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.
