Homework

Purpose

The nursing student should be able to identify seizure activity, how to educate the family and or caregiver of the pediatric patient on what to do if a seizure occurs and what medications to administer, implement safety to prevent injury and treatment of fracture. Develop education to support discharge based on assessment of data.

Competency

Prioritize nursing interventions when caring for pediatric clients with health disorders.

Scenario

A 5-year-old Gabriel is a multiracial male weighing 48 lbs with an allergy to penicillin arrives in the emergency room, no cultural considerations identified. You are handed the following notes on the patient that read:

He arrived in ER with his mother after falling out of bed after jerking movement activity as witnessed by his older brother while sleeping. Right-upper extremity appears with deformity. Mother and child speak English. Child has no significant medical history. Mother reports incontinent of urine during episode.

Your Assessment

Vital Signs: T 102.9, P 135, R 24, BP 118/60, O2 sat 100% RA

General Appearance: appears drowsy; face flushed, quiet

Neuro: oriented X3

Cardiovascular: unremarkable

Respiratory: lungs clear

Integumentary: very warm, dry

GI/GU: abdomen normal

Physician Orders

  • Complete Blood Count (CBC)
  • Complete Metabolic Panel (CMP)
  • Urinalysis with culture and sensitivity (U/A C&S)
  • Blood Cultures x 2
  • X-rays kidneys,
  • Influenza screening
  • Acetaminophen 15 mg/kg PO now
  • Ibuprofen 10 mg/kg PO now
  • Pad side rails
  • Suction at bedside with seizure precautions
  • Radiographs of right arm
  • Cast to right arm
  • Start PO fluids and increase as tolerated

The physician discharges Gabriel from ER to home with a diagnosis of; Right ear infection, Acute Febrile Seizure and fracture of the right ulna.

Discharge orders include:

  • Follow up with pediatrician in 7 days
  • Follow up with pediatric orthopedics in 7-10 days
  • Cefuroxime 30mg/kg PO BID for 10 days not to exceed 1,000mg daily. What is the recommended dosage if cefuroxime is supplied as an oral suspension 125mg/5ml or 250mg/5ml?
  • Acetaminophen 15 mg/kg PO Q4 hours PRN fever or pain and ibuprofen 10 mg/kg PO Q6 hours PRN fever and pain for up to 3 days
  • Acetaminophen is available as 160 mg/5 mL. Ibuprofen is available as 100 mg/ 5 mL.
  • What is the amount of acetaminophen in mg and ml per dose? What is the amount of ibuprofen in mg and ml per dose?
Instructions

Develop a discharge plan with three goals listed in order of priority, prior to discharge from current orders. Provide rationale for why you listed the goals in a particular order. Also, list three nursing interventions to meet each of the goals (you should have nine interventions in total). Last, give the mother the exact dosage she will need to give the child for acetaminophen, ibuprofen, and the cefuroxime when she gets home and explain why the exact dosage is important.

Answer:

Discharge Plan:

Goal 1: Prevent secondary infection and promote healing of the fracture of the right ulna. Rationale: A fracture can lead to the risk of infection, especially if the skin is broken. Preventing infection and promoting healing of the fracture is critical to prevent further complications.

Nursing Interventions:

  1. Educate the mother on proper cast care and the importance of keeping the cast dry.
  2. Provide instructions for wound care, including monitoring for signs of infection.
  3. Encourage the child to rest and avoid using the affected arm.

Goal 2: Manage fever and pain. Rationale: The child has a fever and a fracture, which can be painful. Managing fever and pain will increase the child’s comfort and promote healing.

Nursing Interventions:

  1. Educate the mother on the correct dosage and administration of acetaminophen and ibuprofen.
  2. Monitor the child’s temperature and pain level regularly.
  3. Provide comfort measures such as a cool cloth or a comfortable position.

Goal 3: Prevent future febrile seizures. Rationale: The child has had a febrile seizure and is at risk of having future seizures. Preventing future febrile seizures is essential to ensure the child’s safety.

Nursing Interventions:

  1. Educate the mother on seizure precautions and safety measures, such as padding the bed and avoiding water activities.
  2. Discuss the importance of following up with the pediatrician and orthopedist.
  3. Provide resources and information for the mother to access in case of future seizures.

Dosage: Cefuroxime oral suspension is supplied as 125mg/5ml. The child’s weight is 48 lbs, which is approximately 21.8 kg. The recommended dosage for Cefuroxime is 30mg/kg PO BID for 10 days, not to exceed 1,000mg daily. Therefore, the child will need 657mg (21.8kg x 30mg/kg) of Cefuroxime daily, divided into two doses of 328.5mg each (657mg/2). Since the oral suspension is supplied as 125mg/5ml, the child will need 26.3ml (328.5mg/125mg x 5ml) of Cefuroxime oral suspension for each dose.

Acetaminophen is available as 160mg/5ml. The recommended dosage for Acetaminophen is 15mg/kg PO Q4 hours PRN fever or pain. The child’s weight is 48 lbs, which is approximately 21.8 kg. Therefore, the child will need 327mg (21.8kg x 15mg/kg) of Acetaminophen for each dose. Since Acetaminophen is supplied as 160mg/5ml, the child will need 10.2ml (327mg/160mg x 5ml) of Acetaminophen for each dose.

Ibuprofen is available as 100mg/5ml. The recommended dosage for Ibuprofen is 10mg/kg PO Q6 hours PRN fever and pain. The child’s weight is 48 lbs, which is approximately 21.8 kg. Therefore, the child will need 218mg (21.8kg x 10mg/kg) of Ibuprofen for each dose. Since Ibuprofen is supplied as 100mg/5ml, the child will need 10.9ml (218mg/100mg x 5ml) of Ibuprofen for each dose.

It is important to give the exact dosage of medication to ensure the child receives the correct amount of medication for their weight

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