Discharge plan

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 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.

Sample Solution

 

 

Title:

Variables prompting Frequent Readmission Rate in Impatient Psychiatric Wards in the UK – A Narrative Review of Literature

Survey Question: What variables lead to Frequent Readmission Rate in Impatient Psychiatric wards in the UK.

Presentation and Aim of the Review

The accentuation of moving consideration and backing of emotional wellness patients from mental establishments into network based settings has been the focal point of the UK government as of late. The issue of successive mental readmission rate or the ‘rotating entryway’ wonder presents critical difficulties to the usage of the mental deinstitutionalization strategy, (Langdon et a., 2001).

The point of this account writing audit is to assemble, combine and break down existing writing to discover the elements that lead to visit mental readmission rate in the UK. This would guide administration update and improvement work, just as invigorate further research and feature holes in the writing devoted to this region. The writing will be scrutinized utilizing the Critical Appraisal Skills Program (CASP), (CASP, 2018). In accordance with the Nursing and Midwifery Council set of principles, Confidentiality about the examination members will be kept up all through this writing audit, (Nursing and Midwifery Council (NMC), 2015).

Moral Statement

In inspecting the writing, the writer has guaranteed the writing audit is novel and no current writing is replicated. The writing utilized in this audit, has been dealt with precisely and decently. The writers of the writing utilized were not reached in light of the fact that their writing is now in the open area. Moreover, the account writing audit doesn’t mean to raise any moral issues or cause damage to any individual.

Issue, Context and Background

The UK government has set much accentuation on mental deinstitutionalization, that is moving consideration and backing to the network. Be that as it may, the issue of successive mental readmission represents a critical test, as it uncovered the delicacy of the system of psychological well-being administrations in the UK, (Langdon et a., 2001). The ramifications of successive mental readmission is that, in spite of the fact that patients are not for all time hospitalized, they have created constant psychological wellness sicknesses which are serious and industrious, these ailments for the most part meddles with their relational connections and social aptitudes which open them to visit mental readmissions. The marvel of successive rehospitalisation embodies another type of mental systematization. Moreover, the marvel of regular mental readmissions features the constraints of the emotional wellness administrations organize. Despite the fact that, right now the emotional wellness benefits in the UK are experiencing transforms, regardless they bear highlights of the old models, practices and issues which are yet to be survived. There has been explicit intercessions and network based consideration methodologies planned for lessening the pace of readmissions, (Vigod et al. 2013), in this way increasing a comprehension of the elements related with successive readmission would guide administration overhaul and improvement fill in just as invigorate further research.

Procedure

Search Strategy and Key Words

The writing search was directed utilizing Boolean hunt of the Discover Database. The Discover database was picked in light of the fact that it has a broad rundown of friend checked on diary articles in subjects of nursing, wellbeing, medication and psychiatry.

Considering the inclusion and pertinence of the writing audit, a Boolean hunt was led utilizing various blends of Descriptors (DeCS) in light of the survey question, for example, readmission and mental issue, readmission and psychological well-being, readmission and mental clinic, review and emotional well-being, review and mental medical clinic, review and mental issue, rehospitalisation and psychological well-being. rehospitalisation and mental emergency clinic, rehospitalization and mental issue.

Incorporation and Exclusion Criteria

The hunt was further thin down utilizing a consideration and avoidance parameters as depict underneath. The incorporation criteria were:

(1)articles that tended to the elements related with mental readmission, just as concentrates that assessed adequacy of mental patients changes from in-patient to network care and readmission (2) articles written in English, (3) articles distributed between January 2009 and January 2019; and (4) articles that displayed essential research results or studies; (5) articles for the most part on concentrates from UK and Ireland.

The accompanying rejection criteria were additionally settled:

(1) articles in the organization of a paper, postulation, book, book section, publication, remark or study, procedures and logical reports; (2) survey or intelligent articles on readmission by and large terms, that is, not select to psychiatry; (3) articles about mental readmission, which managed youngsters and youths; (5) articles that considered just long haul hospitalized patients.

At long last, the writer read through the edited compositions of the articles that met the consideration criteria , audited and evaluated them and 7 of the most reasonable articles from the pursuit were chosen and picked up endorsement to be utilized in the writing survey.

Information Extraction

Data in the chose articles was dissected, abridged and extricated to a Datasheet to help the writing survey process. The datasheet with the condensed data has the accompanying Headings;

Article (Full reference), Geography, Number of members, Study Method, Summary of the discoveries, Conclusions, (See Appendix 2)

Catchphrases:

Readmission, Readmitted, Recall, Rehospitalisation, Mental Health Hospital, Psychiatric Hospital,

Writing Review

Portrayal of studies

The articles chose for the survey incorporates a blend of both subjective and quantitative research examines. From the seven articles chosen, 4 articles utilized quantitative technique to complete their examination ponders (Tulloch et al. 2015; Puntis et al. 2016; Stefan et al. 2009; Attfield et al. 2017) and 2 articles utilized subjective plan in their examination considers, (Daly et al. 2017; Chiringa et al. 2014). One article utilized both subjective and quantitative plan in their methodology, (O’Donoghue et al. 2011).

Extensively, examine techniques are part into quantitative and subjective research. Ellis (2013), clarified that quantitative research primarily plans to clarify marvels by gathering numerical information that are examined utilizing scientifically and measurable based techniques. Quantitative research studies center around confirmation, and circumstances and logical results and the discoveries are introduced in numbers, tables and charts. Four of the chose articles (Tulloch et al. 2015; Puntis et al. 2016; Stefan et al. 2009; Attfield et al. 2017) utilized the quantitative methodology. Then again, Ellis (2013) expressed that subjective research centers around attempting to respond to inquiries regarding why and how individuals carry on with a specific goal in mind. It gives inside and out data about human conduct and marvel, two of the chose articles adopted this strategy, (Daly et al. 2017; Chiringa et al. 2014). In contrast with quantitative research, subjective research hopes to ponder what individuals think, accept, feel and get it. In contrast to quantitative research, it isn’t worried about demonstrating ideas. The more prominent level of the examinations took the quantitative philosophy, they planned to discover the causes or factors that prompts visit mental readmissions. Similarly, different investigations which adopted the subjective strategy had the option to find out the reasons for mental readmission as well as learn the perspectives and sentiments of patients who have been recently readmitted.

Detailing the Findings

Three primary subjects were recognized from exploring the writing articles. The three subjects that were recognized were, Clinical variables and readmission, Demographic and Socio-Economic components and readmission, Continuity of consideration and readmission. The select writing will be checked on utilizing these topics.

Clinical components and readmission

The investigation set up that, a patient dysfunctional behavior analysis is an anticipating factor the odds of readmission, The writing concentrates affirmed that after release the odds of readmission goes down rapidly, contingent upon the kind of finding. For example, Tulloch et al. (2015), revealed that patients determined to have character issue are bound to be readmitted contrasted with patient with schizophrenia at the hour of release.

In particular, the examinations called attention to that solitary a finding of character issue had a pessimistic relationship with regular readmission not long after release, in that patient determined to have character issue have an expanded mental readmission rate contrasted with patients determined to have other psychological wellness issue soon after release. In accordance with other research, to a great extent the examinations discovered that, there is a humble estimated impact of determination on readmission aside from the finding of character issue. In any case, It was noted structure the examinations that, despite the fact that the conclusion of character issue may be a foreseeing factor for successive readmission, almost certainly, other fundamental clinical impacts work when release which are not estimated for this high hazard patient gathering. For example, most patients determined to have character issue are known to express a lower fulfillment level with emergency clinic care with their first affirmation and have more odds of being readmitted inside 1 year after release. Additionally, resistance with endorsed prescription prompts improved probability of readmission regardless of the kind of analysis, (Rittmannsberger et al, 2004)

 

 

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