I. Data Collection:
History of Present Problem:
Lia is a 5-year-old female who is previouslyhealthy with a history of ear infections. She lives with parentsand 8-year-old brother. She is in kindergarten and attends anafter-school program with her brother Chua.
History of Present Complaint to ER:
Lia arrived at the ERafter her afterschool director called 911. Lia was in the gym whenthe after-school staff noticed that she seemed to be flushed andbegan shaking. The director called 911 and another after- schoolstaff called the parents. The seizure activity lasted “about 5minutes” per after- school staff prior to EMS arriving. EMSadministered rectal diazepam (5 mg PR), applied oxygen 1 liter forlow oxygen saturation of 90% and the seizures stopped. Theyobtained a full set of vital signs (T: 99.5 ax, HR: 150, RR: 40& O2: 94% on 1l fiO2) and continued to monitor her untilarrival at local hospital. The after- school staff reported thatthey were able to contact Lia’s mother and father and they willmeet come to the ER. (ER report SBAR on back sheet) The ER startsan IV at maintenance rate per hour and obtains a Lumbar Puncture,CBC w/differential, Electrolyte panel. All results are pending.
COMPLETE THE SBAR
Seizure Precautions Oxygen/suction Strict I&O What arethese? Why?
Why? free pediatric source if you are struggling to find Rx pediinfo): Collaborative Management: Rationale for Interventions t& Expected Outcomes (Epocrates online is a good Care ProviderOrders:
What is the therapeutic dose for your patient (medications)?Nursing Implications: 43 pounds & 12 oz (convert to kg)Acetaminophen: 275 mg every 4-6 hours PRN for fever > 101 orPain. Do not exceed more than 5 doses in 24 hours. Lorazepam: 2 mgslow IV push and notify MD Fosphenytoin: 388mg IV to beadministered over 7 minutes for Status Epilepticus after diazepamand notifying MD Phenobarbital 580 mg IV over 20 minutes afterFosphenytoin given Titrate oxygen at 1-2 L per min via FM up to 4 Lper min to maintain O2 > 94% IV D5 NS @ maintenance rate iftaking adequate Schedule EEG Diastat (rectal diazepam) Therapeuticrange acetaminophen is 10-15 mg/kg/dose What’s safe dose range?Therapeutic range for Lorazepam is 0.05-0.1 mg/kg/dose (Max4mg/dose IM/IV) Safe dose? Therapeutic Loading dose of Fosphenytoin20 mg/kg/dose Is this safe dose? Therapeutic range for Loading doseof Phenobarbital is 20-40mg/kg/dose Is this safe dose? ABC’s ofStatus epilepticus? What is maintenance per day? Per hour? What isthis diagnostic test? Teaching? Hint: What do you monitor for? Whatare contraindications or warnings? Hint: How fast would you give itIV? What would you monitor while giving? What should the nursemonitor? What should the nurse monitor? What is the differencebetween loading and maintenance dose?
