Down Syndrome Nursing Diagnosis & Care Plan

Down syndrome (Trisomy 21) is a genetic disorder caused by the presence of an extra copy of chromosome 21. This nursing diagnosis focuses on addressing the unique healthcare needs, developmental challenges, and potential complications associated with Down syndrome to promote optimal patient outcomes and quality of life.

Causes (Related to)

Down syndrome patients may present with various challenges and complications requiring nursing intervention:

  • Genetic factors:
  • Trisomy 21 (extra chromosome 21)
  • Translocation
  • Mosaicism
  • Physical characteristics including:
    • Hypotonia (low muscle tone)
    • Distinctive facial features
    • Small stature
    • Single palmar crease
  • Associated health conditions such as:
    • Congenital heart defects
    • Gastrointestinal abnormalities
    • Thyroid dysfunction
    • Visual and hearing impairments
    • Increased risk of respiratory infections
    • Sleep apnea

Signs and Symptoms (As evidenced by)

Down syndrome presents characteristic features and associated health concerns that nurses must recognize for comprehensive care.

Subjective: (Patient/Family reports)

  • Developmental delays
  • Learning difficulties
  • Speech challenges
  • Fatigue during activities
  • Sleep disturbances
  • Feeding difficulties
  • Social interaction challenges

Objective: (Nurse assesses)

  • Distinctive physical features
  • Decreased muscle tone
  • Delayed developmental milestones
  • Short stature
  • Joint hypermobility
  • Cardiac abnormalities
  • Speech patterns
  • Cognitive function level

Expected Outcomes

The following outcomes indicate successful management of Down syndrome:

  • The patient will achieve developmental milestones within their capacity
  • The patient will maintain optimal physical health
  • The patient will demonstrate improved muscle strength and coordination
  • The patient will engage in age-appropriate social interactions
  • The patient will maintain adequate nutritional status
  • The patient will avoid complications
  • The patient/family will demonstrate an understanding of care requirements

Nursing Assessment

Physical Assessment

  • Evaluate vital signs
  • Assess growth parameters
  • Monitor developmental progress
  • Check muscle tone and strength
  • Evaluate cardiac function
  • Assess respiratory status
  • Monitor nutritional status

Developmental Assessment

  • Monitor cognitive development
  • Assess speech and language skills
  • Evaluate social interactions
  • Track motor development
  • Document milestone achievements

Health Screening

  • Monitor for complications
  • Assess vision and hearing
  • Check thyroid function
  • Evaluate sleep patterns
  • Monitor for signs of infection

Family Assessment

  • Evaluate support systems
  • Assess coping mechanisms
  • Document resources needed
  • Monitor caregiver stress
  • Evaluate home environment

Nursing Care Plans

Nursing Care Plan 1: Delayed Growth and Development

Nursing Diagnosis Statement:
Delayed Growth and Development related to chromosomal abnormality as evidenced by delayed achievement of age-appropriate developmental milestones.

Related Factors:

  • Genetic condition (Trisomy 21)
  • Muscle hypotonia
  • Cognitive challenges
  • Physical limitations

Nursing Interventions and Rationales:

  1. Assess developmental progress regularly
    Rationale: Enables early identification of delays and appropriate intervention
  2. Implement early intervention programs
    Rationale: Promotes optimal development and skill acquisition
  3. Provide family education and support
    Rationale: Enhances understanding and participation in developmental activities

Desired Outcomes:

  • The patient will show progress in developmental milestones
  • The family will demonstrate an understanding of developmental expectations
  • The patient will participate in age-appropriate activities within their capacity

Nursing Care Plan 2: Impaired Physical Mobility

Nursing Diagnosis Statement:
Impaired Physical Mobility related to decreased muscle strength and joint hypermobility as evidenced by delayed motor skill development.

Related Factors:

  • Muscle hypotonia
  • Joint laxity
  • Balance difficulties
  • Coordination challenges

Nursing Interventions and Rationales:

  1. Implement physical therapy exercises
    Rationale: Improves muscle strength and coordination
  2. Ensure safe environment
    Rationale: Prevents injuries while promoting mobility
  3. Encourage age-appropriate physical activities
    Rationale: Enhances motor development and confidence

Desired Outcomes:

  • The patient will demonstrate improved muscle strength
  • The patient will show enhanced coordination
  • The patient will participate safely in physical activities

Nursing Care Plan 3: Risk for Impaired Cardiac Function

Nursing Diagnosis Statement:
Risk for Impaired Cardiac Function related to congenital heart defects associated with Down syndrome.

Related Factors:

  • Congenital heart abnormalities
  • Increased pulmonary resistance
  • Structural cardiac defects
  • Circulatory system changes

Nursing Interventions and Rationales:

  1. Monitor cardiac status regularly
    Rationale: Enables early detection of complications
  2. Implement a prescribed cardiac care plan
    Rationale: Maintains optimal cardiac function
  3. Educate family about warning signs
    Rationale: Promotes early recognition of cardiac problems

Desired Outcomes:

  • The patient will maintain stable cardiac function
  • The family will demonstrate an understanding of cardiac care needs
  • The patient will show no signs of cardiac complications

Nursing Care Plan 4: Impaired Verbal Communication

Nursing Diagnosis Statement:
Impaired Verbal Communication related to developmental delays and anatomical differences as evidenced by difficulty expressing needs verbally.

Related Factors:

  • Speech delays
  • Anatomical differences
  • Cognitive challenges
  • Hearing impairments

Nursing Interventions and Rationales:

  1. Implement speech therapy interventions
    Rationale: Improves communication skills
  2. Utilize alternative communication methods
    Rationale: Ensures effective communication of needs
  3. Support the family in communication strategies
    Rationale: Enhances family-patient interaction

Desired Outcomes:

  • The patient will demonstrate improved communication abilities.
  • The patient will effectively express basic needs
  • The family will utilize effective communication strategies

Nursing Care Plan 5: Risk for Aspiration

Nursing Diagnosis Statement:
Risk for Aspiration related to poor muscle tone and coordination as evidenced by difficulty with feeding and swallowing.

Related Factors:

  • Decreased muscle tone
  • Swallowing difficulties
  • Anatomical differences
  • Coordination challenges

Nursing Interventions and Rationales:

  1. Position properly during feeding
    Rationale: Reduces risk of aspiration
  2. Monitor feeding and swallowing
    Rationale: Ensures safe food and fluid intake
  3. Implement feeding therapy recommendations
    Rationale: Improves feeding safety and efficiency

Desired Outcomes:

  • The patient will demonstrate safe feeding patterns
  • The patient will maintain adequate nutrition without aspiration
  • The family will demonstrate proper feeding techniques

References

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  3. Gonzaga, C. G., & Winokur, E. J. (2022). Care of Adults With Down Syndrome: The Nurse Practitioner Perspective. The Journal for Nurse Practitioners, 18(9), 935-940. https://doi.org/10.1016/j.nurpra.2022.06.012
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  6. Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
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  8. Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. 
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Anna Curran. RN, BSN, PHN

Anna Curran. RN, BSN, PHN I am a Critical Care ER nurse. I have been in this field for over 30 years. I also began teaching BSN and LVN students and found that by writing additional study guides helped their knowledge base, especially when it was time to take the NCLEX examinations.

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