ikon COLLEGE OF NURSING

Mysore road, Bidadi, Bangalore

CHILD HEALTH NURSING

High Risk Newborn Care Plan on:

FAILURE TO THRIVE

SUBMITTED TO
Ms. Grace Leeda
Lecturer in Pediatric Nursing
Ikon College of Nursing
Bangalore

SUBMITTED BY
Mr. Prashantayya Kallimath.
I Yr M.Sc. Nursing
Ikon College of Nursing
Bangalore .

SUBMITTED ON: 18-02-2011

INTRODUCTION
 As a part of our clinical experience in Pediatric nursing, we were posted to IGICH
(Sanjay Gandhi Institute of Child Health), Bangalore. When I was posted to medical ward, I
came across the patient by name B/o Savitha, diagnosed as a Failure to thrive. I have selected
this case for my care plan and theory application on 12/02/11 in order to use this knowledge in
my day to day clinical practice.

I. BIOGRAPHICAL INFORMATION
Name : B/o Savitha
Age : 20 days
Sex : Male
Address : S/o Mr. Ravikumar
Viswas Colony
Tilaknagar
Banagalore
Religion : Hindu
IP No. : 67384
Admission unit : NICU
Date of admission : 16-2-11
Date of history taking : 19-02-11
Informant : Mother.

II. DIAGNOSIS : Failure to thrive

III. PRESENT HISTORY

History of not gaining weight noticed since 20th day of life, pre-lacteal feeds given
up to 3days of life and subsequently started with breast feeding. Child is passing
stools once in 3 days.

HISTORY OF PRESENT ILLNESS

History of not gaining weight since 20th day of life
IV. PAST MEDICAL HISTORY
 Past illness, hospitalizations : The child has not been previously hospitalized.
Allergies : He has no allergies.
Medications : He was not on any medications before.

V. BIRTH HISTORY
Antenatal : Booked
Natal – Place of Birth : Hospital
Mode of Delivery : LSCS
Gestational Age : Full term.
Birth Weight : 2.8 kg.

Postnatal : Baby cried immediately after birth.

VI. FAMILY HISTORY

There is no consanguinity in the marriage.

29 yrs 23 yrs

20 days

VII. GROWTH AND DEVELOPMENT

B/o Savitha is not gaining weight appropriate for the age.

VIII. IMMUNIZATION
Baby received vaccines such as BCG, OPV and Hep B at birth.

IX. ELIMINATION PATTERN

Bowel : Passes stools in normal consistency once in 3 days.
Bladder : Urinates thrice a day.
X. NUTRITIONAL PATTERN
 Recent Weight : 2.5kg Expected Weight: 4 kg
Appetite : Loss of appetite.

24 Hours Diet Recall : Baby is on breast feeding, every 2 hourly.

Degree of Malnutrition : Actual weight /expected weight x 100

2.5/4x100=62.5%
The baby has Grade III malnutrition.

XI. SLEEPING PATTERN: The child is sleeping 9 hours in a day.

PHYSICAL EXAMINATION
1. GENERAL OBSERVATION
B/o Savitha is looking pale and sick and not active also.

2. VITAL SIGNS
Temperature : 98.40F
Respiration : 58 breaths/min
Pulse rate : 134 beats/min
BP : 90/50 mmHg

3. ANTHROPOMETRIC MEASURMENTS
Height : 55cm
Weight : 2.5 kg

4. SKIN &MUCOUS MEMBRANE

Colour : Normal brown.
Edema : Nil
Moisture, temperature : Dry and scaly.
Turgor : Poor turgor
Texture : Poor elasticity
5. Head;
Skull/Cranium Size, Shape : Has no abnormalities.
Fontanelles : Open
Suture : Closed
Movements : Normal
Forehead : No scar or lesion.

6. Face
Appearance : Lethargic
Color : Fair.
Symmetry : Symmetrical
Movements : Normal

7. Eyes
Expression : Appears dull and pale.
Eye Lids : Normal
Lacrimation : Clear fluid.
Eyebrows : Normal; no sign of dandruff.
Conjunctiva : Pale pink in colour
Sclera : White and moist.
Cornea : Dry
Pupil : PERRLA

8. Ears
Appearance : No masses or no lesions.
Discharges : Nil
Lesions : Nil
Any Abnormalities : Absent

9. Nose
Appearance : Normal, no septal deviation
Discharges : Normal discharges
Patency : Both nostrils are patent
10. Mouth And Throat
Lips : Dry and cracked
Tongue : White coated tongue
Teeth : Absent
Gums : Normal color.
Buccal Mucosa : No inflammation.
Palate : Normal
Tonsils : Not inflammed.
Taste : Able to differentiate various taste.

11. Neck:
General Appearance : No lesion.
Trachea : Normal centrally placed trachea.
Lymph Nodes : Not palpable.
Thyroid Glands : Normal
Salivary Glands : Normal
Cysts and Tumors :Nil

12. Chest and respiratory system:

Inspection : Size and shape is normal. Chest expansion is equal in
both sides and respiration is normal.(58 breaths/min)
Palpation : No tenderness present
Percussion : Normal resonance in both lungs.
Auscultation : NVBS heard

13. Cardiovascular system;

Inspection : Normal expansion of chest.
Palpation : No mass or tumours present.
Percussion : No fluid accumulation.
Auscultation : Tachycardia present. Heart rate is 134 beats/min.

14. Abdomen:
Inspection : No distention
Palpation : No tenderness present.
Percussion : No fluid accumulation present.
Auscultation : Peristaltic movements are not heard.

15. Back:
Spine, Curvature : Normal
Symmetry : Symmetrical in shape.
Tenderness : No tenderness noted.

16. Genitallia : Normal male genitalia

17. Extrimities:
Deformities : No deformities present.
Swelling/ Edema : Absent.
Muscles : Strength is less, loose folds of skin in axilla, groin and
gluteal region
Lymph Nodes : Not inflammed or enlarged
Joints : Normal ROM.
Fingers and Toes : No abnormality

18. Central nervous system;

Birth Injuries : Nil
Seizures : Absent
Speech : Absent
Sensory Motor Changes : Responds to touch and painful stimuli.
Gait Changes : Normal
Cognitive Changes : Conscious
Reflexes : Normal

19. Urinary system:

 Urinary Tract Infections : Nil
Any Abnormalities : Nil

20. Psychosocial history:

General Status of the Family: B/o savitha comes from a poor socioeconomic family,
whose father is the coolie with an income of Rs 2000/- month. He is bread winner of the
family. They are staying in a rented house which has a living room, 2 bedrooms, kitchen
& attached toilet.

Activities of Daily Living : Assisted by mother

Play Activities : Absent

School Performance : Absent

Hobbies : Absent

LABORATORY INVESTIGATIONS
INVESTIGATIONS RESULTS NORMAL VALUES
Haemoglobin 8-10gm/dl 14-20 gm/dl
TC 12200 -
Lymphocyte 10 32
Creatinine 1.1 0.3-1.0
Sodium 144 134-146mEq/l
Potassium 4.4 39-5.9
Urea 87.2
Medication name Dosage FrequencyRoute Actions Side effects Nursing responsibilities
1. Inj.Ceftriaxone. 750mg Bd IV Antibiotics Eosinophilia. Dizziness, genital Use cautiously in history of sensitivity to
pruritis, maculopapular lesion, pencillin.Obtain specimen for culture
dyspnoea and sensitivity.
2. Inj. Amikacin. 125 mg Bd IV Antibiotics Headache, lethargy, ototoxicity, Use cautiously in impaired renal
oliguria, hepatic necrosis. functions.Patient should be well
3.Inj. Metrogyl. 100ml Tid IV Antimicrobial. Neutropenia, vertigo, ataxia, edema, hydrated
abdominal cramps, stomatitis. Use cautiously CNS & cardiac
dysfunctions.Tell the patient to avoid
4.Infusion Isolyte P 5ml/ h Per hr. IV - - alcohol.
Use causiously in CHF, COPD
5.Inj Netilmycine. 35mg Bd IV Antibacterial Renal impairments, Ototoxicity, Rash, Monitor vital signs.BP, RR, Pulse.
Nausea, vomiting, Phlebitis. No substitute for blood or flud
deficit.cant administer for
6.Inj. Dexona. 9mg Tid IV Corticosteroids. Euphoria, insomnia, hypertension, tachyarrythmias.
edema, hypokalemia, hyperglycemia. Use cautiously in impaired renal
functions.Patient should be well
9.Inj. Rantac 45mg Bd IV H-2 receptor Neutropenia, malaise, bradycardia, hydrated
antagonists. nausea, constipation, jaundice, rash Contraindicated in systemic pulmonary
disease.
NURSING DIAGNOSIS
1. Impaired growth and development related to failure to thrive as evidenced by decreased
weight gain.
2. Imbalanced nutritional status less than body requirement related to inability to absorb
nutrients as evidenced by decreased feeding.
3. Potential alteration in parenting related to presence of stress as evidenced by the mother’s
over concern.
4. Potential for maternal anxiety related to child’s condition.
5. Parental knowledge deficient regarding the treatment and disease condition.
 NURSING PLANNING
ASSESSMENT OBJECTIVE INTERVENTIONS IMPLEMENTATION EVALUATION
DIAGNOSIS
SUBJECTIVE Impaired growth and The child will -Assess the child’s -Assessed the The child started
DATA: development related achieve the physical growth anthropometrical to gain weight
The mother to failure to thrive as normal weight parameters and measurements and during the course
complains of not evidenced by according to the developmental mile found it is less than the of hospitalization
sucking properly decreased weight age stones based on age normal.
and not gaining gain. norms.
weight -Provide stimulation -Established a
using appropriate relationship of trust with
OBJECTIVE developmental activities. the infant and family.
DATA: -Develop a plan to assist -Assisted the family
The child is not the child n acquiring the members so that they
feeding properly. identified skills and can also participate in
physical growth. child care.
-Assist the parents to -Administered
determine the goals medications as per
realistic for their child physicians order.
and provide appropriate Inj. Ceftriaxone 750
treatment. mg bd.

ASSESSMENT NURSING PLANNING IMPLEMENTATION EVALUATION

 DIAGNOSIS OBJECTIVE INTERVENTIONS
SUBJECTIVE Imbalanced The child will -Assess the nutritional -Assessed the nutritional The child started
DATA: nutritional status less achieve the intake of the child. status of the child. The to gain weight
The mother than body average weight baby has nausea, during the course
complains that the requirement related to according to the vomiting & the inability of hospitalization
baby is not sucking inability to absorb norms during the to suck properly.
properly and not nutrients as period of -Take daily weight of the -Checked the daily
gaining weight. evidenced by hospitalization child and compare with the weight of the child. It is
decreased weight previous weight records 2.5 kg.
OBJECTIVE gain. -Educate the mother -Educated the mother
DATA: about the importance of regarding the
Birth weight of the exclusive breast feeding importance of exclusive
child is 3.5kg and breast feeding.
now child is 2.5kg -Teach the mother the -Taught the mother the
various breast feeding various breast feeding
techniques and positions. techniques and
positions.
-Educate the parents -Educated the parents
about the importance of regarding the growth
nutrition in the growth and development
and development. pattern of normal child.

ASSESSMENT NURSING PLANNING IMPLEMENTATION EVALUATION

OBJECTIVE INTERVENTIONS
 DIAGNOSIS
OBJECTIVE Potential alteration in The mother will -Establish a trust -A trust relationship Mother is able to
DATA: parenting related to demonstrate relationship with the was established with demonstrate all
presence of stress and appropriate child mother. the mother. the child care
Mother is very mother’s concern. care skills, practices
anxious about the feeding behavior. -Allow the mother to -Now mother is taking
condition of the participate in the daily care of the child in
child. care activities of the daily care.
child.
-Provide age appropriate -Advised the mother to
stimulation for the infant provide bright colored
like bright coloured toys. toys for the child.

-Advice the mother to -Advised the mother to

maintain eye contact, maintain eye contact
verbalization during the with the baby while
feedings. feeding.

NURSING PLANNING
ASSESSMENT OBJECTIVE INTERVENTIONS IMPLEMENTATION EVALUATION
DIAGNOSIS
SUBJECTIVE Parental knowledge The parents and -Establish a trustful -A trustful relation was The family
DATA: deficient regarding the family will relationship with the established with the members gained
The mother says,” the disease condition have sufficient parents and family. family members. adequate
I don’t know why and treatment of knowledge about -Provide positive -Positive reinforcement knowledge about
my baby is not disease condition the disease reinforcement to the given to the mother the disease,
gaining weight.” condition and mother. when she had given treatment.
OBJECTIVE treatment. successful breast
DATA: feeding to the child.
-Educate the family -Educated the family
Parents are asking regarding the disease regarding the disease
so many questions condition and the care of condition treatment and
regarding the the child. other aspects of child
treatment and care.
disease. -Positively encourage the -Positively encouraged
parenting skills the parenting skills.
-Encourage the family to --Encouraged the
discuss the fears and family to discuss the
questions regarding the fears and questions
child. regarding the child.