Peps C

Patient Introduction….(The 2 attached document are done by another student, its just an example for you to see how the prof wants it)….

Jackson Weber is a 5-year-old Caucasian male. He was diagnosed with generalized tonic-clonic seizures 2 years ago. Upon diagnosis, Jackson’s neurologist started him on oral phenobarbital. Jackson has been seizure-free until last night, when his mother brought him to the emergency department following a 3-minute tonic-clonic seizure. She is a single mother and the sole source of financial support.

Jackson has not seen his neurologist in 15 months due to his mother’s work schedule. Jackson was seen by his health care provider this morning and currently has an intravenous infusion in his left arm running D5 NS + 20 mEq KCl/L at 58 mL/hr.

He has been eating well, has urine output, and vital signs are stable. His pupils are equal and reactive to light. He is able to move all extremities equally. He is awake and alert and is watching cartoons. His mother is at the bedside.

Pediatric Nursing Care

  1. Kyle, T., and Carman, S. (2021). Essentials of Pediatric Nursing, 4th Edition.
  2. Seizure Disorders, Chapter 16, pp. 488-494
  3. Drug Guide 16.1, Chapter 16, pp. 487-488
  4. Common Medical Treatments 16.1, Chapter 16, pp. 486-487
  5. Promoting a Sense of Control, Chapter 8, pp. 209-212
  6. Promoting Safety and Safety in the Water, Chapter 5, pp. 132-134
  7. Physical Examination, Chapter 29, pp. 1033-1035

Diseases and Conditions

  1. Expert Clinical Content from Lippincott Advisor
  2. Seizure Disorder, Pediatric Seizure Disorder, Pediatric

Pharmacology

  1. Expert Pharmacological Content from Karch, A. (2015). Lippincott Nursing Drug Guide.
  2. Phenobarbital, pp. 953–955 Phenobarbital, pp. 953–955

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  • LWW.coPediatric Case 2

    Jackson Weber (Complex)

    Guided Reflection Questions

     

    Guided reflection. ….please change the wording to your own

    Spring 2021

    Pediatric Case 2: Jackson Weber (Complex)

    Guided Reflection Questions

    Opening Questions

    How did the simulated experience of Jackson Weber’s case make you feel?

    The simulation experience has been an eye opener. I was a bit nervous at the beginning because I did not know what to do when I first got in there. However, since I knew some seizure precautions, I was able to help the client. I felt good because I saved a life and I have also learned more about neurological examination.

    Describe the actions you felt went well in this scenario.

    A lot of actions I felt went well. However, the major ones were the fact that I was able to put the patient in the recovery position in order to help prevent airway obstructions, and also the administration of the 2L nasal cannula.

     

    Scenario Analysis Questions[footnoteRef:1] [1: The Scenario Analysis Questions are correlated to the Quality and Safety Education for Nurses (QSEN) competencies: Patient-Centered Care (PCC), Teamwork and Collaboration (T&C), Evidence-Based Practice (EBP), Quality Improvement (QI), Safety (S), and Informatics (I). Find more information at: http://qsen.org/ ]

    EBP List in order of priority your initial nursing actions identified for Jackson Weber based on physical findings and family interaction.

    Impaired gas exchange related to ineffective breathing. Jackson was admitted for seizure based on physical findings and family interaction. Also, the fact that client’s mother was unable to afford his seizure medications for a while, which had led to an uncontrollable episodes seizures.

    EBP What complications might Jackson Weber face if his symptoms are not recognized and treated in a timely manner.

    One of the greatest concerns is injury, therefore, the patient needs to have padded side rails while in bed. All restrictive clothes and items must be removed, and the client needs to be in a side lying position to prevent airway obstructions. Some complications that may occur are abrasions from the siderails if not padded. If adequate oxygen treatment is not implemented after seizure, it may lead to low oxygen level for the client, which could cause neurological problems.

    PCC What communication techniques should be initiated to decrease anxiety in Jackson Weber’s mother while simultaneously caring for him?

    To help decrease anxiety in Weber’s mother while simultaneously caring for him, the best communication technique to use is to explain to her that everything will been done to help Weber, in addition to giving him medication to help with the seizure activity, and answering all questions and concerns she may have.

     

    PCC/S What seizure precautions should be taken by the nurse in anticipation of and at the onset of Jackson Weber’s seizure? How might such precautions vary from hospital to hospital?

    Several precautions need to be taken in order to ensure safety of client, these includes placing pads alongside the rails of the bed, as well as removing any item from the bed that can harm or interfere with patient’s breathing in the event of seizure. The nurse must be there with the client when seizure occurs, remove restrictive clothes and position him sideways, making sure there is nothing in the mouth to obstruct airway. Every hospital has a different policy regarding seizure precautions. Some require that all four rails put up and others only require two side rails be put up because the nurse is present, some require ambu bags and others do not.

    S/QI Reflect on ways to improve safety and quality of care based on your experience with Jackson Weber’s case.

    Safety is the key if a client has seizures. Since this patient is a child, his mother needs to get every information regarding what is going on as well as getting the provider information whenever necessary. All seizure precautions should be implemented during seizure in order to keep him safe.

    T&C/I What key elements would you include in the handoff report for this patient? Consider the situation-background-assessment-recommendation (SBAR) format.

    Situation: Client was brought into the ER last night after he experienced a-3- minute tonic -clonic seizure. Also, while doing his assessment here, he had another seizure.

    Background: Client is a 5-yearold Caucasian male who was diagnosed with generalized tonic- clonic seizure 2 years ago. He has not seen his neurologist in the last 15 months due to his mother’s work schedule. Meanwhile he is taking oral phenobarbital to control seizure.

    Assessment: Client has an IV in his left arm running at D5 NS+20 mEq KCI/L @ 58ML/hr, client states he has no pain and vital signs are stable. He is awake and oriented, pupils are reactive to light.

    Recommendation: Continue to make sure seizure precautions are adhered to. Also, monitor client and constantly assess his neurological status.

     

     

     

    QI List additional support and health care team members to include to improve the quality of care and to prevent reoccurrence of seizure activity and future hospitalizations for Jackson Weber.

    The primary care physician, the nurse, the social worker, the neurologist and the client himself

    Concluding Questions

    Reflecting on Jackson Weber’s case, were there any actions you would do differently? If so, what were these actions, and why would you do them differently?

    One thing I would do differently would have been to educate the mother of Weber on some factors that trigger or precipitate seizure activities. Examples of which include sleep deprivation, stress, fever and missed medication. This way, she can prevent some of these riggers whenever possible.

     

    Describe how you would apply the knowledge and skills you obtained in Jackson Weber’s case to an actual patient care situation.

    I would first get the history of patient’s diagnosis in order to help me get adequate information about the situation. I would as well do a comprehensive neurological assessment as well as obtain the vital signs and use the FACES scale to obtain the pain level.

     

     

     

    From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

    From vSim for Nursing | Pediatric. © Wolters Kluwer Health.

 
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