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 A SBAR
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free pediatric source if you are struggling to find Rxpedi info):
Collaborative Management: Rationale for Interventions t &Expected Outcomes (Epocrates online is a good
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Care Provider Orders: |
What is the therapeutic dose for your patient (medications)? |
Nursing Implications: |
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43 pounds & 12 oz (convert tokg) Acetaminophen: 275 mg every 4-6 hours PRN forfever > 101 or Pain. Do not exceed more than 5 doses in 24hours. Lorazepam: 2 mg slow IV push and notify MD Fosphenytoin: 388mg IV to be administered over7 minutes for Status Epilepticus after diazepam and notifyingMD Phenobarbital 580 mg IV over 20 minutes afterFosphenytoin given Titrate oxygen at 1-2 L per min via FM up to 4 L per minto maintain O2 > 94% IV D5 NS @ maintenance rate if takingadequate Schedule EEG Diastat (rectal diazepam) |
Therapeutic range 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 Fosphenytoin 20mg/kg/dose Is this safe dose? Therapeutic range for Loading dose of Phenobarbital is20-40mg/kg/dose Is this safe dose? ABC’s of Status epilepticus? What is maintenance per day? Per hour? What is this diagnostic test? Teaching? |
Hint: What do you monitor for? What are contraindications orwarnings? Hint: How fast would you give it IV? What would you monitorwhile giving? What should the nurse monitor? What should the nurse monitor? What is the differencebetween loading and maintenance dose? LIST ABC’s |
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Patient name: Lia Lee DOB:04/05/20xx MR#: 360078 Age:5-year-old Gender: female Weight: ____kg |
Diagnosis: Seizure
Allergies: NKDA |
