Develop a discharge plan with three goals listed in order of priority before discharge from current orders. Provide a rationale for why you listed the goals in a particular order. Also, list three nursing interventions to meet each goal (you should have nine interventions in total). Last, the mother should give the child the exact dosage to provide acetaminophen, ibuprofen, and cefuroxime when she gets home and explain why the actual dosage is important.
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?
Discharge Plan for Gabriel
Priority Goals Before Discharge
- Manage and control fever and pain
- Educate family on seizure management and medication administration
- Ensure proper care and follow-up for fracture
Rationale for Goal Prioritization:
- Manage and control fever and pain: Immediate control of fever and pain is crucial to prevent further febrile seizures and ensure comfort.
- Educate family on seizure management and medication administration: The family must understand how to manage seizures and administer medications correctly to prevent complications.
- Ensure proper care and follow-up for fracture: Proper care and follow-up are essential for the healing process of the fracture and to monitor for any complications.
Nursing Interventions to Meet Each Goal
Goal 1: Manage and control fever and pain
- Administer Acetaminophen: Provide acetaminophen as ordered (15 mg/kg).
- Intervention: Educate the mother on correct dosage calculation and administration technique.
- Rationale: To ensure accurate dosing and effective fever/pain management.
- Administer Ibuprofen: Provide ibuprofen as ordered (10 mg/kg).
- Intervention: Demonstrate how to measure and administer ibuprofen.
- Rationale: To reduce fever and alleviate pain effectively.
- Monitor Vital Signs: Regularly check Gabriel’s temperature and pain level.
- Intervention: Teach the mother how to monitor and record Gabriel’s temperature and pain.
- Rationale: To assess the effectiveness of medication and need for further intervention.
Goal 2: Educate family on seizure management and medication administration
- Seizure Precautions: Instruct the mother on safety measures during a seizure (e.g., pad side rails, have suction equipment ready).
- Intervention: Provide written instructions and a demonstration.
- Rationale: To ensure safety and proper response during a seizure.
- Medication Administration: Educate on the importance of adhering to the medication schedule and correct dosages.
- Intervention: Use teach-back method to confirm understanding.
- Rationale: To prevent medication errors and ensure effectiveness.
- Recognizing Seizure Activity: Teach the mother signs of seizure activity and when to seek emergency help.
- Intervention: Provide educational materials and contact information for emergency services.
- Rationale: To ensure timely and appropriate response to seizures.
Goal 3: Ensure proper care and follow-up for fracture
- Cast Care: Instruct the mother on how to care for the cast, including keeping it dry and signs of complications.
- Intervention: Provide a demonstration and written instructions.
- Rationale: To prevent cast-related complications and promote healing.
- Activity Restrictions: Explain the importance of limiting certain activities to prevent further injury.
- Intervention: Provide a list of activities to avoid and safe alternatives.
- Rationale: To protect the fracture site and ensure proper healing.
- Follow-up Appointments: Emphasize the importance of attending follow-up appointments with the pediatrician and orthopedic specialist.
- Intervention: Help the mother schedule these appointments before discharge.
- Rationale: To monitor healing and make any necessary adjustments to treatment.
Medication Dosages
Acetaminophen Dosage Calculation
- Order: 15 mg/kg
- Gabriel’s Weight: 48 lbs (21.8 kg)
- Dosage in mg: 15 mg/kg x 21.8 kg = 327 mg
- Acetaminophen Concentration: 160 mg/5 mL
- Dosage in mL: (327 mg / 160 mg) x 5 mL = 10.2 mL
Ibuprofen Dosage Calculation
- Order: 10 mg/kg
- Gabriel’s Weight: 48 lbs (21.8 kg)
- Dosage in mg: 10 mg/kg x 21.8 kg = 218 mg
- Ibuprofen Concentration: 100 mg/5 mL
- Dosage in mL: (218 mg / 100 mg) x 5 mL = 10.9 mL
Cefuroxime Dosage Calculation
- Order: 30 mg/kg PO BID
- Gabriel’s Weight: 48 lbs (21.8 kg)
- Total Daily Dosage in mg: 30 mg/kg x 21.8 kg x 2 = 1308 mg (not to exceed 1,000 mg/day)
- Recommended Dosage: 500 mg BID
- Cefuroxime Suspension: 250 mg/5 mL
- Dosage in mL per dose: (500 mg / 250 mg) x 5 mL = 10 mL per dose
Importance of Correct Dosage
Providing the correct dosage is crucial to ensure the effectiveness of the medications and to avoid potential side effects or toxicity. Under-dosing may lead to ineffective treatment, while overdosing can cause serious harm, particularly in pediatric patients.