A Case Study

By

GROUP ____

December 4, 2010

I. INTRODUCTION

Definition:

It is a genetic bone disorder of collagen

formation characterized by bones that break easily without a specific cause. Collagen is a

protein in found in bones and other

connective tissue.

Cause•due to a genetic defect that causes imperfectly-formed, or an inadequate amount of, bone collagen•a faulty gene that instructs their bodies to make too little type 1 collagen or poor quality type I collagen

Incidence/Prevalence•approximately 1 in 20,000 births•equal frequency among males and females •seen in among all racial and ethnic groups

OI: At a Glance

Types of Osteogenesis ImperfectaAccording to the Osteoporosis and Related Bone Diseases National Resource Center, part of the National Institutes of

Health (NIH)

Type I:

most common mildest form bones fracture easily can usually be traced through the family near normal stature or slightly shorter blue sclera (the normally white area of the eye ball) dental problems (brittle teeth) hearing loss beginning in the early 20s and 30s most fractures occur before puberty; occasionally

women will have fractures after menopause triangular face tendency toward spinal curvatures

Type II:

most severe form newborns severely affected; frequently fatal, although

a few have lived to adulthood severe bone deformity with many fractures usually resulting from a new gene mutation very small stature with extremely small chest and

under-developed lungs

Type III:

bones fracture very easily bone deformity tend to be isolated family incidents very small in stature fractures at birth very common x-ray may reveal healing of fractures that occurred

while in the uterus may have hearing loss loose joints and poor muscle development in arms and

legs barrel-shaped rib cage triangular face spinal curvature possible respiratory problems

Type IV:

between Type I and Type III in severity can frequently be traced through the family bones fracture easily - most before puberty normal or near-normal colored sclera problems with teeth spinal curvatures possible hearing loss

Type V:

clinically similar to Type IV OI in appearance and symptoms

a dense band seen on x rays adjacent to the growth plate of the long bones

unusually large calluses, called hypertrophic calluses, at the sites of fractures or surgical procedures (A callus is an area of new bone that is laid down at the fracture site as part of the healing process.)

calcification of the membrane between the radius and ulna (the bones of the forearm), which leads to restriction of forearm rotation

sclera normal in color (i.e., white or near-white)

normal teeth “mesh-like” appearance to bone when viewed under the microscope

dominant inheritance pattern

Type VI:

clinically similar to Type IV OI in appearance and symptoms

slightly elevated activity level of alkaline phosphatase (an enzyme linked to bone formation), which can be determined by a blood test

distinctive “fish-scale” appearance to bone when viewed under the microscope

diagnosed by bone biopsy

unknown whether this form is inherited in a dominant or recessive manner, but researchers believe the mode of inheritance is most likely recessive

eight people identified with this type of OI to date

Type VII:

resembles Type IV OI in many aspects of appearance and symptoms in the first described cases

in other instances, similar appearance and symptoms to Type II lethal OI, except infants had white sclera, a small head, and a round face

small stature

short humerus (arm bone) and short femur (upper leg bone)

coxa vara (a deformed hip joint in which the neck of the femur is bent downward) is common; the acutely angled femur head affects the hip socket

results from recessive inheritance of a mutation in the CRTAP gene. Partial (10 percent) expression of CRTAP leads to moderate bone dysplasia. Total absence of the cartilage-associated protein has been lethal in all identified cases

Type VIII:

resembles lethal Type II or Type III OI in appearance and symptoms, except infants have white sclera

severe growth deficiency

extreme skeletal undermineralization

caused by absence or severe deficiency of prolyl 3-hydroxylase activity due to mutations in the LEPRE1 gene

Skeletal Comparison among OI Types

Diagnostic Procedure

sTREATMENT

To date, there is no known treatment, medicine, or surgery that will cure osteogenesis imperfecta (OI). The goal of treatment is to prevent deformities and fractures and allow the child to function as independently as possible. Treatments for preventing or correcting symptoms may include:

 

•care of fractures - Sometimes a fracture can be treated with just a splint or a cast.

•surgery

•rodding - a procedure to insert a metal bar the length of a long bone to stabilize it and prevent deformity. The rods will help with healing and prevention of fractures.

•dental procedures

•physical therapy

•assistive devices, such as wheelchairs, braces, and other custom-made equipment

• X-Ray • An

Examination Of The Ear, Nose, And Throat 

• Collagen/DNA Test

• Fibroplast Skin Biopsy

ManagementManagement of the disease includes focusing on preventing or minimizing deformities, and maximizing the individual's functional ability at home and in the community. Management of OI is either non-surgical or surgical. Non-surgical interventions may include one or more of the following:physical therapypositioning aids (to help sit, lie, or stand)braces and splints (to prevent deformity and promote support or protection)medicationspsychological counselingSurgical interventions may be considered to manage the following conditions:fracturesbowing of bonescoliosis - a lateral, or sideways curvature and rotation of the back bones (vertebrae), giving the appearance that the person is leaning to one side.heart problemsSurgery may also be considered to maintain the ability to sit or stand.

Long-term outlook for an individual with osteogenesis imperfecta (OI):

American Actor: MICHAEL J. ANDERSON

Jazz Pianist: MICHAEL PETRUCCIANI

Guinness Book of World Records Smallest Man:

HE PINGPING

II. NURSING HISTORYa. PATIENT PROFILE

MOTHER Name: GGU-S Age: 16 years old Birthday:November 14, 1994 Sex: Female Address: Naguilian, Isabela Nationality: Filipino Civil Status: Married under Civil

Law with the consent of parents

Religion: Roman Catholic Occupation: N/A Obstetric History: G1P0 Date Admitted: November 18, 2010 Time Admitted: 6:15 AM Date Discharged:December 1, 2010 Attending Physician: Dra. Elizabeth

Castillo

FATHER

Name: AAS Age: 31 years old Sex: Male Address: Minanga, Naguilian,

Isabela Nationality: Filipino Civil Status: Married Religion: Roman Catholic Occupation: Farmer

OFFSPRING• Name: Bb Boy Lucky Son• Birthday: November 18, 2010• Sex: Male• Address: Minanga, Naguilian,

Isabela• Nationality: Filipino• Civil Status: NB• Religion: Roman Catholic• Date Admitted: November 18, 2010• Date Discharged: December 1, 2010• Time Admitted: 8:41 AM• Admitting Diagnosis: LBB born to a 16yo

G1P0 mother via LTCS, BS = 36-38 wks AOG; BPT; BW = 2.7 kgs; AGA T/C Bone Dystrophy

• Principal Diagnosis: Osteogenesis Imperfecta

• Attending Physician: Dra. Fermindoza

HISTORY OF PRESENT ILLNESSApproximately 4-5 hours PTA, the mother complained

of pain taken as related to labor pains. Also she noted the intense movement of the baby inside her as well as gush of blood and water flowing from her legs. Therefore, she panicked and asked her mother to bring her to the hospital immediately. Fetal distress was considered by the attending physician since below normal FHT was noted. Pelvic inadequacy is also in question because of the mother’s age and her skeletal physique. Furthermore, her ultrasound revealed a baby in breech position with unusually small lower extremities making it difficult for her to deliver it vaginally. Finally, LTCS option was decided because of the amount of blood loss and the impending factors mentioned. And with the consent of the patient’s mother since the husband is not yet in, LTCS was performed by Dra. Castillo, under spinal anesthesia as inducted by Dra. Argonza. At 8:41AM of the same day, Baby Lucky Son was delivered operatively, alive and not resuscitated even if he is in a breech position with his umbilical cord coiled to his neck.

PAST MEDICAL HISTORYThe mother mentioned that she doesn’t have a

regular prenatal check-up because she has no one to accompany her to go to the hospital. She also said that she have to be left at home to tend to household chores. Good thing, she had an ultrasound done a few weeks PTA to aid the attending physician with knowledge on her current condition. According to the patient’s mother, also attested by other relatives, they are a family of usually “ tall people”, especially in the side of the child’s father. It was a shock that the baby is small. However, the maternal grandmother mentioned that they have a great-great grand uncle with a skeletal anomaly. His leg is smaller than the other and clubfooted at the same time. And no one in either side has any other known skeletal problem since that may be related to the child’s present condition.

11 GORDON’S FUNCTIONAL PATTERNHEALTH PERCEPTION:

Before Confinement:•The mother stated that when she is not feeling well she just takes a rest, if her condition got worst that is the only time he will consult to a health care provider. Both side of the family has no known history of hereditary diseases like Diabetes or Asthma but have a history of hypertension as verbalized by the maternal grandmother. Ms. GGU’s reaction to admission is bound by fear and anxiety especially for the possible complications that she might suffer as well as the safety of the baby inside of her.

During Confinement:•Secondary to the felt fears mentioned above are the burdens of financial constraints from GGU and her baby’s hospital expenses since they have stayed for more two weeks already and her being subjected to ceasarian delivery.

NUTRITION:

Before Confinement:•The patient usually eats three times a day with a snack in between. She prefers vegetables in her diet and seldom eats pork because she was told by her elders that it may increase her blood pressure which may complicate her pregnancy.

During Confinement:•On GGU’s first day of confinement, the ROD ordered her immediately on NPO since she was brought directly to the Operating Room for pre-op care upon admission. Gradual shift from NPO, to soft foods was ordered for her after 12hrs post op, and then DAT after as tolerated. •Her son was also maintained on NPO until the following day when Dra. Fermindoza ordered him to be fed with 5-10cc of glucose water every four hours in three doses and then to be switched to milk feeding if the three doses of glucose water can be tolerated. S26 was the prescribed milk brand for Baby Lucky Son, 5-10cc in 1:2 dilution every four hours while being kept on watch for aspiration precaution. On 11/20/10, the Attending Physician increases this dosage to 5-15cc of MF, and on 11/21/10, an increased again to 15-30cc of MF. This was his oral nourishment during the course of his stay in confinement.

SLEEP / REST PATTERN:

Before Confinement:•GGU’s usual sleeping pattern was eight hours at night and an additional 1-2 hours of naps in the afternoon. Even with her pregnant condition, she said that she is not usually bothered and she still manages to sleep a lot.

During Confinement:•The sleeping pattern GGU has established was not the same during her first two days of confinement. She is only able to sleep for 5-6 hours which is sometimes even interrupted because of therapeutic management and the anxiety and grief she said she is feeling regarding her condition and of her baby. However, with the help and fervent support of her family and other relatives she was able to regain her strength again, since she is always assisted in caring for herself and for her son in almost every way by her family.•With Baby Lucky Son, he was a good sleeper of almost all parts of his everyday of about 20 hours. He is just disturbed slightly when he is hungry and when it is time to change clothes and his soiled diaper. During their confinement, nurses are always in attendance as his clothes are changed since the family is somehow very cautious on how to handle him. Sometimes even a slight touch to change his position as ordered seems really painful for the small angel as he cries due to his fragile condition.

ELIMINATION PATTERN:

Before Confinement:•Ms. GGU usually voids for 2-3 times a day and the color of her urine was yellow orange and sometimes darker. However, 1 day PTA, she complained of pain upon urination that she said causes her to void in small quantities. She defecates 1-2 times a day in small portions.

During Confinement:• Ms. GGU voids in about 400-500cc every 8 hours as measured in her urine bag attached to the two-way catheter that was on her during the first 2 days of her confinement post op. On the third day, her catheter was removed as ordered after bladder training in which she voided 1-2x a day in small quantities on that day. She has defecated once a day starting on the 2nd day of her confinement until the day they were discharged.•Baby Lucky Son, on the other hand, seemed to finally establish a strict defecation schedule according to his primary caregiver, his maternal grandmother. 10 mins after being fed his milk every 4 hours, his diaper will almost always get soaked with poop. And traces of urine is also evident.

ACTIVITY PATTERN:

Before Confinement:•Patient GGU can perform household chores like cooking and also washing the dishes and tending their humble abode. She used to go in their farm to help her husband because according to her this is their means of living. She also had a daily walking exercise to go to their neighbors who are also his parents and other relatives.

During Confinement:•The patient appears weak to go to the bathroom during her first week. After being weaned from her catheter, she uses a bedside commode to defecate and urinate. She also opts in being assisted by her husband or her mother in tepid sponge baths in bed in the morning and at night in relation to family custom of not taking a full bath immediately after giving birth. However, she can maintain good grooming while on bed and also exercises around the room by walking.•Since Baby Lucky Son is dependent on his oxygen inhalation and splints on his extremities, they are unable to give him a full bath since he was given his newborn care after birth. They just give him sponge baths and daily cord care in his cradle and frequent change in clothing usually every 4-8 hours while turning him side to side slightly with the aid of pillows.

ROLE-RELATIONSHIP:

Before Confinement:•The patient GGU stated that she has a good relationship with her husband. The live in their own house near the compound of their other relatives and next of kin. They were said to be married by the Mayor of their town under civil law with consent of GGU’s parents a year ago. As husband and wife, inspite their evident age gap, they get along well, mutually discuss and decide over familiar problems and situations together as one. As a wife, she does the chores in the home and her husband performs the manual labor to provide for the needs of their starting family. But when she got pregnant, they were given assistance by their relatives so as not to burden the young mother with her condition while maintaining their home.

During Confinement:•Her husband seemed supportive of the GGU’s condition. He is always seen almost every day tending to her wife’s needs. The patient affirmed this by stating that her husband is the one making her strong. Even with the condition of their first born, she is still positive and without remorse since for her she did what she know is best in caring for herself throughout her pregnancy. And with the added love and care of both their families they are optimistic that they will get along fine.

VALUES & BELIEF PATTERN:

Before Confinement:•She said she attends Sunday masses regularly in their barangay which is near their home but her recent confinement hinders her practice.

During Confinement:•During hospitalization, GGU said she prays to God to bless her and her family with good health. She said that she is very sorrowful and frequently asks God to forgive her in any sins she may have that might have caused the of her baby. However, she also believes that above all these things happening to her and her family, she feels that the God she knows and believes in is the real Lord which she believes is her Great Refuge in these trying times.

COGNITIVE PATTERN:•Patient GGU can read and write and her senses functions well. The decision for the benefit of the patient is communed by GGU and her husband AAS. But they also employ and take into consideration the opinions and suggestions of their immediate families.

STRESS PATTERN:•She said asks for assistance from her husband in terms of making decisions to avoid stress. She believes that since her husband is older than her, he knows better and that he will take care of her no matter what. Although when faced with troubles, he assisted her husband through fervent and earnest prayer because she believes that her condition and that of her son is somehow to test her faith in God.

SELF-PERCEPTION PATTERN:

Before Confinement:

•GGU said that prior to hospitalization; she believed she was perfectly fine. Not until she experienced those symptoms mentioned above several hours PTA.

During Confinement:

•At first sight of the condition of her son, GGU was shocked and dejected not knowing what has caused a very awful condition to befall them. She is also worried that her son will not grow as the normal children and will be taunted by society because of his appearance. But with the aid and support of their family, she was able to accept the fact that whatever her son’s condition is, he is still hers, she carried him for nine months and not anything or any condition can make her love for her first born waver in any way. She now has a new outlook in life that her son will bring them good luck, and that he is their lucky charm, thereby, their Lucky Son.

SEXUAL/SPIRITUAL PATTERN:

Before Confinement:•She said still performs her duty as a wife to her husband if he asks for it, which is about 4-6x/wk, even if she is pregnant.

During Confinement:•No coitus due to hospitalization.

III. PHYSICAL EXAMINATIONNovember 20, 2010

CEPHALOCAUDAL EXAMINATION on Baby Lucky Son

 

Vital Sign:•Wt:2.7kgs•T: 38.8 ºC•CR: 130bpm•RR: 59 cpm

IV: LABORATORY RESULT for Baby Lucky Son

Whole Body X-Ray Films Result (Baby Lucky Son)

Date: 11/19/10

 •*No reading yet

Upon looking at the x-ray films even with no official readings yet from the Radiologist, the fractures all over his body are evident.

 •Radius and ulna of both upper extremities•Rib cage•Femur•Missing ball and socket of the knees on both LE.

 

V. REVIEW OF THE SYSTEMANATOMY AND PHYSIOLOGY

Summary

In summary, the more severe forms of OI are caused by genetic mutations that produce bad structural components (bad fibers) that become part of the skeleton. A major advance in treating OI will be to find a way to prevent the bad fibers from being made in the first place. If this objective could be achieved, the result would be Type1 OI, with the person having one normal collagen gene that produces a smaller number of normal collagen fibers instead of defective fibers. Once this goal is accomplished, medicines to stimulate more collagen fiber production from the remaining normal collagen gene might increase bone strength even more.

PATHOPHYSIOLOGYOsteogenesis

Imperfecta

VI. NURSING CARE PLAN for

Baby Lucky Son

Ineffective Breathing PatternIn effective Breathing Pattern occurs since there is evidence of presence of spasm and inflammation of the lung tissue and parenchyma of Baby Lucky Son, these results in inability of the pt to move air in and out of the lungs as needed to maintain adequate tissue oxygenation and perfusion.

ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE EVALUATIONS: (none) O:- appears weak- appears tachypnic in rate, rhythm, and depth of breathing-cyanotic if not in o2 inhalation- with DOB and wheezes in right lung upon auscultation-nasal flaring VS:Wt:2.7kgsT: 38.8 ºCCR: 130bpmRR: 59 cpm 

Ineffective breathing pattern r/t dyspnea due to abnormalities of lung collagen and rib fractures 2º disease condition

After 8 hours of Nursing intervention, the patient will be able to maintain normal breathing pattern and prevent respiratory distress

- Established trust and rapport with the patient, Ms. GGU and the family    - Auscultated breath sounds, note areas of decreased/adventitious breath sounds as well as fremitus - Elevated HOB and turn baby from side to side q4 as ordered. Beneficial positions for an infant with OI include being held, carried, held on a caregiver’s shoulder, and side lying. 

- Maintained on O2 therapy inhalation /cannula at 0.5-1LPM as instructed - Suctioned secretions PRN as stated    - Instructed the SO and other primary caregiver to avoid and prevent contracting infection by avoiding contact with people who has flu or colds - Due meds and broncodilators administered via nebulization -Kept close watch for cyanosis and dyspnea as well as aspiration precaution

- To be able to facilitate a trusting relationship with the persons involved towards the success of the planned interventions - To ascertain status and note progress or complications  - To enhance ventilation to various lung segments for adequate and patent airway, also to avoid contractures esp. additional fractures d/t too much pressure - Form of medical aid to assist the infant in his breathing - To prevent additional difficulty that may farther impede normal breathing pattern - This is to avoid transferring the infection to the easily susceptible NB, Baby Lucky Son  - Pharmacologic treatment for condition - For immediate prevention for further complications

After 8 hours of Nursing Intervention, the pt was able to achieve a normal respiratory rate and did not show any signs of impending respiratory distress. GOAL MET RR: 49cpm

Acute PainPain is a subjective unpleasant sensation resulting from stimulation of sensory nerve endings by injury, or other harmful factors. Pain is activated when a pt’s pain threshold is reached. Pain threshold is the point at which a stimulus activates pain receptors to produce a feeling of pain. Pain usually accompanies inflammation. It results from the synthesis of prostaglandins, which are hormones produced during the inflammatory process. In Baby Lucky Son’s condition, the pain is caused by the fractures in his bones that is very difficult for him being a newborn.ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE EVALUATION

S: none O:  - crying when respositioned or when touched - increased in RR- restlessness-weak in appearance VS:Wt:2.7kgsT: 38.8 ºCCR: 130bpmRR: 59 cpm 

Acute pain r/t congenital fractures due to disease condition

After 2-3 hours of Nursing Intervention, the pain felt by the patient will be reduced if not prevented through proper handling and management of the newborn with his condition.

- Established trust and rapport with the patient, Ms. GGU and the family  - Instructed the SO to handle and lift the baby by placing one hand under the buttocks and legs and the other hand under the shoulders, neck and head. - Advised SO not lift under the armpits or lift by the ankles when changing a diaper - Immobilized extremities with splints as ordered   - Identified other ways with the SO on how to further minimize the pain felt like using pillows as a support when moving or handling the baby. - Administered analgesics as ordered 

- To be able to facilitate a trusting relationship with the persons involved towards the success of the planned interventions - To prevent instilling more pain to the baby than he is already in by knowing how to handle him properly  - So as not to cause any more pain   - To prevent further injuries and pain when turning patient for position changes and when handling him - The pillows cushion s the baby and his injuries from mobility that may cause pain   - Pharmacologic treatment for the pain caused by the congenital fractures

After 2-3 hours of Nursing Intervention, the pain felt by the patient was significantly minimized through proper handling and management of the newborn by his primary caregivers as evidenced by sound undisturbed sleep. GOAL MET

HyperthermiaPresence of microorganisms stimulates the release of pyrogen from the leukocytes resetting the body’s thermostat to febrile level and then there would be activation of the hypothalamus, which will result in increase in epinephrine and norepinephrine, vasoconstriction of cutaneous vessels. The heat will be produced as peripheral vasodilation results in skin flushing and skin is warm to touch. In Baby Lucky Son, his fever may be caused by the congenital bone fractures in relation with the pain that he is suffering from it.

ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTION

RATIONALE EVALUATION

S: “Mainit siya”, as stated O: - increase in body temperature-warm to touch- irritability VS:Wt:2.7kgsT: 38.8 ºCCR: 130bpmRR: 59 cpm  

Hyperthermia r/t trauma caused by congenital fractures 2º to disease condition

After the shift and series of Nursing Interventions, the increased temperature of 38.8 ºC will be decreased and maintained within normal levels

- Monitored vital signs and recorded      - Maintained O2 inhalation as ordered at 0.5-1LPM   - Provided adequate rest and nap time - Changed soiled linens and clothing properly and with care - Administered Paracetamol 0.25cc thru IV push q4 as analgesic as ordered

- Baseline data needed not just for comparison purposes but also for monitoring for progress on current pt status  - Increase in body temperature also increases BMI thereby increase O2 demand - To promote wellness - To provide comfort and avoid instilling pain from improper pt handling - Pharmacologic management for hyperthermia

After 8 hours of Nursing Intervention, the increased temperature of 38.8 ºC was lowered to 37.7. GOAL MET

Risk for InfectionThis occurs when a person is at risk for being invaded by pathogenic organisms. Transmission of an infectious agent from a source to a susceptible host occurs within an environment. Organisms live and multiply in a reservoir. The reservoir provides what the organisms needs for survival at a specific stage in its life cycle. In this case, the dressing and broken skin can be the reservoir that may lead to infection.

ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE EVALUATION

S: none O:-hyperthermia VS:Wt:2.7kgsT: 38.8 ºCCR: 130bpmRR: 59 cpm 

Risk for Infection r/t musculoskeletal impairment

 

After 1 day of nursing interventions, the patient’s SO and primary caregivers will demonstrate techniques, lifestyle changes to promote safe environment for the NB, Baby Lucky Son.

- Monitored vital signs esp. temperature  - Instructed patient’s caregiver to wash hands before and after contact with him. Teach use of aseptic technique during dressing change, or handling or manipulating the baby’s food, soiled clothing and such - Educated the SOs on the condition of the patient and the importance of maintaining his good health as well as the health of people around him.   - Administered due meds as ordered     - Kept on close watch

- Temperature is usually the first evident symptom of an impending or growing infection - Hand washing remains the most effective method of infection control.      -Health teaching is employed to involve not only the patient but also his significant others on ways of helping the pt maintain optimum health in spite of present condition - These are pharmacologic defense administered on the NB to prevent infections esp with his susceptible and compromised condition - To immediately prevent untoward signs and symptoms

After 1 day of nursing interventions, the patient’s SO and primary caregivers was able to learn and demonstrate techniques, and commit to lifestyle changes to promote safe and healthy environment for the NB, Baby Lucky Son. GOAL MET

VII. NURSING CARE PLAN FOR

MS. GGU AND THE REST OF THE FAMILY

Coping with and adjusting to having a child with OI is stressful for families. The stress of having a baby with a serious medical condition can strain the family’s resources and lead to postpartum depression in the mother. Being the mother and the first patient admitted at CDH in relation to Baby Lucky Son’s condition and secondary reason for his confinement, it is thereby appropriate to provide plan of care for his mother, Ms. GGU and the rest of the family as their guide in caring for this special little angel’s

special needs as well as develop appropriate coping mechanisms in this situation.

 Situational Low Self-EsteemA person normally have a confidence to whatever he/she may do but in the case of the patient having a low self esteem happens when there is a significant change in the usual situation of one’s life that may be peculiar to most. In relation to Baby Lucky Son’s condition and his family, it is a shock for them to be in a situation of having a special family member more so, with the idea that they will now be branded a “different” family from the common families in their community. Baby Lucky Son’s mobility impairments include upper body and lower body disabilities due to his congenital fractures. The condition was caused by birth defect brought about by the disease, OSTEOGENESIS IMPERFECTA. During confinement, he is on splints as ordered and as he grows, he may need other assistive devices to aid him in his condition.ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE EVALUATION

S: none O: -loneliness-slip of the tongue self negating verbalizations- indecisive behavior 

Situational low self-esteem r/t newborn son’s physiologic impairments due to a genetic anomaly 2º disease condition

After a day of nursing interventions, the significant others esp the parents will be able to   identify feelings and underlying dynamics for negative perception of the condition and be able to demonstrate behaviors to restore positive self-esteem in light of the current situation

- Established trust and rapport  - Determined each individual situation related to low self-esteem that is brought about by the present circumstances -  Encouraged expression of feelings anxiety    - Assisted clients to problem-solve situation, developing plan of action and setting goals to achieve desired outcome - Assessed emotional and psychological factors affecting the current situation

- To be able to gain their trust and cooperation and facilitate good intervention - To know current general condition of the family member   -  To know what are the appropriate action on how to deal on expressed source of feelings of anxiety -  Enhances commitment to plan, optimizing outcomes    - To determine the emotional and psychological response of each family member of the patient regarding the disease condition

After a day of nursing interventions, the significant others esp the parents was be able to  sort out their feelings and underlying dynamics for negative perception of the condition of their son and was able to commit in demonstrating behaviors to restore positive self-esteem in light of the current situation

Deficient KnowledgeIt is the absence or deficiency of cognitive information related to specific topic. The family members and primary caregivers may not be completely knowledgeable about Baby Lucky Son’s condition, its causes, and rationale for the instructed proper care and management for his condition. This may be due to low educational background because of financial matters. Through this care plan, we will assist the family to gain basic needed background on the condition for them to comprehend the importance of all the health teachings that was imparted on them

ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE EVALUATION

S: Paano nga kaya siya nagkaganito?, as stated O: -Verbalizes inadequate knowledge of care/use of immobilization device, mobility limitations, complications, and follow-up care.- SOs expresses concerns about ability to manage independently at home.- Confusion; asking multiple questions-

Deficient Knowledge related to new condition and treatment and cognitive limitations.

After 8 hours of NI, the family, will eagerly participate in the learning process and will verbalize understanding of the condition process and treatment and then will assume responsibility for fully taking care of the baby properly even with no further assistance from the nursing staff

- Assessed current understanding of treatment and follow-up care.   - Determined if hazards exist in the home that will compromise the patient’s ability to be effectively mobile at home. - Performed with them the prescribed exercises several times a day for the pt as ordered. 

- Identified and taught to report to physician signs of neurovascular compromise of extremity: pain, numbness, tingling, burning, swelling, or discoloration. - Taught about proper nutrition suitable for the pt. 

- Involved all the caregiver in procedures. Supervised those performing procedures and taught of proper technique like in aseptic technique, changing clothes and diaper, handling the baby and using splints. - Provided SO with sample medical supplies and assistive devices needed like splints and how to make one

- Effective planning is based on a clear understanding of the needs of the patient and family members who will assume caregiver roles. -To prevent patient from injury.  

- Regular exercise is necessary to maintain muscle tone and promote healing. -Early assessment and prompt reporting reduces the risk of injury or complications  - This promote good health and prevents constipation. - Ability to perform self-care procedures using proper aseptic technique decreases risk of infection and optimize therapeutic effect in the home care environment. - Efforts to enhance self-care abilities promotes successful transition/ accommodation to home environment.

After 8 hours of NI, the family, did eagerly participate in the learning process and demonstrated understanding of the condition process and treatment. They also assumed responsibility for fully taking care of the baby properly even with no further assistance from the nursing staff

Readiness for Enhanced Therapeutic RegimenTherapeutic management regimen is a set of program for the treatment of the illness and is sequelae that are satisfactory for meeting specific health goals.  Baby Lucky Son’s primary caregivers exhibit readiness to this regimen when they demonstrate eagerness to integrate these into learned health teachings religiously to their routine daily living.

ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE EVALUATION

S: none O:- compliance to medical management - willingness to do Doctor’s orders in caring for the baby the right way not in the way they know is right- eagerness to learn ways to prevent further complications

Readiness for enhanced therapeutic management regimen in preparation to home care.

After 8 hours of NI, the SOs will demonstrate proactive management by actively participating in treatment regimen of their pt.

- Established rapport  - Checked and recorded VS - Monitored pt’s general condition  - Gave due recognition to the SO’s initiative to comply with medical management - Empowered pt’s whole family who are present to manage illness by explaining actions of drugs and benefits from complying to course of treatment. Also explained the lifelong treatment process in which they have to be with the pt supporting him all the way 

- To gain family’s trust - Baseline data -To provide adequateInterventions as needed - Serves as a motivation to continue desirable behavior - Knowing the benefits of treatment makes the baby’s primary caregiver understandthe importance of such interventions in maintaining the desired health outcomes for Baby Lucky Son’s disease management 

After 8 hours of NI, the SOs was able to understand indepthly the need to demonstrate proactive management by actively participating in treatment regimen of their pt.

VIII. DISCHARGE CARE PLAN / HEALTH TEACHING

THANKS FOR LISTENING THE END….