Pediatric Data, Assessment, and Prioritization of Interventions

Pediatric Data, Assessment, and Prioritization of Interventions

Discharge Plan

First Care Plan: Febrile Seizure

The first goal of treatment is to manage the febrile seizure and to maintain the patient’s temperature within the normal range. This is important because hyperthermia can lead to febrile seizures, which usually happen in temperatures over 102.2 degrees Fahrenheit. These usually occur within the first day of illness and are usually harmless. The child may, however, injure himself during the seizure. The desired outcome would be for the child to have a normal temperature and will not experience any complications or sequelae that may arise from seizures and hyperthermia, such as injuries and brain damage. To achieve this,

Antipyretics need to be administered. These are usually NSAIDs. Tylenol and ibuprofen should be administered as indicated. These drugs lower the body temperature by reducing inflammation and promoting vasodilation, which reduces the body temperature by redistributing the heat and also through sweating. Hire our assignment writing services in case your assignment is devastating you. Our team of experts is ready to help.

The temperature will need to be monitored regularly by the nurse, and appropriate interventions will be taken to ensure it does not go beyond 102.2 degrees (Martin, 2019).

The child needs to be assessed for dehydration. This is because a high body temperature increases insensible fluid loss. The child should, therefore, be kept hydrated.

During seizures, the child develops impaired ventilation. To ensure that the child maintains a patent airway, the parent can be educated on the best position to place the child in the event that he has another seizure. This is the left lateral position which helps to prevent aspiration (Doenges et al., 2019).

Second Care Plan: Ulna Fracture

Another goal is to create the appropriate care plan for the ulna fracture. This is to ensure timely wound healing. Fractures can lead to peripheral neurovascular dysfunction. Fractures are also painful as this causes stress on the body, which might lead to a derangement in the patient’s vital signs, including an increase in temperature and heart rate. The desired outcome of this goal is to ensure the client maintains tissue perfusion as evidenced by palpable peripheral pulses, has normal sensations, is free of pain, and has stable vital signs. To achieve this:

The nurse should assess the injured extremity for swelling or edema. A comparison with the uninjured extremity should be made, and the appearance should be noted. An increase in diameter and tenderness might indicate the development of compression syndrome. This is a medical emergency that needs to be managed promptly (Doenges et al., 2019)

The nurse should evaluate the quality of the pulse distal to the fracture. An absent pulse may indicate the presence of vascular injury, and this may warrant immediate medical evaluation.

Any breaks in the skin should also be assessed as these may be the possible sites of entry of infection. The parents should be educated on ways to handle the child, including practicing hand hygiene before touching the area of the fracture or around the skin breaks (Vera, 2019).

Also, analgesics, i.e., Tylenol and ibuprofen, should be administered as prescribed.

Third Care Plan: Right Ear Infection

The third goal is to treat the right ear infection and prevent any complications that may arise from it. This is because the infection can be the cause of the fever in the patient, and resolving this could go a long way in preventing the febrile seizure. Also, the ear infection could disseminate into the bloodstream or spread to the meninges to cause meningitis. Meningitis can be fatal and is usually considered an emergency. Meningitis presents with fever, convulsions, etc. The desired outcome for this goal is that the patient will remain afebrile, and any potential complications of the ear infection will be avoided. To achieve this:

Antibiotic treatment should be started. Cefuroxime should be administered as indicated. The parent should be advised to make sure the recommended dose of antibiotic is completed. This will go a long way in preventing recurrent infections and complications.

The parent’s knowledge of ear infections needs to be assessed. This includes the risk factors, the causes, and what to do in the event of an infection (Doenges et al., 2019).

The parent will also be educated on the necessary measures required to prevent the chances of the infection from reoccurring, such as completing the prescribed dosage of antibiotics.

Rationale

When listing the goals, managing the seizure and the hyperthermia is the main priority so as to prevent the recurrence of seizures. This is also to ensure that the child does not get more injuries or complications. The next priority is to care for the fracture. This is important so as to manage the pain and prevent complications such as compartment syndrome and wound infection. This comes second because the orthopedic review is 7-10 days away. Splinting and assessing the wound is important to prevent further complications as the patient awaits the review. Lastly, the ear infection should be addressed as it may be the cause of the fever and also because it may spread to cause meningitis.

Dosage

Cefuroxime:

Recommended dosage for 125mg/5mL: 654.5 mg per dose or 26 mL per dose

Recommended dosage for 250mg/5mL: 654.5 mg per dose or 13 mL per dose

Acetaminophen (Tylenol):

Recommended dosage for 125mg/5mL: 13 mL per dose

Recommended dosage for 250mg/5mL: 6.5 mL per dose

Ibuprofen:

Recommended dosage for 125mg/5mL: 9 mL per dose

The recommended dosage for 250mg/5mL: 4 mL per dose (Vallerand et al, 2019)

Exact dosing is essential for safety purposes and to ensure the medication is effective. Giving a low dose of antibiotics can lead to failure of clearance of the pathogens and the development of resistant strains. Acetaminophen is hepatotoxic and nephrotoxic in high doses. The adverse effects of incorrect doses can be long-lasting or irreversible (Vallerand et al., 2019).

References

Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nursing care plans Guidelines for individualizing client care across the life span (10th ed.). Philadelphia: F.A. Davis

Martin, P. (2019, April). 4 febrile seizure nursing care plans. Nurselabs. https://nurseslabs.com/4febrileseizure-nursing-care-plans/

Vallerand, A. H., Sanoski, C. A., & Quiring, C. (2019). Davis’s drug guide for nurses (16th ed.). Philadelphia: F.A. Davis

Vera, M. (2019, September 10). 11 Fracture Nursing Care Plans. Nurselabs. https://nurseslabs.com/8-fracture-nursing-care-plans/7/

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Pediatric Data, Assessment, and Prioritization of Interventions
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 a multiracial male weighing 48 lbs with an allergy to penicillin, arrives in the emergency room, and no cultural considerations are 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 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 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 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.

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
Resources
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RUBRIC

Dosage
16% of total grade

Mastery: Advanced or exceeds achievement
The correct dosage is specified and the explanation for the exact dosage is skillfully explained.

Discharge Goals and Prioritization of Discharge Goals
33% of total grade

Mastery: Advanced or exceeds achievement
Goals are detailed and listed in order of priority. The rationale for the prioritization of the goals is explained in depth.

Nursing Interventions
40% of total grade

Mastery: Advanced or exceeds achievement
The nursing interventions are detailed and show a direct relation to the goals listed.

Spelling and Grammar
5% of total grade

Mastery: Advanced or exceeds achievement
Demonstrates an exemplary application of spelling and grammar.