She seemed not used to be with other people and thus she show signs of low self-esteem. Meanwhile, if seeing LD as an adolescent (which usually happens to the children under the age 12-18), LD is also different from the other adolescents under this stage. It must be noted that this phase of life (adolescence), issues regarding identity and role confusion usually arises. This is the time when the adolescent integrate the healthy resolution of all earlier conflicts. Adolescents who have successfully dealt with earlier conflicts are ready for the "Identity Crisis," which is considered as the single most significant conflict a person must face (http://psychology.about.com/library/weekly/aa091500a.htm,2006). However, guidance from the older person is very important for a kid to successfully overcome such confusion.

The best possible source of guidance is the parent, and since LD is a girl, a mother is the best possible source of guidance for her. Since LD's mother just died, she has no one to look up to when it comes to 'girl things'.

Hence, LD's peculiar behavior can all be attributed to her situation wherein she has not had any chance of interacting with other children her age and her lack of mother whom she can turn to.

Planning and Implementation

Goal

First of the goal is to achieve normal medical/laboratory test result for LD. She must have normal glucose, potassium other components of the blood tests on her next laboratory test. Second, LD blurry vision and frequent attacks of headaches should be minimize and eventually eliminated. Lastly, LD's confidence or self-esteem must be enhanced in a way that she would learn to talk freely with all other kids her age.

Nursing Intervention and Rationale pediatric nurses are providing outstanding child-focused, family-focused, sensitive, and technologically-proficient care (Selekman, 2000).

To achieve better medical laboratory test result for LD, her diet must be enhanced. She needs more amount of carbohydrate and fruits to increase both her glucose and potassium level. She should be fed with the combination of bread, wheat, milk, banana and other fruits on her meals. If LD continuously complain about lack of appetite, nurses then...

Such as giving her reward or incentive if she eats what is served to her (Selekman, 2000).
Rewards may include game activities, hearing nice stories or small items such as ribbons, clips or headbands for her hair.

Regarding LDs blurry visions and headache attacks, nurses could then advice LD to minimize her reading activities for the meantime. Her eyes are affected by the impact of the accident. She should not over use her eyes. Instead, she must have extra long hours of rest and sleep, which is also good for to ease her headaches.

The nurses then could suggest other activities which would interest LD but will not make her use her eyes. One possible activity is listening to music. An MP3 player or a simple small radio component where LD could listen to music of her own choosing will relax her mind and eyes. She could fall asleep while listening to music. This then enable LD to rest her eyes, have a better sleep, thereby helping improve her blurry visions and eliminate headaches.

Nursing Action

Nursing intervention with regards to the foods to be served to LD will be done every meal. The nurses should also notify the parent, siblings and other friends or relatives who will visit LD (and who will bring some foods for her) about the kind of diet that LD should be having. Every time the nurses will check and visit LD, these people will always be reminded about the said diet and food intake.

The nurse' intervention regarding the suggested activity of listening to music instead of reading will be done immediately. If it has been done, the nurse will then check from time to time if LD still suffers from blurry vision and headaches (even if she has gradually stopped reading or over using her eyes).

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