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.
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.
- QUESTION
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.
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