Child Health Assessment Tool (NURS 415).
1. Initials in points:
A.A. is 2 months old.
Only put the last two digits of the room number.
Age-appropriate vital signs range: B/P – 75-100 P- 90-150 R- 25-40
3. Diet that is age and diagnosis appropriate
4. Medical Diagnosis/or Diagnosis(es):
Dysphagia
Laryngomalacia congenital
Chronic illnesses (comorbidities):
Fever
Flu
Pneumonia
All diagnoses' pathophysiology and S&S:
Feeding difficulties
Inadequate weight gain
A high-pitched noise
Breathing that is too loud (stridor)
With each breath, pull the chest and neck.
Apnea (breathing cessation) (breathing stoppage)
S&S of potential complication (What could possibly go wrong? What should you be looking out for?)
Cyanosis (becoming blue) (turning blue)
Aspiration (the inhalation of food materials into the lungs)
Choking while feeding
Gastroesophaegal reflux
Respiratory distress
Possible treatments with rationale
Possible medical treatment with rationale
Possible medications with rationale
90% of Laryngomalacia cases resolve by the time the child reaches 18-20 months. Time can be used as a treatment but if it worsens or becomes severe, surgery may be performed. The recommended procedure is Suproglottoplasty surgery to correct the condition.
The possible medication for the infant is the prescription of anti-reflux medicine. The medication will manage the Gastroesophaegal reflux (GERD) (Escher, Probst & Gysin, 2015). This in turn will also help the infant gain weight as well as improving the infant’s eating habit.
Possible labs/x-rays
Neck and chest X-rays: X-ray should be conducted to identify if the infant has problems in the upper airway.
Possible teaching needs- *Required*
A background understanding of respiratory disorders.
A good grasp of the signs and symptoms of congenital Laryngomalacia
A proper grasp of the diagnosis and treatment of congenital Laryngomalacia
5. Growth and Development:
Erickson’s level Trust vs. Mistrust
Piaget’s level Sensorimotor Stage
Expected G&D milestones: Compare actual G&D milestones
Strong Reflex movement
Hearing is fully mature
Leg and Arm movement becomes smooth
Weak reflex movement as a result of poor eating
Hearing is somehow mature
Leg and arm movement is somehow rigid
6. Play
Appropriate therapeutic play:
Giving the infant some materials to handle and explore experiences in a way that is reassuring and enjoyable.
Appropriate diversional play:
Offering rings rattles and keys.
Actual play implemented:
Placing toys in front of the infant to allow crawling, rolling and kicking.
Nursing Diagnosis * X-ray of the Neck
Expected Outcome #1 The patient will have problems in the upper airway
Interventions for Outcome #1
The results may show problems in the upper airway
If it is mild, time will correct the problem. Surgery is not required
If it is severe, the infant will be given a prescribed medication.
4.
5.
6.
Nursing Diagnosis * Flexible laryngoscopy
1.
Expected Outcome #1 The patient will have a floppy cords
Interventions for Outcome #1
The infant will be checked regularly by the doctors.
2. The parent will be needed to bring the child for occasional checking
3
No intervention is needed if the issue is not severe.
4.
The infant will outgrow the laryngomalacia
5.
Nursing Diagnosis * Impedance probe
Expected Outcome #1 The patient will have a moderate or severe Laryngomalacia
Interventions for Outcome #1
An impedance probe will be recommended for the patient
Oral medication will be prescribed for the child to check the degree of Gastroesophaegal
A proton pump inhibitor will be used for the patient to control the acid reflux
Nissen fundoplication may be required for the infant
5.
6.
Nursing Diagnosis# Severe laryngomalacia
Surgery for Laryngomalacia will be needed for the infant
Expected Outcome #1 The patient will
Interventions for Outcome #1
Suproglottoplasty is recommended (Kiran, Rajesh & Baliga, 2015).
The vocal cords will need to be trimmed under general anesthesia
A tube is inserted in the left place and left for some time.
The child will have to be placed in the pediatric intensive care until he/she heals
References
Escher, A., Probst, R., & Gysin, C. (2015). Management of laryngomalacia in children with congenital syndrome: the role of supraglottoplasty. Journal of pediatric surgery, no. 50, pp. 519-523.
Kiran, B., Rajesh, S. M., & Baliga, B. S. (2015). Laryngomalacia in Neonates: A Review and the Surgical Management or Severe Cases. J Neonatal Biol, no. 4, pp. 42167-0987.
