You are an RN working for the Migrant Health Clinic in your area. Today, you are assisting with health screenings. A Hmong family enters with a 4 year-old daughter, L.M. Limited English is spoken by the family. During the screening process, you discover that L.M. has had seizures for about one year’s time, and currently has a prescription for Dilantin 8mg/kg daily in two divided doses. L.M’s mother shows you a bottle of Dilantin which label reads “Dilantin 125mg/5ml”. The mother also shows you a 1 teaspoon medicine dropper and with her oldest daughter, age 9, interpreting, describes how she gave L.M. one full medicine dropper at the morning and evening meals until two months ago. L.M. has had 2 seizures since the medication was stopped by the family.
Mother has not attended any pre-natal visits in an American healthcare office. Additionally, the 9-year-old daughter indicates that there are currently no community agencies that visit the family on a regular basis. L.M’s parents bring L.M. her to the health screenings every 6 months.
Part I: Determining learning needs
Complete the following questions with short answers.
1. Given the information received from the oldest daughter regarding the medication administration at home, calculate the safe range of the Dilantin dose, and determine the accuracy of the home administration.
5ml=1tsp However she was giving that dose twice a day. So she was doubling the dose.
2. What other person in the family would benefit from nursing care and what is your course of action?
The mother, since she has not had any pre-natal visits and she is 5 months pregnant. Set up with an interpreter to educate on the importance of prenatal care. Offer phone numbers to see a physician for pre-natal visits. Referral to be seen by a social worker to determine what services she would need.
3. How may L.M.’s health and healthcare needs be affected by her culture, or family cultural beliefs?
Their spiritual wellbeing has to be in balance with physical needs. Maybe prenatal visits is something she doesn’t agree with since they believe in natural remedies. Information will be provided to educate her of the benefits of prenatal care.
Provide an interpreter. Give her information about her daughter’s seizure disorder and the correct dosing for the medication. Encourage follow up visits. Mark syringe with a sharpie where she needs to fill the syringe to, to give the correct medication. Part II: Care plan: 1. Assessment: Briefly cluster nursing information obtained from case scenario and list inferences based on this data. Are there areas that would require further assessment? Use this process to identify all actual/potential patient concerns/health needs.
Inferences: she care’s about her daughter, she showed interest in helping her daughter by bringing her to the clinic, she is willing to learn.
Area’s for further assessment: need for interpreter to help with education
2. Diagnosis: List your top 3-5 nursing diagnosis based on inferences above. Remember to write them as full two or three part statements with related factors and manifestations, as appropriate (actual dx 3 parts, risk for dx 2 parts).
1. noncompliance r/t lack of knowledge of prescription medication a/m/b seizures. 2. impaired parenting r/t lack of knowledge a/m/b child’s current health status. 3. impaired communication r/t foreign language barrier a/m/b incorrect medication dosage. 4. impaired health maintenance r/t language barrier, lack of health seeking behaviors, inability to self identify accurate medication administration a/m/b 9 year old interpreting of inaccurate dosing information.
Then, using the care plan template on the following page(s), create a care plan for the client. Choose your top priority dx from your NANDA Nursing diagnoses listed above and identify at least 2 desired outcomes (remember to include all 5 components of a goal), list 5-6 nursing interventions designed to meet the outcomes, and the theoretical rationale for each intervention.
CARE PLANNING ACTIVITY TEMPLATE
#1 Nursing Diagnosis:
Impaired health maintenance r/t language barrier, lack of health seeking behaviors, inability to self identify accurate medication administration a/m/b 9 year old interpreting of inaccurate dosing information.
1. The client will demonstrate correct dose with the medicine dropper measuring out 2.5ml by the end of the clinic visit.
2. The client will verbalize two reasons why prenatal care will benefit her and her fetus by the end of this appointment.
1. Provide a visual aid, ie: a chart that she could check off twice daily with the correct dose in each box.
2. Give client a medicine dropper marked at the correct dosing level.
3. Provide an interpreter to help client in understanding of education.
4. Provide pamphlets on prenatal care.
5. Schedule follows up appointments.
6. Assess her cultural beliefs in prenatal care.
1. this will aid as a visual reminder for the correct time and dose.
2. this is a visual aid so the mother cannot overdose her child.
3. To avoid the language barrier and to ensure the clients understanding.
4. to educate on the benefits of prenatal care.
5. To promote compliance and assess mother’s health.
6. to better understand how to meet our clients’ needs to integrate her beliefs with better health care.