings
Test/value or result Why was it ordered? If abnormal—potential How is abnormal being Additional space here if
reason treated? needed
Blood cultures Routine diagnostics with Still waiting on results
osteomyelitis/ Rule out or
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

confirm hematogenous
osteomyelitis (Fritz &
McDonald, 2008).
ESR/ 38.6 To see if elevated as Inflammatory response Antibiotics
consistent with diagnosis from infection
of osteomyelitis
CRP/ 52 To see if elevated as Inflammatory response Antibiotics
consistent with diagnosis from infection
of osteomyelitis
CBC w/ diff. MPV 7.2 (L) Elevated WBC is Infection/ inflammatory Antibiotics
Absolute monocyte consistent with diagnosis response
0.8(H) of osteomyelitis or any
Neutrophils 72 (H) infection.
Lymphocytes 17 (H)
Monocytes 10 (H)
MRI/ shows contusion of Shows any possible injury Possible injury to bone Antibiotics, pain
distal radial metaphysis, or abnormality to bone site where infection is medication, ice and
soft tissue edema and no site. present. elevation.
definitive fracture line.
X-Ray/ suspicion of Shows any possible injury Possible injury to bone Antibiotics, pain
abnormal patchy lucency or abnormality to bone site where infection is medication, ice, and
in the volar radial site. present. elevation.
metaphysis. No other
well-defined linear
fracture line seen.
Lucency raising the
possibility of distal right
radial metaphyseal injury.



Temperature 97.3 oral 97.3 oral 97.1 oral 97.3 97-100
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

HR 69 (sleeping) 86 69 92 60-95
RR 16 17 16 20 12-18
Blood Pressure 86/49 (L arm) 99/60 (L arm) 84/39 99/60 100-120/60-75
Pain level 0/10 0/10 0 6 0
Pulse OX 99% room air 99% room air 0 99 95-100
Supplemental O2 none
IV sol, rate, site Saline lock, left antecubital
Diet Regular
Activity order As tolerated
Intake 240ml
Output 400 ml

ADDITIONAL INFO AS NEEDED: 1033 pain was at 4. Ibuprofen 400 mg was given PO. Pain re-assessed at 1130 and pain level was at a 0/10.
Physician switching orders to morphine to not mask any fevers.
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

SHOW YOUR MATH Calculated for patient Actual for patient

Weight 39.7 kg
_____87.34_ lbs ____39.7__ kg

INTAKE / OUTPUT 1500 Input: 240ml

24 Hour Fluid Requirement: 39.7-20 = 19.7 x 20 = 394 Input: 480ml
100ml x first 10kg 1500 + 394 = 1894 ml/ day Input: 3ml
50ml x next 10kg Input: 3ml
20ml x remainder of weight in kg
Shift Fluid Requirement: 631.2ml 1894 ml / 24 = 78.9ml/ hr Total for 8 hour shift: 726 ml
_ 8 hour 78.9 ml x 8 hrs = 631.2 ml

Hourly Fluid Requirement: 78.9 ml/hr ___No IV __x_Saline lock

1894ml / 24 = 78.9 ml/ hr
IV Fluid: ___________________
@ ___________________mL/hour
IV bag change due:_______
IV tubing change due: __________
Medication tubing change due: _7/31/2017___

24 Hour Output Requirement: 952.8- 39.7 x 1 = 39.7 ml/hr x 24 = 952.8ml/ 24hr Output per hour during 8 hour shift: 50ml/hr
1,905.6 ml/ 24hrs 39.7 x 2 = 79.4 ml/ hr x 24 = 1,905.6ml/24hr 400ml/8 = 50ml/hr x 24 = 1,200 if patient
1 – 2ml/kg/hour continues same output. Patient has not been
admitted to the hospital for 24hrs yet so this is
not an actual 24 hr total.
Shift Output Requirement: 317.6 -635.2 39.7ml x 8 = 317.6 ml/ 8hrs Output during 8 hour shift: 400ml/ 8hrs
ml/ 8hrs 79.4 x 8 = 635.2 ml/ 8hrs
_ 8 hour

Based on your calculations, was the patient’s intake and output adequate? Explain:
For each calculation the patient’s intake and output fell within the expected range, therefore the patient’s intake and output is adequate.
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

(Include PRN’s)
Patient Wt. _39.7_____ kg

Medication Nursing Ordered Recommende Wt Based Dosage Safe Why is patient Major side effects & nursing
+ Diagnosis Dosage d Dosage Calculation (mg/dose) Y/N receiving? implications
Classification number & Route (mg/kg/dose) SHOW MATH
Actual/#3 408mg 10mg/kg/dose 10 x 39.7 = 397mg/ dose Orde Infection of the Abdominal pain, Diarrhea,
Clindamycin IV red bone. Nausea/ possible
(cleocin) infused dose hypersensitivity reaction
Antibacterial over 10- is
60 min. sligh Instruct patient to report
Default tly diarrhea and to contact
time: abov physician before taking anti-
30min. e, diarrhea medication. Instruct
but patient to report any signs of
cons hypersensitivity reaction
idere including rash or trouble
d breathing.
#1 500mg 10- 10 x 39.7 = 397mg/dose Y Pain Pruritus, constipation, nausea,
PO/PRN 15mg/kg/dose 15 x 39.7 = 595.5mg/dose vomiting, steven-Johnson
Acetaminophen q 6 hrs syndrome, liver failure
antipipyretic Instruct patient not to take
more than 4000mg in a 24 hr
period and to take with full
glass of water. Also when
taking at home check labels of
other medications being taken
to assure they do not contain
acetaminophen as well.
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Ibuprofen #1 400mg 5- 5 x 39.7 = 198.5 mg/dose Y Pain/inflammat abdominal pain, constipation,

NSAID/analges PO/PRN 10mg/kg/dose 10 x 39.7 = 397mg/dose Rou ion diarrhea, dyspepsia, heartburn,
ic q 6 hrs nd nausea, vomiting, dizziness,
weig headache and hemorrhage
ht to
40kg Advise patient to report any
signs of bleeding, rash or signs
of hepatotoxicity. Teach to take
with food or glass of milk to
minimize GI irritation.
Morphine #1 7.5mg 200- 200/1000 = 0.2mg x 39.7 = Y Pain/ do not dizziness, anxiety, confusion,
analgesic PO/ PRN 500mcg/kg/do 7.94mg/dose Dr. want to mask nausea, vomiting, headache, or
q 6 hrs se 500/1000 = 0.5 x 39.7 = verb fever somnolence, constipation, slow
19.85mg/dose alize respirations, pruritis
want Closely monitor respirations
ed while on medication. Teach
on about constipation side effects
low and importance of high
dose fiber/adequate water intake and
ambulation/ activity as
tolerated to minimize.
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

No blanks or N/A for care map submission---use “unable to assess” or “not present” or “not utilized” for spaces as indicated

Neuman Systems Variables Assessment Physiological (Systems Review) Assessment

Mom and family at bedside, comfort
objects from home such as own pillow and
Coping/comfort methods blanket. LOC A&O x 4
Slightly anxious about being in the
Mood/Affect hospital and going home, but fatigued. Wakefulness Easily aroused
Cognitive abilities Appropriate to developmental stage. Orientation Oriented to person, time, place and situation
Agitation Not present Speech Clear
Values Unable to assess Follows commands Yes
Pupils equal, round, reactive to light and
Memory Appropriate PERRLA accommodation
Swallow/gag reflex Present
5/5 in all extremities except right radius with
Extremity strength strength a 3/5.
Limited movement in right radius with full
sensation and full movement in all other
DEVELOPMENTAL STAGE Movement/ Sensation extremities.
Full ROM except in right radius with limited
Developmental stage (Erikson) Industry vs. Inferiority ROM ROM.
Physical changes such as height and
weight, development of axillary sweating,
breast changes, and vaginal PH. Pubic hair
begins to develop. Logical thinking is being
developed with improved memory and
Maturational events language abilities. Activity/Gait Limited activity due to fatigue/ steady gait
School/friends/sports/family vacation,
Significant life/family events bonding Equipment/ CPM/Traction Absent
Role/Occupation Student CARDIAC
Clear S1 and S2 auscultated, absent from
Heart sounds murmurs or any extra heart sounds.
+2 in all extremities except right radius which
was non-palpable due to swelling. Doppler
Pulses confirmed pulse present.
Absent in all extremities except right radius with
SOCIO-CULTURAL Edema non-pitting edema present.
Access to healthcare Yes Capillary refill <3 sec. all extremities.
Family resources Adequate SCDs Teds Absent
Financial concerns/support No financial concerns
Both mom and dad live in home with
Family structure patient and older brother. RESPIRATORY
No apparent ethnic-cultural believes or
Ethnic-cultural practices. Caucasian family. O2 amt/mode Absent/ room air
Language(s) English O2 saturation 99%
Literacy Fluent Respiratory effort No distress
Primary caregivers/partners Mom and dad Lung sounds Clear in all lung fields
SPIRITUAL Cough/Secretions Absent
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Religious beliefs Unable to assess Chest tube Absent

Spiritual values Unable to assess
Hopefulness Appears hopeful GI
Soft, flat, non-tender. Free from any rash,
Chaplain/spiritual leader visit Abdomen lesions or scares.
Physiological (start systems review) Bowel sounds Normal active in all four quadrants.
INTEG Appetite/% eaten Reduced appetite/ 25% eaten
Color/Temp Appropriate to ethnicity/ warm Nausea/vomiting Absent
Turgor/Moisture Appropriately moist Tube feeding: type/site Absent
Mucous membranes Moist Other tubes/drains Absent
IV site Free from redness, swelling or pain GU
Dark Yellow/concentrated/non-cloudy, no foul
Braden score/stage 18 Urine description odor
Catheter Absent
Bladder scan Absent

Growth and Development

1. What is the stage of development that your patient is in? (ex. newborn, infant, toddler, etc.) _School age_______________________
2. According to Piaget and Erickson, what developmental stage is expected for their age range?
Piaget: __Concrete operational stage (7-11) or formal operational stage_(11-15).__________________________________________________________
Erickson: _Industry versus Inferiority.___________________________________________________________________________________________________________

3. What developmental milestones should your patient have achieved by this point?
a. Gross Motor: __Gradual increase in dexterity becoming more limber, improved coordination, strength, balance, and rhythm. Ability to climb, ride bike, skip,
jump rope, swing, swim, dance, do somersaults, and skate (Ward, Hisley & Kennedy, 2016).
b. Fine Motor: _Use of good eye-hand coordination and improved balance. Ability to sew, draw, make arts and crafts, build models, and play video games.
Improved handwriting and can print and write. Enjoys activities that promote dexterity including playing musical instruments and building models (Ward,
Hisley & Kennedy, 2016).
c. Language: Accelerated vocabulary with word expansion to 8,000 to 15,000 words. With expanding comprehension the child can engage in long
conversations on different topics, enjoy jokes, and may experiment with profanity (Ward, Hisley & Kennedy, 2016).
d. Social: _Increased peer group involvement with peers having greater influence on values and beliefs, and more same-sex friends. Mastering skills at this age
increases confidence and self-esteem (Ward, Hisley & Kennedy, 2016).

4. What does your book say regarding the child’s potential reaction to hospitalization and procedures for their age? A school age child may feel a loss of
competence and enforced dependence. They may also experience fear of loss of bodily functions and bodily mutation. School age children may also have
concerns about pain, imminent death or disability, as well as anxiety about going under anesthesia (WakeMed, 2017).
5. Which of these behavioral reactions did you observe in your patient? Provide examples: Observing the patient I noticed concerns of pain and feelings of
enforced dependence. For example, the patient seemed fearful of having any pain, even when her pain was controlled and also was concerned about how long
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

she would continue to have pain. Also, the patient seemed frustrated when she needed help from her mom with things like brushing her hair and teeth because
she was right handed and was not able to use her left hand that well.
6. Summary: How did your patient compare with the textbook’s description of milestones, and Erickson’s and Piaget’s theories of development?
Provide examples: _The patient seemed to be right on track with meeting the milestones and developmental stages appropriate for her age. For example,
although I did not observe the patient doing these things I know the patient injured her wrist while at a trampoline park with friends. It was also stated that
while at the park she was doing flips and somersaults on the trampolines which would make her gross motor milestones on track. Furthermore, she was with
friends which is consistent with where she should be with her social milestones. The patient also verbalized she enjoys school and gets good grades which
would put her on track with Erickson’s theory of Industry vs Inferiority. The patient also demonstrated consistency with concrete operational stage and even
formal operation stage when she voiced her concerns of having to be on antibiotics for 4-6 weeks and how this could make her miss her upcoming vacation in
2 weeks. After I explained that she would most likely go home on antibiotics and not have to stay in the hospital to receive them as she is now, she felt better
and realized this could mean she wouldn’t have to miss her vacation.
7. Based on your knowledge of growth and development for this patient’s age, how did you adjust your approach when assessing this child and
providing care? Provide examples: _Knowing that privacy is important to an 11 year old girl, I made sure to keep the patient covered throughout all
assessments. I also make sure to ask permission to assess underneath the gown before going forward with care each time. Furthermore, I was able to
communicate by asking questions about friends and activities that the patient was interested in knowing that peers are important at her age and what
activities are common to a child her age. This allowed for a better therapeutic relationship and the development of trust between the patient and nurse.
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Physiological Stressor # 2
Physiological Stressor # 1
S “My wrist really hurts.” Stated pain as S “I can’t move my wrist, it hurts too much.” “I T
Student Concept Map, p1 have to use my other hand to eat.”
“4/10.” U
Life threatening stressors penetrate D
Core E
Guarding behavior, grimacing facial
expression, decreased appetite and decreased N
O Abnormal Symptoms penetrate O Limited ROM of right radius and decrease in T
use of right radius. ESR/ 38.6 and CRP 52. fine motor skills of right extremity. Distal
Bony tenderness, distal radius, ventral aspect normal line of defense
radius, ventral aspect swelling and can’t fully
swelling and can’t fully extend wrist with N
Stressors penetrate flexible line of extend wrist, and bony tenderness.
tenderness. A
defense & ^risk for penetration of M
Acute pain R/T inflammation and swelling. NLD E
Impaired physical mobility R/T pain and
A A inflammation
Patient will have reduced pain. Patient will have improved ROM and fine A
P Medical Diagnosis:
P motor skills. T
Osteomyelitis E
CC: Pain and swelling in
right radius with weakness
Positive Variable
Positive Variable Aiding Aiding Resistance:
Defense: Good family Ct. Initials Young, active and
support. Good friend J.D. otherwise current
support. Age: 11 condition is healthy.

HPI: Patient was at Trampoline Park with no Other Stressor # 4

Physiological Stressor # 3 recollection of injury but some scrapes on
knuckles. After a couple days pain started
“I still have to wash my hurt hand?”
with increasing, unrelieved pain and S “I hope I don’t really have an infection.”
S swelling over 9 days. Patient seen in ED “Because then I will have to be on antibiotics
with fever, pain and swelling and elevated for 4-6 weeks and be in the hospital and miss
Possible abscess formation of bone, WBC, ESR and CRP. friends and my family vacation.”
hematogenous osteomyelitis, and any
O hospital-risk related infections. ESR O Anxious look on face.
38.6 and CRP 52. Absolute monocytes
0.8, Neutrophils 72, Lymphocytes 17, Flexible line of defense
and monocytes 10.
Normal line of defense
A Risk for infection
Lines of Resistance A Mild anxiety R/T hospital stressors AEB
verbalization of wanting to go home and fear
Patient will remain free from further Basic Structure/Central of missing family vacation.
P infection. Core P Patient will have reduced or relieved anxiety.
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Nursing Concept Map p.2: Attach clinical prep sheet to this form
Student Name: Jeanine Diaz Patient Initials: J.D.
Nursing Dx: Acute pain R/T inflammation and swelling AEB verbalization of pain at a 4/10 using standardized pain scale, guarding behavior, facial expression,
appetite and activity changes, can’t fully extend wrist, bony tenderness and distal radius, ventral aspect swelling. ESR 38.6, CRP 52.
Behavioral Outcome: The client will….Verbalize pain as relieved or controlled using the numeric rating scale on the day of care (Doenges, Moorhouse & Murr,

Interventions: Rationale: Implementation: Evaluation/ Pt. Responses:

1033 Patient rated
Perform pain assessment each time pain This demonstrates improvement in
Student nurse assessed pain each pain as a 4/10 using
occurs. Document and investigate status or to identify worsening of
time pain occurred using the numeric rating
changes from previous reports and underlying condition or developing
numeric rating scale and asking scale. Patient
evaluate results of pain interventions complications (Doenges, Moorhouse &
patient to describe the type of described pain as
(Doenges, Moorhouse & Murr, 2016). Murr, 2016).
pain occurring. throbbing and

Helpful in recognizing presence of pain, When student

Observe nonverbal cues such as but if cues are not congruent with verbal nurse assessed
Student nurse noticed guarding
guarding behaviors, grimacing facial reports further evaluation is needed pain due to
behavior, grimacing of facial
expression, narrowed focus and poor (Doenges, Moorhouse & Murr, 2016). nonverbal cues,
expression and poor feeding
feeding (Doenges, Moorhouse & Murr, patient reported
prompting assessment of pain.
2016). pain as a 4/10.

Provide or promote nonpharmacological Complementary care can help alleviate 1130 Patient
Student nurse provided ice packs
pain management such as cold or reduce pain to a greater degree than reported pain as
to be applied for 20 minutes on
compresses, comfort position and quiet just medication alone, and can also cut reduced to a 0/10
and 1 hour off as well as
environment (Doenges, Moorhouse & back on the use of pharmacological using numeric
encouragement of elevating
Murr, 2016). methods. (no rationale in book, used my effected extremity above head on a rating scale.
own.) pillow.

Administer analgesics to maximal The type of medications ordered 1130 Patient

dosage as needed to maintain depends on the type and severity of pain 1035 Student nurse administered reported pain as
“acceptable” level of comfort for patient (Doenges, Moorhouse & Murr, 2016). maximum dose of Ibuprofen relieved to a 0/10
(Doenges, Moorhouse & Murr, 2016). Also, administration of adequate dose of 400mg PO. using numeric
analgesics to relief pain is important for rating scale.
adequate pain management.

Evaluate and document client’s response Limits adverse effects and possible 1130 Patient
to analgesics and assist in any barriers to sufficient use of analgesics 1130 Student nurse re-evaluated reported pain as
adjustments that need to be made (Doenges, Moorhouse & Murr, 2016). and documented patient’s pain 0/10 showing
(Doenges, Moorhouse & Murr, 2016). giving adequate time for effects of adequate pain
analgesics to take place. relief was
achieved using
Assessment of behavioral outcome: Patient verbalized pain as relieved by reporting pain as 0/10 on numeric rating scale. Ibuprofen.
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Nursing Concept Map p.2: Attach clinical prep sheet to this form
Student Name: Jeanine Diaz Patient Initials: J.D.
Nursing Dx: Impaired physical mobility R/T pain and inflammation AEB limited ROM of right radius, decrease in fine motor skills, distal radius, ventral aspect
swelling, can’t fully extend wrist and bony tenderness.
Behavioral Outcome: The client will….maintain or increase strength and function of affected body part on the day of care (Doenges, Moorhouse & Murr, 2016).

Interventions: Rationale: Implementation: Evaluation/ Pt. Responses:

0900 Patient has
Identifies strengths and deficits such as muscle strength of 3/5
Determine degree of immobility,
observing muscle strength, tone, and ability to participate in ADL’s and 0900 and 1200 Student nurse and very limited
degree of lack of movement (Doenges, assessed muscle strength of right ROM in right radius.
joint mobility (Doenges, Moorhouse & 1200 muscle strength
Moorhouse & Murr, 2016). radius as well as ROM.
Murr, 2016). re-assessed still
showing 3/5 with
slight increase of
To maximize potential for mobility and
Assist with treatment of underlying 1035 Student nurse administered 1200 Patient had
best function (Doenges, Moorhouse &
conditions of affected area (Doenges, NSAID for pain/inflammation as improved ROM in
Murr, 2016).
Moorhouse & Murr, 2016). well as applied ice packs. right radius but
1315 student nurse administered remained at 3/5 in
antibiotics for treatment of muscle strength.
Assist with or encourage client to This will improve circulation to tissues repositioned right
reposition self on regular schedule as and reduce risk of tissue ischemia Student nurse taught importance arm periodically
dictated by patient’s situation (Doenges, (Doenges, Moorhouse & Murr, 2016). of changing positions of right throughout the
Moorhouse & Murr, 2016). radius q 2 hrs as tolerated per pain. day as tolerated.
Patient’s strength
remained weak
Note change in strength to do more or throughout the day.
To promote physical and psychological Patient was able to
less self-care or ADL’s (Doenges,
benefits of self-care and to adjust level use unaffected hand
Moorhouse & Murr, 2016). Student nurse observed patient’s with some self-care,
of assistance needed (Doenges, strength and ability to feed self, but needed
Moorhouse & Murr, 2016). brush teeth, and perform areas of assistance with
self-care throughout the day. brushing hair and
Perform and encourage regular skin
examination and neurovascular checks Reduce pressure on sensitive areas and
(Doenges, Moorhouse & Murr, 2016). Patient’s skin
prevent developments of skin integrity Student nurse performed regular remained warm, dry
problems (Doenges, Moorhouse & skin and neurovascular checks at and intact with cap
Murr, 2016). 0900 and 1200. refill <3 seconds,
and skin color
appropriate to
Assessment of behavioral outcome: Patient was able to maintain strength and function of affected body part, but showed no improvement in muscle strength with 3/5. ethnicity. Pulse was
non-palpable in
right radius due to
swelling, Doppler
obtained with pulse
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Nursing Concept Map p.2: Attach clinical prep sheet to this form
Student Name: Jeanine Diaz Patient Initials: J.D.
Nursing Dx: Risk for infection R/T possible abscess formation of bone and spread of infection due to possible hematogenous osteomyelitis and any hospital related
infections. ESR 38.6 and CRP 52. Absolute monocytes 0.8, Neutrophils 72, Lymphocytes 17, and monocytes 10.
Behavioral Outcome: The client will….Achieve timely wound healing, be free from purulent drainage or erythema, and be afebrile on the day of care (Doenges,
Moorhouse & Murr, 2016).

Interventions: Rationale: Implementation: Evaluation/ Pt. Responses:

Handwashing is the first line of Patient remained free
Practice and emphasize proper from any further signs
hand-washing techniques before and defense against healthcare- of infection on day of
Student nurse maintained standard
after all care contacts and after associated infections (Doenges, precautions throughout all patient care remaining
contact with items that may be Moorhouse & Murr, 2016). care and washed hands, or performed afebrile and
hand hygiene before and after all understood the
contaminated (Doenges, Moorhouse importance of proper
patient contact.
& Murr, 2016). hygiene.
Successful treatment of all forms of
osteomyelitis requires appropriate antibiotic
Administer and monitor medication therapy. Antibiotics that have proven efficacy Patient tolerated
against S. aureus bone and joint infections Student nurse administered administration
regimen as prescribed (Doenges,
include nafcillin, clindamycin, first- of antibiotics
Moorhouse & Murr, 2016). generation cephalosporins and vancomycin 408mg of Clindamycin IV as
(Harik & Smeltzer, 2010). Treating current prescribed. well.
infection appropriately will help stop spread
of infection.
Patient’s IV site
Choose proper vascular access device based
remained free from
on anticipated treatment duration and This reduces potential for IV-related Student nurse maintained aseptic signs of infection
solution or medication to be infused and best
bloodstream infections (Doenges, and remained
aseptic insertion techniques; cleanse insertion technique while administering IV
sites daily/ per facility protocol with Moorhouse & Murr, 2016). antibiotics by using gloves and
appropriate solution (Doenges, Moorhouse & cleaning IV access with alcohol
Murr, 2016). wipe for 15 sec. prior to access.
Although the patient
understood the
Provide or encourage balanced diet, Immune function is affected by protein importance of a
emphasizing proteins to feed immune intake and a balanced diet. A deficiency healthy diet, the
system (Doenges, Moorhouse & Murr, of proper nutrients puts the patient at Student nurse encouraged and taught patient did not have
2016). increased risk for infection (Doenges, the importance of eating a healthy, an adequate appetite
Moorhouse & Murr, 2016). balance diet during the healing process to eat appropriately,
and also encouraged adequate but did start to drink
hydration. an adequate amount.
Premature discontinuation of treatment
Emphasize necessity of taking such as antibiotics when client starts to
medications such as antibiotics as feel better may result in return of Patient verbalized
directed (Doenges, Moorhouse & Murr, infection and potentiate drug-resistant Student nurse discussed the possibility understanding of
2016). of the patient going home on importance of
strains (Doenges, Moorhouse & Murr, finishing full course
antibiotics and the importance of
2016). of antibiotics.
finishing the full course as well as
potential implications of not finishing.
Assessment of behavioral outcome: Patient received treatment for timely would healing and remained free from purulent drainage with reduced erythema, and remained afebrile.
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics

Nursing Concept Map p.2: Attach clinical prep sheet to this form
Student Name: Jeanine Diaz Patient Initials: J.D.
Nursing Dx: Mild anxiety R/T hospital stressors AEB verbalization of wanting to go home and fear of missing family vacation.
Behavioral Outcome: The client will…. Verbalize awareness of feelings of anxiety, appear relaxed and use support systems effectively on the day of care.

Interventions: Rationale: Implementation: Evaluation/ Pt. Responses:

Once the patient
Distorted perceptions of the situation may
Identify patient’s perception of the threat realized she would be
intensify the patient’s feelings. Student nurse identified patient was
represented (Doenges, Moorhouse & Understanding the patient’s view of the anxious about being stuck in the able to go home on
Murr, 2016). hospital long term and missing their antibiotics she felt a
situation promotes a more accurate plan of
family vacation because she was told lot more relaxed and a
care (Doenges, Moorhouse & Murr, 2016).
she would need antibiotics for 4-6 smile was observed
weeks for treatment. on patient’s face.

Enables patient to become comfortable Patient shared she

Establish a therapeutic relationship, Student nurse was able to establish a was anxious about
and to begin looking at feelings and therapeutic relationship with patient
conveying empathy as well as dealing with situation (Doenges, being in the hospital
by identifying patient’s and missing out on
unconditional positive regard (Doenges, Moorhouse & Murr, 2016). developmental stage and asking
Moorhouse & Murr, 2016). being with friends
appropriate questions to elicit a and missing her
response. family vacation.

Be available to patient for listening and Establishes rapport, promotes Patient was able to
talking (Doenges, Moorhouse & Murr, expression of feelings that the patient Student nurse made self available for
share feelings once
may not realize they have (Doenges, a therapeutic
2016). listening and talking by being attentive
Moorhouse & Murr, 20160. relationship was
to patient’s needs and spending time in
the patient’s room.

Encourage patient to acknowledge and Acknowledging feelings allows patient to Patient was able to
to express feelings using active listening, accept and deal more appropriately with Student nurse was able to encourage express feelings of
and reflection techniques (Doenges, situation, thus relieving anxiety (Doenges, patient to talk about her concerns of anxiety and feel
Moorhouse, & Murr, 2016). Moorhouse & Murr, 2016). being stuck in the hospital once this better once she
was identified as the main source of realized she would
her anxiety. most likely go home
in a day or two.

Identify actions and activities the patient Realizing that they already have coping
Patient realized
has previously used to cope successfully skills that can be used in current and Student nurse was able to identify that by sharing
when feeling anxious (Doenges, future situations can empower patients that the patient usually talks to her anxious
Moorhouse & Murr, 2016). (Doenges, Moorhouse & Murr, 2016). mom to relieve anxious feelings. feelings she was
able to feel better.

Assessment of behavioral outcome: Patient was able to verbalize awareness of anxious feelings and appear relaxed. Patient continued to express feelings of concern to mom.
Cedar Crest College Clinical and Concept Map Worksheet for Nursing 330 Pediatrics


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care. Philadelphia, PA: F.A. Davis Company.

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Ward, S., & Hisley, S. (2016). Maternal-child nursing care(2nd ed.). Philadelphia, PA: F.A. Davis Company