Im a nurse doing a case senario on 6 yr old primary dx: cerebral palsy secondary seizures nos meds currently taking: prevacid 15mg/5ml bid polu visol/ iron 0.5ml bid which thought s/b qd viokase 0.375tab/3ml tid prevacid 15mg/5ml dose 7.5mg/2.5ml dose Q12 reglan 5mg/5ml dose 0.5mg/0.8ml qid thought more for cancer no wt given Has an absence seizure and tonic clonic also has bipap during naps qhs no times on mars need bpap settings thinking 8/4 has trach and im totally lost as to what size trach to have I chose 5.0 shiley and to call md abt seizure med w/think depakote, keppra, ativan 02 1/2 lpm via bipap can be up to 2.5 would think during grandmal seizure all meds via g/b which they have 4 fr which no such thing so i put 14 fr desperate for help on times which med to dc i have no experience with case management which rns do not lvns and just totally lost and desperate on which way to go and due by sunday pm would appreciate any help thank you
Person's Gender: Female
Person's Age: 6 yr old
dont know what direction
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Hello, For some reason your question was not initially posted to Pediatrics. Happy to try to give feedback on your answers. Are you to complete this assignment from the nursing standpoint? Not quite sure what is the question?
Please post back when you're online.
Yes from nurses standpoint and is for pediatrics never had experience with vent/bipap and we are to go in and answer with mars on hand ad lib notes etc.... most of the time when ive worked all times for meds etc.. are already set up has been to long ago to even remember. From what i can gather theyre trying to find out knowledge base but some of it is so vague and others unbelieveable as to why would a pt have a 4 fr g/b when no such thing. Have to give seizure activity of absence (petit mal) and tonic clonic (grand mal) dc a med get an order for tao (which already has neosporin prn) because pt has a crusty inflamed g/b and after calling md find out has had this health issue in past which is staph infection ordered amoxicillin 250mg/5ml bid and which is good handwashing technique etc... was going to do med order for maalox to dry area up first then apply tao, then get order for seizure med that covers both seizures and havent had to get order for medication and wt etc.. so trying to get insight knowledge and know one understands new forms so asking other nurses feel like blind leading the blind Lol but wanting to understand figured who better to ask than a neurologist and how meds times are setup for the meds listed, situation etc no its not an actual person just figured who better to ask someone who has knowledge and could help healthcare person have insight knowledge and HELP lol i thank u for any help given and direction
Go ahead and send me the actual question and your first try at answers and I'll make suggestions. I can barely understand what you say in your post.
ok did u get the very 1st inquiry?
Yes, I did.
I got the bkgd info on the case scenario. I cannot tell what is the QUESTION?
How is the question written in your assignment?
Just primary dx with secondary seizure nos with resp insufficiency she has nebs bid, sx prn vest, 4 fr mickey bolus which i chose 14F resp insuff/has albuterol bid/pulmicort bid 240ml pediasure x 5 feeds flushes , incontintent, parameters are T<100.5 HR-60-120 R-12-22 Spo2 greater 95% trach have to decide what size no clue to hookup to bipap/uses vent during sleep bpap mode adlib settings, g/b inflamed crusty which later find out has had staph previously so Im to call md for tao ( which has neosporin prn on mar) and find out abt previous staph infect (so is reacurrent)md calls in amoxil 250/5ml bid x 10 days can I get order for maalox bid prn to dry up prior to tao, then I observe absence seizure/tonic clonic does pt need to see neurologist first to get med if not thinking depakote, keppra ativan prn or dilantin,phenobarb?then use tao? Or how is that treated? Unsure of seizure meds what is prescribed for age appropriate depends on wt some say not for younger children some given older and what rx is truly given. Ive seen nurses give all meds together in 60cc syringe prevacid, phenobarb, robinol,keppra so i would like to get correct way. Im thinking to hard tired interruptions now grandchildren here so cant finish thought thru but jest of it
Treatment of a generalized seizure in this patient is simples A B C's. Airway Breathing Circulation. This is not about longer term meds issues. That will be for tomorrow or next week. Make sure the trach is not occluded, suction, protect airway, assess. Ativan or rectal diastat for GTC seizure longer than 5 min. Call 911.
Please ACCEPT if this helps get you started on your answer. Feel free to post YOUR answer and I will make suggestions. Post other Q's as much as needed, best of luck,
Hello? Any further questions?
Called office to get ext on paperwork Absolutely that is a must! So w/b safe to call get diastat for prn. How is that dose for a 6yr old dose rt ? Also depending on generalized 02 sats which I put 80 % 02 turned up to 5lpm. On the medications is there anything I would absolutely dc? I know I wouldnt get an order for TAO when its already a prn med for neosporin. Out of the meds unsure what to dc? Pancreatic med helps to break down and process, reglan for n/v if keep meds in a 24 hr time can i give together or break them apart 1 hr? Resp meds can give together.
You are not going to give any but emergency meds to a pt having a seizure. O2 on high 100% , no matter LPM. You are not going to worry about neosporin in a pt having a seizure - this is emergency management here.
I'M SORRY TRYING TO GET THE HIGHLIGHTED AREAS OF QUESTION ALL IN ONE. AT THIS MOMENT THERE IS NOTHING AVAILABLE SO I HAVE TO CONTACT ALL PARTIES RN,MD,PCG MY SCENARIO IS PT HAD ABSENT FOR 10SECS BEGINNING OF SHIFT THEN AT 730 /GTC FOR 1 MIN. SATS OK DID USE 02/FLUSH SO IF PT HAS CONCENTRATOR UP TO 5LPM AND 02 CYLINDERS W/AMBU BAG. I CHO0SE 02 CYLINDER W/AMBU AT FLUSH WHICH IS ALL THE WAY BEYOND 10 LPM. MY PT IS POST ICTAL SLEEPING VS WNL BUT I DO NEED ORDER FOR DIASTAT OR ATIVAN ASAP SINCE NONE AVAILABLE JUST PRAY DOESNT HAVE ANOTHER 5MIN OR LONGER THEN 911 OR DO I JUST GO AHEAD CONTACT 911 SINCE I DONT HAVE A CRYSTAL BALL. LOL
You don't give diastat if pt has stopped seizure activity. Pt needs eval in ED.
ITS THUNDERING / LIGHTNING SO HOPE ELECTRICITY DOESNT GO DOWN. SO FROM CASE SCENARIO I'LL NEED TO PUT GTC EITHER FIRST OF SHIFT OR TOWARDS END OF SHIFT I COULD PLACE AT 1ST OF SHIFT 0730 CALL 911 BECAUSE OVER 5MINS CONTACT EVERYONE THEN WOULD HAVE MED/THEN DO PAPERWORK ACCORDINGLY AT THAT TIME AT ER CAN INFORM DETECTED ABSENCE SEIZURE. BECAUSE PT SLEEPING FROM 1300-1500 SINCE NO EMERGENCY MED WHICH I DO UNDERSTAND DONT GIVE UNLESS ACTIVE SEIZURE, BECAUSE ITS SO VARIABLE CAN BE 1-5+ MINS WHICH IS TERMED STATUS EPILEPTICUS / ABSENCE SEIZURE CAN NOTE AT 1ST OF SHIFT BUT SOMETHING THAT NEEDS TO BE MONITORED. BECAUSE BRIEF AND CAN GO UNDETECTED BY EVERYONE. BUT IS VERY COMMON TYPE SEIZURE
I THANK YOU AND FOR YOUR TIME SO NOW WHAT I NEED IS WENT TO ER GOT ORDERS WHAT WILL THEY BE BECAUSE PREVIOUSLY STATED NEED WT WHICH ARE THE MEDS ON THE MAR GEARED TO 6 YR OLD AND WT? AND MED W/NAME HOW SUPPLIED WHAT DOSE ROUTE PER WT. WHAT I KNEW HOW TO DO 12YRS AGO DIDNT USE BECAUSE I WORKED ADULTS. NOW DOING PEDIS AND CASES IVE WORKED BECAUSE OF MD REG VISITS MEDS ALREADY FIGURED BY WT ON MAR. ONES I DID FIND WERE SIMPLY LIKE TYLENOL SUSP DROPS FIGURED WT AT SO MANY POUNDS AND THATS BEEN YRS AGO. AND THINGS I THINK HAVE CHGD WITH THAT MEDICATION/MEDS
I cannot tell you that. All meds are dosed by weight in children. Any pediatric reference text will give drug doses in mg/kg.
DO YOU HAVE ANY SUGGESTION ON VENT/BIPAP MODE SETTINGS?
What parameters can you set on the vent?
I CANT VENT TIDAL VOL RATE PEEP 02LPM PRES CONTRO PRES SUPPORT INSP TIME HI/LOW PRESSURE ALARM LOWMIN VOL ALARM BUT BIPAP CAN RUN THROUGH VENTS WHICH IF UNDERSTAND CORRECTLY BIPAP IS IPAP/EPAP WHICH I CHOSE 8/4 BUT DO I ALSO NEED ALL THE ABOVE SETTINGS I WOULDNT THINK SO BECAUSE ALL IT IS IS BIPHASIC INHALATION/EXHALATION SO THAT AVEOLI DONT COLLAPSE
I will critique your answers but will not answer for you. What have you learned in class and from reading about vent settings? BTW vents are typically set by an RT or MD not an RN.
MD ORDERS THEN SET BY RT OR IS SETUP AT HOME BY RT BUT HAVE TO HAVE AN ORDER. SO THATS ITS DONT HAVE ORDER SO NOT GOING TO DO IT. LOL SOMETIMES TIRED AND JUST DONT GET IT THANK YOU ONE LAST QUESTION PROMISE WITH THE MEDS THAT YOUR AWARE OF IS THERE ANY REASON WHY THEY ALL CANT BE GIVEN TOGETHER?
Reglan increases rate of gastric emptying and intestinal transit time so would be given by itself not within 30 min of food or other med.
Pediatrician, Board-certified in Ped Hematology/Oncology