Discharge Plan for Gabriel (Age 5, 48 lbs)

Priority Goals (Listed in Order):

1. Reduce fever and discomfort: A fever can worsen Gabriel’s discomfort and potentially trigger another seizure.
2. Immobilize and promote healing of the fractured ulna: Proper immobilization with a cast is crucial for bone healing and preventing further injury.
3. Treat the ear infection: Treating the ear infection can prevent complications and further discomfort for Gabriel.

Rationale for Priority Order:

• Addressing the fever is most critical to prevent another seizure and ensure comfort.
• Immobilization minimizes pain and prevents further damage to the fractured bone.
• Treating the ear infection prevents complications and promotes overall healing.

Nursing Interventions:

Goal 1: Reduce Fever and Discomfort

1. Administer medications as prescribed: Ensure timely administration of acetaminophen and ibuprofen following recommended dosages based on weight.
2. Monitor vital signs: Monitor temperature regularly to assess the effectiveness of medications and identify any potential complications.
3. Encourage adequate hydration: Offer fluids frequently to prevent dehydration which can worsen fever.

Goal 2: Immobilize and Promote Healing of Fractured Ulna

1. Cast care education: Educate the mother on proper cast care, including keeping it dry, clean, and elevated when possible.
2. Pain management: Monitor pain levels and administer pain medication as prescribed.
3. Monitor for complications: Assess for signs of circulatory impairment, infection, or discomfort around the cast.

Goal 3: Treat the Ear Infection

1. Medication administration: Educate the mother on administering cefuroxime at the correct dosage and frequency.
2. Monitor for medication side effects: Advise the mother to watch for potential side effects like rash, diarrhea, or nausea.
3. Complete medication course: Emphasize the importance of completing the full 10-day course of antibiotics.

Medication Dosing:

• Cefuroxime: Based on Gabriel’s weight (48 lbs) and the prescribed dose (30mg/kg), the daily dosage is 1440mg (30mg/kg x 48 kg).
• Recommended suspension: 250mg/5ml (provides the most accurate dosing with minimal wasted medication).
• Dosage calculation: To deliver 1440mg, administer 5.76 ml (1440mg / 250mg/ml). Round down to 5.75 ml for a more practical measurement.
• Acetaminophen: For a 48 lbs child, the dose is 720mg (15mg/kg x 48 kg).
• Dosage calculation: Using the available concentration (160mg/5ml), administer 4.5 ml (720mg / 160mg/ml).
• Ibuprofen: For a 48 lbs child, the dose is 480mg (10mg/kg x 48 kg).
• Dosage calculation: Using the available concentration (100mg/5ml), administer 4.8 ml (480mg / 100mg/ml).

Educating Mother on Medication Dosing:

Explain to the mother the importance of using the exact medication dosage as prescribed.

• Overdosing can be dangerous: Too much medication can cause serious side effects.
• Underdosing can be ineffective: Inadequate medication won’t effectively treat the infection or manage fever/pain.
• Measure accurately: Use the provided measuring device (spoon or syringe) to ensure the correct amount is administered.

By following these discharge instructions and prioritizing the listed goals, Gabriel can recover comfortably at home with proper treatment for his ear infection, fracture, and potential future fevers.