Nursing Interventions when Caring for Pediatric Clients with Health Disorders

Nursing Interventions when Caring for Pediatric Clients with Health Disorders

Discharge plan

Goals of the Discharge Plan and Nursing interventions

First Goal: Preventing seizures from occurring and treating occurring seizures promptly

The first goal is to treat any seizure that occurs promptly and to prevent recurrence of seizures. After being diagnosed with a seizure, it is common for the seizures to reoccur. Therefore, the nurse should teach the patient how to deal with seizure episodes when they occur and how to prevent the seizures from reoccurring. When not prevented or managed in the correct way, seizures can lead to injuries or even death (Buelow, Miller & Fishman, 2018). Therefore, the top priority is to ensure the family members can prevent the seizure from occurring or manage any episode correctly when it occurs (Buelow, Miller & Fishman, 2018). This will reduce injury and other complications of the seizures. Effective management of seizures requires that any person around during the episodes should act promptly.

Nursing Intervention

The first nursing intervention is to teach the family members the importance of adhering to medications. The family members or parents should always ensure that the client adheres to seizure medication, preventing seizures from reoccurring.

The second intervention is to teach the patient the warning signs or aura of seizures and how to manage them (Gutierrez et al., 2018).

The third intervention is to ensure the safety of the client. Since the client is at high risk of developing seizures, the environment should be kept clean and safe (Buelow, Miller & Fishman, 2018). The client should always be away from sharp objects, fire, or any object that may lead to harm.

The fourth intervention is to teach the family members what to do when a seizure occurs. This includes positioning the client in the best position, putting the client on oxygen, and identifying danger signs to observe for the client to be rushed to the hospital (Gutierrez et al., 2018). The family members will be able to deal with the seizure episodes when they occur when trained.

Second goal: Manage ear infection and prevent complications of the infection

The client is diagnosed with a right ear infection, and therefore, the second goal is to manage the ear infection and prevent complications of the ear infection. Ear infection can lead to complications such as loss of hearing. The infection can also spread to other parts of the body, such as the nervous system. Therefore, the ear infection should be managed properly to prevent complications.

Nursing Interventions

One of the interventions to manage the ear infection is to teach the client’s family members the importance of adhering to the antibiotics prescribed (Szmuilowicz & Young, 2018). The client should adhere to the cefuroxime and complete the dose as prescribed to manage the ear infection.

The second intervention is to teach the importance of hygiene and sanitation. The child should be kept in a clean environment and should keep the body clean, especially the ear. Proper cleaning of the ear should be explained to family members (Szmuilowicz & Young, 2018).

The third intervention is to teach the family members to ensure the child does not insert foreign objects into the ear or use headphones. Any material inserted into the ear can be the source of more infection, leading to complications.

Third Goal: Reducing the risk of falling

On assessment, the client has a history of seizures and upper extremity deformity. Based on these assessments, the client is at risk of falling. Being a child also increases the risk of falling. Therefore, the third goal is to reduce the risk of falling. Reduction of the risk of falling will reduce complications such as head injury or fractures (Gutierrez et al., 2018). It will also reduce the risk of infections.

Nursing Interventions

The first nursing intervention to teach the family members is to improve the lighting of their rooms. Proper lighting will reduce falls since the patient will see the areas that can lead to falls, such as slippery floors, and act accordingly (Gutierrez et al., 2018).

The other intervention is to teach the patient how to use rails or support equipment. Rails should be placed in areas such as patient’s beds and bathrooms. Alarms should be placed in various areas of the house so that in case of an episode, the client can use the alarms to notify members around (Gutierrez et al., 2018).

Lastly, the final intervention involves the client not being allowed to perform any heavy activity. Making name tags for the client also helps the public manage the client well in case of a seizure in public places.

Dosage for the Medications Prescribed

The client is prescribed acetaminophen, ibuprofen, and cefuroxime. Since the client is 5 years old, the dosage of the medication will be calculated using the child’s weight. The client’s weight is 48 lbs, which, when converted into kg, becomes 21.77 kilograms.

Acetaminophen dosage 

The client is on oral acetaminophen 15 mg/kg every 4 hours PRN for pain and fevers. Therefore, the required acetaminophen is found by multiplying 15MG x 21.77kg (48lbs)=326.55mg/21.77kg. For 125mg/5ml acetaminophen, we divide the desired dose 326.55mg by 125mg; the stock dose then multiplied the result by 5mls of the stock volume. 326.55mg / 125mg x 5ml =2.608 x 5ml =13mls. Thus, 13mls should be given for the 125mg/5ml acetaminophen suspension. For 250mg/5ml acetaminophen suspension, we divide the desired dose 326.55mg by 250mg, then multiply by 5mls. Hence, 326.55mg/250 mg X 5ml =1.3 X 5ml =6.5ml. Thus, for 250mg/5ml acetaminophen suspension, the client will be required to take 6.5mls.

Ibuprofen dosage

The prescription is per oral ibuprofen 10 mg/kg Q6 hours PRN fever and pain for up to 3 days. The desired dosage: 10MG x 21.7kg (48lbs) =217mg/21.7kg. For 125mg/5mls suspension: 217mg/ 125mg x 5ml =1.7x5ml =8.5ml. Therefore, the client should take 8.5 mls for 125mg/5mls suspension. For 250mg/5ml suspension: 217mg 250mg x 5ml =0.86 X 5ml =4.3ml. Thus, the client should take 4.3 mls suspicion for 250mg/5ml suspension.

Cefuroxime Dosage.

The prescription is per oral cefuroxime 30mg/kg twice a day for 10 days and should not exceed 1000mg daily. The desired dose is 30mg x 21.7kg =651mg/21.7kg. For 125mg/5ml suspension; 651mg / 125mgx 5ml =5.2 mg x 5ml =26ml. For 250mg/5ml; 651mg) / 250mg x 5ml=2.6 x 5ml =13ml. The client, therefore, will have to take 26 of 125mg/5ml cefuroxime suspension or 13 mls of 250mg/5ml cefuroxime suspicion.

References

Buelow, J., Miller, W., & Fishman, J. (2018). Development of an epilepsy nursing communication tool: improving the quality of interactions between nurses and patients with seizures. The journal of neuroscience nursing, 50(2), 74.

Gutierrez, E. G., Crone, N. E., Kang, J. Y., Carmenate, Y. I., & Krauss, G. L. (2018). Strategies for non‐EEG seizure detection and timing for alerting and interventions with tonic-clonic seizures. Epilepsia, 59, 36-41.

Szmuilowicz, J., & Young, R. (2018). Infections of the Ear. Ear, Nose, and Throat Emergencies, An Issue of Emergency Medicine Clinics of North America, E-Book, 37(1), 1.

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Module 08 Content

Purpose

The nursing student should be able to identify seizure activity, educate the family and or caregiver of the pediatric patient on what to do if a seizure occurs and what medications to administer, and implement safety to prevent injury and treat 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 arrived in the emergency room; no cultural considerations identified. You are handed the following notes on the patient that read:

He arrived in the ER with his mother after falling out of bed after jerking movement activity, as witnessed by his older brother while sleeping. The right upper extremity appears with deformity. Mother and child speak English. The child has no significant medical history. The mother reports incontinent of urine during the 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 the bedside with seizure precautions
Radiographs of the right arm
Cast to right arm
Start PO fluids and increase as tolerated

The physician discharged Gabriel from the 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 250/5ml?
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 at 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 a 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 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
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