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 Incidence/Prevalence
•due to a genetic •approximately 1 in
defect that causes 20,000 births
imperfectly-formed, or •equal frequency
an inadequate among males and
amount of, bone females
collagen
•seen in among all
•a faulty gene that
racial and ethnic
instructs their bodies groups
to make too little type
1 collagen or poor
quality type I collagen
OI: At a
Glance
 Types of Osteogenesis Imperfecta
According 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 TREATMENT
Procedures 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
• X-Ray  fractures and allow the child to function as
independently as possible. Treatments for preventing
• An or correcting symptoms may include:
Examination  
Of The Ear, •care of fractures - Sometimes a fracture can be
treated with just a splint or a cast.
Nose, And •surgery
Throat  •rodding - a procedure to insert a metal bar the
length of a long bone to stabilize it and prevent
• Collagen/DNA deformity. The rods will help with healing and
Test prevention of fractures.
•dental procedures
• Fibroplast •physical therapy
Skin Biopsy •assistive devices, such as wheelchairs, braces, and
other custom-made equipment
 Management
Management 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 therapy
positioning aids (to help sit, lie, or stand)
braces and splints (to prevent deformity and promote support or
protection)
medications
psychological counseling
Surgical interventions may be considered to manage the following
conditions:
fractures
bowing of bone
scoliosis - a lateral, or sideways curvature and rotation of the back
bones (vertebrae), giving the appearance that the person is leaning to one
side.
heart problems
Surgery 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

Guinness Book of World Jazz Pianist:

Records Smallest Man: MICHAEL PETRUCCIANI
HE PINGPING
 II. NURSING HISTORY
a. PATIENT PROFILE
MOTHER FATHER
 Name: GGU-S
 Age: 16 years old  Name: AAS
 Birthday: November 14, 1994  Age: 31 years old
 Sex: Female  Sex: Male
 Address: Naguilian, Isabela  Address: Minanga, Naguilian,
Isabela
 Nationality: Filipino
 Nationality: Filipino
 Civil Status: Married under Civil Law
with the consent of  Civil Status: Married
parents  Religion: Roman Catholic
 Religion: Roman Catholic  Occupation: Farmer
 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
 • Name: Bb Boy Lucky Son
OFFSPRING • 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 ILLNESS
Approximately 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 HISTORY
The 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 PATTERN
HEALTH 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 EXAMINATION
November 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 SYSTEM
ANATOMY 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.
PATHOPHYSIOLOGY
Osteogenesis
Imperfecta
VI. NURSING CARE
PLAN
for
Baby Lucky Son
Ineffective Breathing Pattern
In 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 EVALUATION
S: (none) Ineffective After 8 hours of - Established trust and rapport with - To be able to facilitate a After 8 hours of
  breathing pattern Nursing the patient, Ms. GGU and the family trusting relationship with the Nursing Intervention,
O: r/t dyspnea due intervention, the   persons involved towards the the pt was able to
- appears weak to abnormalities patient will be able   success of the planned achieve a normal
- appears tachypnic of lung collagen to maintain normal   interventions respiratory rate and did
in rate, rhythm, and and rib fractures breathing pattern     not show any signs of
depth of breathing 2º disease and prevent - Auscultated breath sounds, note - To ascertain status and note impending respiratory
-cyanotic if not in o2 condition respiratory distress areas of decreased/adventitious progress or complications distress. GOAL MET
inhalation breath sounds as well as fremitus    
- with DOB and     RR: 49cpm
wheezes in right - Elevated HOB and turn baby from - To enhance ventilation to
lung upon side to side q4 as ordered. Beneficial various lung segments for
auscultation positions for an infant with OI include adequate and patent airway,
-nasal flaring being held, carried, held on a also to avoid contractures
  caregiver’s shoulder, and side lying. esp. additional fractures d/t
VS:   too much pressure
Wt:2.7kgs  
T: 38.8 ºC - Maintained on O2 therapy - Form of medical aid to assist
CR: 130bpm inhalation /cannula at 0.5-1LPM as the infant in his breathing
RR: 59 cpm instructed  
    - To prevent additional
- Suctioned secretions PRN as stated difficulty that may farther
  impede normal breathing
  pattern
   
  - This is to avoid transferring
- Instructed the SO and other primary the infection to the easily
caregiver to avoid and prevent susceptible NB, Baby Lucky
contracting infection by avoiding Son
contact with people who has flu or  
colds  
  - Pharmacologic treatment for
- Due meds and broncodilators condition
administered via nebulization  
  - For immediate prevention for
-Kept close watch for cyanosis and further complications
dyspnea as well as aspiration
 Acute Pain
Pain 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 Acute pain r/t After 2-3 hours of - Established trust and rapport - To be able to facilitate a trusting After 2-3 hours of
  congenital Nursing with the patient, Ms. GGU and relationship with the persons Nursing Intervention,
O: fractures due Intervention, the the family involved towards the success of the pain felt by the
  to disease pain felt by the   the planned interventions patient was
- crying when condition patient will be     significantly minimized
respositioned or reduced if not - Instructed the SO to handle - To prevent instilling more pain to through proper
when touched prevented and lift the baby by placing one the baby than he is already in by handling and
- increased in through proper hand under the buttocks and knowing how to handle him management of the
RR handling and legs and the other hand under properly newborn by his
- restlessness management of the shoulders, neck and head.   primary caregivers as
-weak in the newborn with     evidenced by sound
appearance his condition. - Advised SO not lift under the - So as not to cause any more pain undisturbed sleep.
  armpits or lift by the ankles   GOAL MET
VS: when changing a diaper  
Wt:2.7kgs    
T: 38.8 ºC - Immobilized extremities with - To prevent further injuries and
CR: 130bpm splints as ordered pain when turning patient for
RR: 59 cpm   position changes and when
    handling him
   
- Identified other ways with the - The pillows cushion s the baby
SO on how to further minimize and his injuries from mobility that
the pain felt like using pillows as may cause pain
a support when moving or  
handling the baby.  
   
- Administered analgesics as - Pharmacologic treatment for the
ordered pain caused by the congenital
  fractures
Hyperthermia
Presence 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 RATIONALE EVALUATION
INTERVENTION
S: “Mainit siya”, as Hyperthermia r/t After the shift and - Monitored vital - Baseline data After 8 hours of
stated trauma caused series of Nursing signs and recorded needed not just for Nursing
  by congenital Interventions, the   comparison Intervention, the
O: fractures 2º to increased   purposes but also increased
  disease temperature of   for monitoring for temperature of
- increase in body condition 38.8 ºC will be   progress on current 38.8 ºC was
temperature decreased and   pt status lowered to 37.7.
-warm to touch maintained within     GOAL MET
- irritability normal levels - Maintained O2 - Increase in body
  inhalation as temperature also
VS: ordered at 0.5-1LPM increases BMI
Wt:2.7kgs   thereby increase
T: 38.8 ºC   O2
CR: 130bpm   demand
RR: 59 cpm - Provided adequate  
  rest and nap time - To promote
    wellness
- Changed soiled  
linens and clothing - To provide
properly and with comfort and avoid
care instilling pain from
  improper pt
- Administered handling
Paracetamol 0.25cc  
thru IV push q4 as - Pharmacologic
analgesic as management for
ordered hyperthermia
Risk for Infection
This 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 Risk for After 1 day of - Monitored vital signs esp. - Temperature is usually the After 1 day of
  Infection r/t nursing temperature first evident symptom of an nursing
O: musculo interventions,   impending or growing infection interventions, the
-hyperthermia skeletal the patient’s     patient’s SO and
  impairment SO and primary - Instructed patient’s caregiver - Hand washing remains the primary
VS: caregivers will to wash hands before and most effective method of caregivers was
Wt:2.7kgs   demonstrate after contact with him. Teach infection control. able to learn and
T: 38.8 ºC techniques, use of aseptic technique   demonstrate
CR: 130bpm lifestyle during dressing change, or   techniques, and
RR: 59 cpm changes to handling or manipulating the   commit to
  promote safe baby’s food, soiled clothing   lifestyle changes
environment and such   to promote safe
for the NB,     and healthy
Baby Lucky - Educated the SOs on the -Health teaching is employed to environment for
Son. condition of the patient and involve not only the patient but the NB, Baby
the importance of maintaining also his significant others on Lucky Son. GOAL
his good health as well as the ways of helping the pt maintain MET
health of people around him. optimum health in spite of
  present condition
   
- Administered due meds as - These are pharmacologic
ordered defense administered on the
  NB to prevent infections esp
   with his susceptible and
  compromised condition
   
- Kept on close watch - To immediately prevent
untoward signs and symptoms
 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-Esteem
A 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 Situational After a day of - Established trust and - To be able to gain their trust and After a day of
  low self- nursing rapport cooperation and facilitate good nursing
O: esteem r/t interventions, the   intervention interventions, the
-loneliness newborn significant others     significant others
-slip of the son’s esp the parents - Determined each - To know current general esp the parents
tongue self physiologic will be able to   individual situation related condition of the family member was be able
negating impairment identify feelings to low self-esteem that is   to  sort out their
verbalizations s due to a and underlying brought about by the   feelings and
- indecisive genetic dynamics for present circumstances   underlying
behavior anomaly 2º negative   -  To know what are the dynamics for
  disease perception of the -  Encouraged expression of appropriate action on how to deal negative
condition condition and be feelings anxiety   on expressed source of feelings of perception of the
able to   anxiety condition of their
demonstrate     son and was able
behaviors to - Assisted clients to -  Enhances commitment to plan, to commit in
restore positive problem-solve situation, optimizing outcomes demonstrating
self-esteem in light developing plan of action   behaviors to
of the current and setting goals to achieve   restore positive
situation desired outcome   self-esteem in
    light of the
- Assessed emotional and - To determine the emotional and current situation
psychological factors psychological response of each
affecting the current family member of the patient
situation regarding the disease condition
Deficient Knowledge
It 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 Deficient After 8 hours - Assessed current understanding of - Effective planning is based on a After 8 hours
kaya siya Knowledge of NI, the treatment and follow-up care. clear understanding of the needs of NI, the
nagkaganito?, related to family, will   of the patient and family members family, did
as stated new eagerly   who will assume caregiver roles. eagerly
  condition and participate in     participate in
O: treatment and the learning - Determined if hazards exist in the home -To prevent patient from injury. the learning
  cognitive process and that will compromise the patient’s ability to   process and
-Verbalizes limitations. will verbalize be effectively mobile at home.   demonstrated
inadequate understanding   understanding
knowledge of of the - Performed with them the prescribed - Regular exercise is necessary to of the
care/use of condition exercises several times a day for the pt as maintain muscle tone and condition
immobilization process and ordered. promote healing. process and
device, mobility treatment and     treatment.
limitations, then will -Early assessment and prompt They also
complications, assume - Identified and taught to report to physician reporting reduces the risk of assumed
and follow-up responsibility signs of neurovascular compromise of injury or complications responsibility
care. for fully taking extremity: pain, numbness, tingling,   for fully taking
- SOs expresses care of the burning, swelling, or discoloration.   care of the
concerns about baby properly   - This promote good health and baby properly
ability to even with no - Taught about proper nutrition suitable for prevents constipation. even with no
manage further the pt.   further
independently assistance   - Ability to perform self-care assistance
at home. from the procedures using proper aseptic from the
- Confusion; nursing staff - Involved all the caregiver in procedures. technique decreases risk of nursing staff
asking multiple Supervised those performing procedures infection and optimize therapeutic
questions- and taught of proper technique like in effect in the home care
aseptic technique, changing clothes and environment.
diaper, handling the baby and using splints.  
  - Efforts to enhance self-care
- Provided SO with sample medical supplies abilities promotes successful
and assistive devices needed like splints transition/ accommodation to
Readiness for Enhanced Therapeutic Regimen
Therapeutic 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 Readiness for After 8 hours of - Established rapport - To gain family’s After 8 hours of NI,
  enhanced NI, the SOs will   trust the SOs was able to
O: therapeutic demonstrate     understand
- compliance to management proactive - Checked and recorded - Baseline data indepthly the need
medical regimen in management by VS   to demonstrate
management  preparation to actively   -To provide adequate proactive
- willingness to do home care. participating in - Monitored pt’s general Interventions as management by
Doctor’s orders in treatment condition needed actively
caring for the baby regimen of their     participating in
the right way not in pt.   - Serves as a treatment regimen
the way they know is - Gave due recognition to motivation to of their pt.
right the SO’s initiative to continue desirable
- eagerness to learn comply with medical behavior
ways to prevent management  
further   - Knowing the
complications - Empowered pt’s whole benefits of treatment
family who are present to makes the baby’s
manage illness by primary caregiver
explaining actions of understand
drugs and benefits from the importance of
complying to course of such interventions in
treatment. Also explained maintaining the
the lifelong treatment desired health
process in which they outcomes for Baby
have to be with the pt Lucky Son’s disease
supporting him all the way management
   
VIII. DISCHARGE CARE PLAN / HEALTH
TEACHING
THE END….

THANKS FOR LISTENING 