Discharge plan

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Develop a discharge plan with three goals listed in order of priority before 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 goal (you should have nine interventions in total). Last, the mother should give the child the exact dosage to provide acetaminophen, ibuprofen, and cefuroxime when she gets home and explain why the actual dosage is important.

 

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?

 

Sample Solution

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.

 

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