Prioritize nursing interventions when caring for pediatric clients with health disorders|Essay pro

Posted: February 20th, 2023

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.

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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.

SOLUTION

As the nurse assigned to care for Gabriel, your initial priority is to assess and identify any signs of seizure activity and provide appropriate interventions. You will also need to educate the family on how to manage seizures, implement safety measures to prevent injury, and treat any fractures. Additionally, you will need to develop an individualized plan of care for Gabriel to support his discharge from the hospital.

To prioritize nursing interventions for Gabriel, you can follow the steps below:

  1. Perform a thorough physical assessment of Gabriel, including vital signs, neurologic assessment, and assessment of the right-upper extremity deformity. Document your findings in the patient’s medical record.
  2. Assess for any signs of seizure activity, including jerking movements, loss of consciousness, incontinence of urine or stool, and postictal state. Administer emergency seizure medications if necessary.
  3. Implement safety measures to prevent injury during seizures, such as removing any sharp or dangerous objects from the patient’s surroundings and ensuring that the patient is positioned safely.
  4. Provide education to the family on how to manage seizures, including what to do if a seizure occurs, how to administer emergency seizure medications, and when to seek medical attention.
  5. Treat any fractures or other injuries that Gabriel may have sustained during the fall, including providing pain management and immobilization as appropriate.
  6. Develop an individualized plan of care for Gabriel based on his assessment data, including goals, interventions, and expected outcomes. Involve the family in the care plan to ensure that they are informed and able to participate in their child’s care.

Remember to communicate effectively with Gabriel and his family throughout the care process, using language and communication methods that are appropriate for their cultural and linguistic backgrounds. Document all nursing interventions and patient responses in the medical record to ensure continuity of care.

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