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Pediatric Patient: Carlos, Discharge Plan: The team will aid in Carlos'…
Pediatric Patient: Carlos
Care Issue 3: Continued Evaluation of Carlos
Social Work Input:
Aid with transportation and lodging if Carlos/family needs to travel, identify the closest lab and ED, coordinate care to minimize multiple trips to specialists to avoid parent taking time off work, follow Medicaid requirements as to avoid lapse in insurance coverage.
Dental Input:
Recommend how often Carlos has cleanings, prioritize procedures, manage oral side effects that may develop due to cancer therapy.
NP/Physician Input:
Decide how often Carlos should follow up with his care team, timing for routine lab work and diagnostic imaging, communicate timing of immunosuppressive periods to team.
Registered Nurse Input:
Administer/teach family about analgesics to promote comfort with oral care and relieve pain associated with mucositis (Linder et al, 2017) Review treatment plan with patient/his family, provide a written copy as reference upon discharge.
Care Issue 2: Transition Back
into School/Normal Activities
Social Work Input:
Perform cognitive assessment to evaluate cognitive effects of cancer (NASW). Coordinate with teachers and administrators a continuity in education plan, offer homeschool options, evaluate psychological and social effects of cancer (NASW).
Dental Input
: Recommend oral care throughout day, foods to avoid- encourage non-cariogenic diet (Guideline on Dental Management, 2013).
NP/Physician Input:
Monitor health status and guide speed of transition, sign any paperwork required for school records
Registered Nurse Input:
Provide patient and mother with education regarding how to address patient needs while at home/school, and give family contacts of who to call/contact in case questions arise.
Care Issue 4: Continued Monitoring of CLABSI
Social Work Input:
Ensure patient knows locations of laboratory sites close to home, set up home health services.
Dental Input:
Continued evaluation for signs of infection that may provoke a systemic infection (Bertl & Stavropoulos, 2017). Identify causative factors for Carlos' resistance to proper oral hygiene with prior CLABSI (dental sensitivity/pain, nausea, oral bleeding) (Guideline on dental management, 2013)
NP/Physician Input:
Discuss antibiotic prophylaxis prior to routine dental maintenance r/t hematological considerations. (Guideline on dental management, 2013)
Registered Nurse/Home Health Nurse Input:
Ensure patient and family are educated on proper procedure in cleaning and doing dressing change for central line. Educate family members on signs of infection, instruct when to come to the hospital for care, and how to get supplies needed to maintain central line
Care Issue 1: Oral Hygiene
Social Work Input:
Ensuring access to supplies and dental care at home, connect patient with a program similar to Chemo Without Cavities (oral assessment and flouride varnish) (Hartnett & Krainovich-Miller, 2017)
Dental Input:
Communicate with team members the comprehensive oral care plan. Communicate changes in oral health i.e.: dental caries, endodontic needs, urgent care. Identify patient/family preventive strategies for oral hygiene i.e.: fluoride, lip care, diet. (Valera et al, 2014)
NP/Physician Input
: Evaluate overall health in relation to oral health.
Registered Nurse Input:
Works with care team to understand goals and helps convey to patient and family at the bed side. Reinforces teachings of supplies needed, and proper techniques in performing tasks
Discharge Plan:
The team will aid in Carlos' transition back to school/home activities.
Discharge Plan:
The team will continually monitor Carlos' overall health upon discharge from inpatient hospitalization.
Discharge Plan
: The team will prevent CLABSI infection.
Discharge Plan:
The team will monitor and treat Carlos' oral health to maintain optimal health.
Interprofessional Team Communication in Treatment Planning for Pediatric Oncology Patient
Communication plan if issues arise:
The dentist will lead oral hygiene care, requesting input from team members if changes in oral health arise.
Communication plan if issues arise:
The social worker will lead transition back into normal activities, requesting assistance from team members when obstacles arise.
Communication plan if issues arise:
The NP/Physician will lead the continued health evaluation and will communicate changes in treatment/patient status to all team members.
Communication plan if issues arise:
The registered nurse will lead infection prevention and will communicate to all team members changes in patient's vital signs, lab work, mentation, s/sx of systemic infection.
References
Guideline on Dental Management of Pediatric Patients Receiving Chemotherapy, Hematopoietic Cell Transplantation, and/or Radiation Therapy. Pediatric Dentistry. 2013;38(6):334-342.
Hartnett, Erin, Krainovich-Miller, Barbara (2017) Preventive Dental Care: An Educational Program to Integrate Oral Care into Pediatric Oncology. Clinical Journal of oncology nursing 21(5):611-616.
Linder LA, Gerdy C, Abouzelof R, Wilson A. (2017) Using Practice-Based Evidence to Improve Supportive Care Practices to Reduce Central Line–Associated Bloodstream Infections in a Pediatric Oncology Unit. Journal of Pediatric Oncology Nursing 34(3):185-195.
Valera, Marie-Cecile, Noirrit-Esclassan, Emmanuelle, Pasquet, Marlene, Vaysse, Frederic. (2014) Oral complications and dental care in children with acute lymphoblastic leukaemia. Journal of Oral Pathology & Medicine, 44: 483-489.
National Association of Social Workers (NASW). Childhood Cancer Survivorship: An Overview for Social Workers. www.socialworkers.org