NU225CL Unit 9 Pediatric Crohn Disease Plan of Care Example

Six Weeks of Formula and a Seat in the Lunchroom: A Plan of Care for a Composite Twelve-Year-Old Admitted With a Crohn Disease Flare and Started on Exclusive Enteral Nutrition, Planning for School as Seriously as for the Gut

[Student Name]

Purdue University Global

NU225CL: Pediatric Nursing Clinical

Unit 9 Plan of Care

[Instructor Name]

[Date]

The child and family are composite; values are bracketed where illustrative, and treatment is directed by the pediatric gastroenterology team.

Admission Summary

[Marcus], composite, 12, diagnosed with Crohn disease of the ileum and colon [eight] months ago. Admitted with [three] weeks of cramping abdominal pain, [five to six] loose stools a day, fatigue and a weight loss of [3.2] kg. Height-for-age has slipped from the [40th] to the [25th] percentile over a year. Labs: hemoglobin [10.4] g/dL, albumin [3.0] g/dL, C-reactive protein raised. The team starts exclusive enteral nutrition, a complete liquid formula taken by mouth as the only source of nutrition for [six to eight] weeks, which pediatric guidelines recommend as first-line treatment to bring active Crohn disease into remission while supporting growth (Ruemmele et al., 2014).

Problem 1: Imbalanced Nutrition and Growth Delay

Data: weight loss, slowed growth, low albumin. Goal: takes the prescribed formula volume, [2,200] mL a day, by day [4]; weight up [0.5] kg by the clinic visit in [two] weeks. Interventions and reasons: offer formula chilled and in his chosen flavors, because taste fatigue is the main reason children stop; set a drinking schedule across the day with him, because large volumes at once cause bloating; weigh daily on the same scale, because weight is the earliest sign the plan is working; refer to the dietitian, who sets the volume. Evaluation: day 4, [2,000] mL a day; goal partly met. He finds the last two cartons hard after 8 p.m.; the schedule moved one carton to mid-morning.

Problem 2: Pain, Diarrhea and Fluid Loss

Data: pain [6] of 10 with cramping, [five] stools a day. Goal: pain at or below [3] and stools [three] or fewer a day by day [7]. Interventions and reasons: record stool number and type, because improvement on formula usually shows in stools first; offer heat and positioning; give medications as ordered; watch for dehydration through intake, output and mucous membranes. Evaluation: day 6, pain [3], three formed stools.

Problem 3: Risk for Social Isolation and Nonadherence at School

Data: he says, "I'm not drinking that in front of everyone." He eats lunch with three friends every day.

Six weeks of formula is a medical treatment for the gut, but it is lived out at a lunch table in front of three friends.

Goal: by discharge, he has a plan for school lunch that he chose, and he states who at school knows. Interventions and reasons: ask him what would make lunch bearable, because a plan he chooses is one he will follow; offer options, such as drinking formula from an opaque bottle, sitting with friends while they eat or using the nurse's office with one friend; with his consent, help his parents prepare a letter for the school nurse and a Section 504 plan covering bathroom access and missed work; connect him with a peer support group for young people with inflammatory bowel disease. Children with inflammatory bowel disease face social and emotional strain, and attention to school life is part of good care (Mackner et al., 2013). Evaluation: he chose the opaque bottle and lunch with friends, and told one friend why.

Problem 4: Body Image and Developmental Concerns

Data: he says he is "the shortest in seventh grade" and worries about being seen running to the bathroom. Goal: names one adult he can talk to and one activity he will keep during treatment. Interventions and reasons: explain plainly that the formula is helping him grow and that catch-up growth is possible as the disease settles; keep him involved in his own care, such as tracking his own weight and stools, because adolescents need some control over their treatment; let him keep basketball practice as energy allows (Perry et al., 2022). Evaluation: he named his coach and kept practice.

More of the Routine in His Hands

By discharge, Marcus records his own formula volume and stools on his phone and reviews them with his mother each evening. The nurse checks his record rather than replacing it, and praises accuracy rather than perfect numbers, so that he keeps logging on the hard days too.

Why One Goal Was Only Partly Met

The nutrition goal was set at the full prescribed volume by day four, and he reached about nine tenths of it. Recording that honestly matters, because the shortfall pointed to a real problem, taste fatigue and evening fullness, that the new schedule addresses. A plan that reported the goal as met would have hidden the reason he might stop at home. The dietitian will review the volume at the clinic visit.

Discharge Readiness

Taking [2,100] mL of formula daily, pain [2], stools formed, a written school plan, a dietitian follow-up and a gastroenterology visit in [two] weeks.

References

Mackner, L. M., Greenley, R. N., Szigethy, E., Herzer, M., Deer, K., & Hommel, K. A. (2013). Psychosocial issues in pediatric inflammatory bowel disease: Report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. Journal of Pediatric Gastroenterology and Nutrition, 56(4), 449-458. https://doi.org/10.1097/MPG.0b013e3182841263

Perry, S. E., Hockenberry, M. J., Cashion, K., Alden, K. R., Olshansky, E., & Lowdermilk, D. L. (2022). Maternal child nursing care (7th ed.). Elsevier.

Ruemmele, F. M., Veres, G., Kolho, K. L., Griffiths, A., Levine, A., Escher, J. C., Amil Dias, J., Barabino, A., Braegger, C. P., Bronsky, J., Buderus, S., Martín-de-Carpi, J., De Ridder, L., Fagerberg, U. L., Hugot, J. P., Kierkus, J., Kolacek, S., Koletzko, S., Lionetti, P., . . . Turner, D. (2014). Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease. Journal of Crohn's and Colitis, 8(10), 1179-1207. https://doi.org/10.1016/j.crohns.2014.04.005