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).

QUESTION

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 100mg 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.
• What will be the dosage if the child take suspension and it comes in 125mg/5mls or 250/5mls?

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

ANSWER

“Discharge Plan for a 5-Year-Old Multiracial Male with Acute Febrile Seizure, Ear Infection, and Fractured Ulna: Goals, Nursing Interventions, and Medication Dosages”

Discharge Plan

Goal 1

Manage the Acute Febrile Seizure and Ensure Safety

Rationale: The safety and well-being of the child are of utmost priority. Managing the acute febrile seizure and implementing measures to prevent further seizures is crucial to provide immediate relief and reduce the risk of harm.

Nursing Interventions

Provide seizure precautions: Pad side rails to prevent injury during future seizures.

Educate the mother on seizure management: Teach her to position the child on their side during a seizure, clear the area of any potential hazards, and provide reassurance and comfort to the child during and after the seizure (National Academies Press (US), 2012).

Teach the mother to monitor and record seizure activity: Instruct her to keep a seizure diary noting the date, time, duration, and any observed triggers or associated symptoms. This information will be helpful for further evaluation and management.

Goal 2

 Address the Right Ear Infection

Rationale: The diagnosis of a right ear infection indicates the need for appropriate treatment to resolve the infection, alleviate pain, and prevent complications. Addressing this condition is important for the child’s overall well-being and comfort.

Nursing Interventions: Educate the mother on proper administration of prescribed antibiotics: Instruct her to administer the cefuroxime suspension as prescribed by the pediatrician, emphasizing the importance of completing the full course of antibiotics.

 Provide pain relief measures: Advise the mother on the appropriate dosage and administration of acetaminophen and ibuprofen to relieve pain and reduce fever. Explain the importance of adhering to the prescribed dosage and frequency.

Teach the mother about ear care: Instruct her on proper ear hygiene, such as avoiding water entry into the ear, gently cleaning the outer ear with a clean cloth, and avoiding the use of cotton swabs, which can push wax deeper into the ear and potentially worsen the infection.

Goal 3

 Manage the Fracture of the Right Ulna

Rationale: The fracture of the right ulna requires appropriate management to facilitate healing, alleviate pain, and prevent further injury or complications (Rafi, 2023). Ensuring proper care for the fracture will contribute to the child’s overall recovery and well-being.

Interventions: Educate the mother on cast care: Instruct her on proper cast care, including keeping the cast dry, avoiding placing any objects inside the cast, and notifying the pediatrician if there are signs of skin irritation or increased pain.

 Provide pain management strategies: Teach the mother non-pharmacological pain relief measures, such as elevation and cold compresses, to help reduce swelling and alleviate discomfort.

Encourage follow-up with pediatric orthopedics: Emphasize the importance of the scheduled follow-up appointment to monitor the healing process, assess the need for any adjustments to the cast, and address any concerns or complications.

Dosages for Medications

Acetaminophen

The child’s weight is 48 lbs, which is approximately 21.8 kg.

The recommended dosage for acetaminophen is 15 mg/kg.

Thus, the child would require 327 mg of acetaminophen per dose.

The mother should administer the acetaminophen suspension accordingly based on the concentration available (125mg/5ml or 250mg/5ml) to achieve the required dosage.

Ibuprofen

The child’s weight is 48 lbs, which is approximately 21.8 kg.

The recommended dosage for ibuprofen is 10 mg/kg.

Thus, the child would require 218 mg of ibuprofen per dose.

The mother should administer the ibuprofen suspension accordingly based on the concentration available (125mg/5ml or 250mg/5ml) to achieve the required dosage.

Cefuroxime

The prescribed dosage is 30 mg/kg PO BID, not to exceed 100 mg daily.

The child’s weight is 48 lbs, which is approximately 21.8 kg.

The maximum daily dosage is 100 mg, so the mother should not exceed this limit.

The cefuroxime suspension is available in 125mg/5ml or 250mg/5ml concentrations, and the mother should administer the appropriate volume to achieve the prescribed dosage.

Importance of Exact Dosage

Administering medications at the exact prescribed dosage is crucial to ensure optimal therapeutic effects, minimize adverse reactions, and promote the child’s recovery. Medications are carefully dosed based on factors such as the child’s weight and specific condition, aiming to achieve the desired therapeutic response while minimizing the risk of toxicity (Kim, 2023). Deviating from the recommended dosage can lead to underdosing, reducing the effectiveness of the medication, or overdosing, potentially causing harm or adverse effects. Therefore, it is essential for the mother to accurately measure and administer the medications as directed by the healthcare provider to ensure the best outcomes for the child.

In summary, the discharge plan for Gabriel includes prioritizing the management of the acute febrile seizure and ensuring safety, addressing the right ear infection, and managing the fracture of the right ulna. The goals are listed in this order based on the immediate need for seizure management, followed by the importance of treating the infection and providing pain relief. Nine nursing interventions are outlined to meet these goals, including seizure precautions, medication education, and instructions for proper care. The mother is provided with the exact dosages for acetaminophen, ibuprofen, and cefuroxime based on the child’s weight and the available concentrations of the suspensions. Administering the exact dosage is crucial to optimize the therapeutic effects and minimize the risk of adverse reactions.

References

Kim, J. (2023, February 12). Medication Routes of Administration. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK568677/ 

National Academies Press (US). (2012). Educating People with Epilepsy and Their Families. Epilepsy Across the Spectrum – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK100608/ 

Rafi, B. M. (2023, January 21). Forearm Fractures. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK574580/