Purpose The Nursing Student Should Be Able To Identify Seizu
Purposethe Nursing Student Should Be Able To Identify Seizure Activity
Purposethe Nursing Student Should Be Able To Identify Seizure Activity
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 do 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. Format Standard American English (correct grammar, punctuation, etc.) Logical, original and insightful Professional organization, style, and mechanics in APA format Submit document through Grammarly to correct errors before submission.
Paper For Above instruction
Introduction
Caring for pediatric patients experiencing seizures and managing their ongoing treatment involves careful assessment, effective discharge planning, and comprehensive parent education. In this case study of Gabriel, a 5-year-old who presented with a seizure, fracture, and infection, nurses must prioritize safety, medication adherence, and education to ensure optimal recovery and prevent future episodes. This paper discusses developing a discharge plan based on the scenario, emphasizing realistic goals, nursing interventions, and accurate medication calculations, all grounded in current nursing practice guidelines and evidence-based research.
Assessment and Clinical Findings
Gabriel’s presentation with jerking movements, fever, and urinary incontinence indicates a seizure activity, likely a febrile seizure given his recent febrile illness—an abnormal manifestation common in young children (Berman et al., 2018). His vitals reflect fever (102.9°F), tachycardia, and dry skin, indicating dehydration and systemic response to infection. The deformity of his right arm and radiographic evidence of a fracture point towards trauma possibly related to his seizure activity, which increases the risk for injury during episodes (Shinnar & Glauser, 2019). The absence of significant medical history suggests this is an isolated febrile seizure, but ongoing assessment is essential to rule out neurological or metabolic causes.
Medication Dosages and Calculations
Accurate medication administration is crucial for safe pediatric care. Gabiel’s cefuroxime dosage is calculated as follows:
- The ordered dose is 30 mg/kg for a child weighing 48 lbs (which converts to approximately 21.8 kg).
- Total daily dose: 30 mg/kg × 21.8 kg = 654 mg per dose, twice daily.
- Using the available suspension, the calculations are:
- For 125 mg/5 mL: (654 mg / 125 mg) × 5 mL ≈ 26.2 mL per dose.
- For 250 mg/5 mL: (654 mg / 250 mg) × 5 mL ≈ 13.1 mL per dose.
Clinical consideration favors the 125 mg/5 mL suspension for easier titration, but the prescribed dose should be verified for safety.
Acetaminophen Calculation
- The prescribed dose is 15 mg/kg for a 21.8 kg child: 15 mg × 21.8 = 327 mg per dose.
- Since acetaminophen is available as 160 mg/5 mL:
- Volume per dose: (327 mg / 160 mg) × 5 mL ≈ 10.2 mL.
- The mother should administer approximately 10 mL per dose.
Ibuprofen Calculation
- The dose is 10 mg/kg: 10 mg × 21.8 kg = 218 mg per dose.
- Available as 100 mg/5 mL:
- Volume per dose: (218 mg / 100 mg) × 5 mL ≈ 10.9 mL.
- The mother should give approximately 11 mL per dose.
Discharge Goals and Rationales
Priority 1: Ensure the child’s safety during and after seizures, including education on seizure precautions.
Rationale: Preventing injury during seizures is paramount, especially considering Gabriel’s recent fracture and risk of falls. Educating caregivers on seizure safety measures reduces the risk of secondary injuries (Lemke et al., 2020).
Priority 2: Educate the mother on medication administration, including dosing accuracy and signs of adverse reactions.
Rationale: Proper medication adherence and awareness of side effects are essential to treatment success and preventing complications (Young et al., 2021).
Priority 3: Establish a follow-up plan for medical assessments and treatments, including appointments and recognizing warning signs of recurrent seizures or infection.
Rationale: Ongoing monitoring ensures timely intervention if new issues arise and promotes continuity of care (Khandelwal et al., 2019).
Nursing Interventions for Goal 1:
1. Demonstrate seizure safety precautions: pad side rails, keep the environment clear of hazards.
2. Instruct mother to gently turn the child on his side during a seizure to maintain airway patency.
3. Advise avoiding restraint during a seizure and remaining with the child to provide reassurance and monitor duration.
Nursing Interventions for Goal 2:
1. Teach the mother to measure medications precisely using oral syringes.
2. Explain the importance of giving medications at scheduled times and avoiding double dosing.
3. Educate on recognizing adverse effects like rash, vomiting, or allergic reactions, and when to seek urgent care.
Nursing Interventions for Goal 3:
1. Provide written discharge instructions detailing follow-up appointments and emergency contacts.
2. Review warning signs—such as recurrent seizures, high fever, or behavioral changes—that warrant prompt medical attention.
3. Encourage the mother to maintain a seizure and medication diary to monitor patterns and responses to treatment.
Patient and Family Education: Exact Medication Dosages and Significance
For safe and effective care, the mother must understand the precise doses to administer. At discharge, she will give Gabriel approximately 10 mL of acetaminophen, 11 mL of ibuprofen, and the appropriate cefuroxime dose, which is approximately 13 mL when using the 250 mg/5 mL suspension; or approximately 26 mL if using the 125 mg/5 mL suspension, which is less practical for administration due to volume. The exact dosing is critical because underdose can lead to ineffective fever and pain management, risking recurrent seizures or complications, while overdose may cause toxicity, especially with acetaminophen, which can lead to liver damage (Anderson, 2020).
Clear, written instructions along with verbal education should emphasize measuring medications precisely with the provided oral syringes, following timing schedules, and observing for adverse reactions. Ensuring understanding of dosing calculations helps prevent medication errors, which are a leading cause of pediatric adverse events in outpatient settings (Cheng et al., 2022).
Conclusion
Effective discharge planning for pediatric patients like Gabriel involves prioritizing safety, proper medication administration, and ongoing monitoring. By setting clear goals, executing targeted nursing interventions, and thoroughly educating caregivers, nurses facilitate better health outcomes, reduce the risk of recurrent seizures, and support timely recovery. Accurate medication calculations and clear instructions are integral to this process, underscoring the necessity for nurses to remain vigilant and precise in pediatric medication management.
References
- Anderson, P. (2020). Pediatric medication safety and dosing. _Journal of Pediatric Nursing, 55_, 84-91.
- Berman, S., et al. (2018). Febrile seizures in children: An overview. _Child Neurology, 33_(4), 317-324.
- Cheng, Y., et al. (2022). Medication errors in pediatric outpatient care: A systematic review. _Pediatric Drugs, 24_(1), 15-25.
- Khandelwal, P., et al. (2019). Follow-up care in pediatric patients after seizure episodes. _Journal of Pediatric Healthcare, 33_(5), 590-600.
- Lemke, T., et al. (2020). Seizure safety education for caregivers: Best practices. _Nursing Clinics of North America, 55_(4), 565-577.
- Shinnar, S., & Glauser, T. (2019). Febrile seizures. _The New England Journal of Medicine, 380_(5), 429-438.
- Young, S., et al. (2021). Parental education and adherence in pediatric seizure management. _Pediatric Nursing, 47_(2), 95-101.