Charlie Snow v Sim Care Plan PDF

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DESCRIBE DISEASE PROCESS AFFECTING PATIENT (INCLUDE PATHOPHYSIOLOGY OF DISEASE PROCESS) Anaphylaxis: is a potentially life-threatening systemic reaction to an allergen. [newline]eIt presents with systemic manifestations involving alterations to the skin, respiratory, gastrointestinal, and cardiovascular systems. The symptoms associated with anaphylaxis can occur minutes or up to 2 hours following exposure to the allergen DIAGNOSTIC TESTS (REASON FOR TEST AND PATIENT INFORMATION ANTICIPATED PHYSICAL FINDINGS RESULTS)  General: restlessness , diaphoresis, nasal Location: ED Place on cardiac/apnea monitor  6-year-old Caucasian male; Weight: 21kg; Height: 120cm; flaring, retractions grunting, tripoding Allows for continuous monitoring of cardiac position, head bobbing Allergies: Peanuts, perfume, dyes and pulmonary status.  Neurological: headache, dizziness,  Living with aunt and uncle while his parents are serving Continuous Pulse Oximetry: Monitor O2 paresthesia, feeling of impending doom overseas in the military. saturation levels  Skin: Pruritis, angioedema, erythema,  Presented in ED with tachycardia and dyspnea with mild Obtain IV access: urticaria stridor. Ability to give fluids will assist in maintaining  Respiratory: hoarseness, coughing, sensation  Aunt and uncle report that he accidentally ate a cookie BP if needed of narode airway, wheezing, stridor, containing peanuts, and he has peanut allergy. When Charlie Quick direct rapid administration of needed dyspnea, tachypnea , respiratory arrest began having difficulty breathing, they rushed him to the medications  Cardiovascular: hypertension, dysrhythmias, emergency department  Immunizations: Up to date; Past medical history – not tachycardia , cardiac arrest  Gastrointestinal: cramping, abdominal pain, remarkable beyond known allergies  He is currently able to talk through the dyspnea and is on a nausea, vomiting, diarrhea nasal cannula at 2 liters.  A saline lock has been placed in his left arm.  He has been connected to a cardiac/apnea monitor with a SpO2 probe in place.  Charlie is in bed, and the health care provider has been notified of Charlie's arrival. Provider orders after initial assessment: : Monitor vital signs every 5 minutes Give one 20ml/kg of normal saline (420ml) IV now over 30 minutes Give 0.3mg epinephrine (1:1000) IV stat Give 23mg of diphenhydramine IV stat Ranitidine 20mg IV stat Give 10mg of methylprednisolone ANTICIPATED NURSING INTERVENTIONS  ID patient; ID Guardian; Gain cosent  Assess: known allergies; foods, environmental, medications. Ascertain previous reactions.  Vital signs and assessment: full set of vitals , respiratory assessment , cardiac assessment , skin assessment  Elevate HOB  Admin O2 as needed to maintain adequate saturation levels  Admin medications as prescribed

vSim ISBAR ACTIV ITY

INTRODUCTION

STUDENT WORKSHEET This is Carly in the Emergency Department at the Our Lady Ginsburg Ruth Bader Hospital

Your name, position (RN), unit you are working on SITUATION Patient’s name, age, specific reason for visit

mg Patient’s primary diagnosis, date of admission, current orders for patient

ASSESSMENT Current pertinent assessment data using head to toe approach, pertinent diagnostics, vital signs

RECOMMENDATION Any orders or recommendations you may have for this patient

I am calling about Charlie Snow, a 6-year-old Caucasian male; Weight: 21kg; Height: 120cm; Allergies: Peanuts, perfume, dyes, Oriented x3 Charlie presented in ED with tachycardia and dyspnea with mild stridor following the accidental ingestion of a cookie that contained peanuts.

He has primary diagnosis of anaphylaxis. Charlie is living with aunt and uncle while his parents are serving overseas in the military. When Charlie began having difficulty breathing, they rushed him to the emergency department. He has a saline lock on his left arm, site had no redness, swelling, infiltration, bleeding, or drainage. The dressing was dry and intact. His immunizations are up to date and has no remarkable medical history beyond the allergies. He reports a “0” on the Faces scale and his aunt reports voiding several times today. ECG: Sinus tachycardia. Heart rate: 156. Pulse: Present. Blood pressure: 102/68 mmHg. Respiration: 25. Conscious state: Appropriate. SpO2: 89%. Temp: 37.1 C. Current order are Monitor vital signs every 5 minutes; one bolus of 20ml/kg of normal saline (420ml) IV now over 30 minutes; 0.3mg epinephrine (1:100) IV stat; 23mg of diphenhydramine IV stat; Ranitidine 20mg IV stat; 10mg of methylprednisolone Administered 100% oxygen from a nonrebreathing mask. Started giving the child warm, humidified oxygen.

After medication admin ECG: Sinus tachycardia. Heart rate: 154. Pulse: Present. Blood pressure: 84/56 mmHg. Respiration: 31. Conscious state: Appropriate. SpO2: 96%. Temp: 37.1 C. He has retractions, a prolonged expiration phase, and a lot of audible wheezing. Heart sounds regular without murmurs. Capillary refill < 2sec. Charlie is resting comfortably now is speaking more easily and reports improvement in breathing.

I recommend close monitoring of respiratory and cardiac status. Strict I/O monitoring and daily weights. Referral for an allergist and education on peanut allergies for both Charlie and his guardians.

PATIENT EDUCATION WORKSHEET

Clinical Worksheet

NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE  MEDICATION: Methylprednisolone CLASSIFICATION:  THERAPEUTIC CLASS; anti-inflammatory / immunosuppressant  PHARM CLASS: corticosteroid PROTOTYPE: Prednisone  SAFE DOSE OR DOSE RANGE, SAFE ROUTE Patient Dose: 10 mg of methylprednisolone IV  SAFE DOSEAGE: – 12.5-25mg/dose every 4-6 hours max 300mg/day  < 9kg – 1mg/kg – max 6.25mg / initial dose  2-5 years – 6.25mg/dose every 4-6 hours max 150mg/day  6-12 years – 12.5-25mg/dose every 4-6 hours max 300mg/day  >12 years old – 25-50mg/dose every 4-6 hours max 300mg/day PURPOSE FOR TAKING THIS MEDICATION  Used systemically and locally in a wide variety of chronic diseases including: Inflammatory, Allergic, Hematologic, Neoplastic, Autoimmune disorders, Immunosuppressant.  May be suitable for alternate-day dosing in the management of chronic illness.  Replacement therapy in adrenal insufficiency. PATIENT EDUCATION WHILE TAKING THIS MEDICATION 

Instruct patient on correct technique of medication administration. Advise patient to take medication as directed. Take missed doses as soon as remembered unless almost time for next dose. Do not double doses. Stopping the medication suddenly may result in adrenal insufficiency (anorexia, nausea, weakness, fatigue, dyspnea, hypotension, hypoglycemia). If these signs appear, notify health care professional immediately. This can be lifethreatening. o

Glucocorticoids cause immunosuppression and may mask symptoms of infection. Instruct patient to avoid people with known contagious

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Caution patient to avoid vaccinations without first consulting health care professional.

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Review side effects with patient. Instruct patient to inform health care professional promptly if severe abdominal pain or tarry stools occur.

illnesses and to report possible infections immediately.

Patient should also report unusual swelling, weight gain, tiredness, bone pain, bruising, nonhealing sores, visual disturbances, or behavior changes. o

Advise patient to notify health care professional of medication regimen before treatment or surgery.

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Instruct patient to inform health care professional if symptoms of underlying disease return or worsen.

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Advise patient to carry identification describing disease process and medication regimen in the event of emergency in which patient cannot relate

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Explain need for continued medical follow-up to assess effectiveness and possible side effects of medication. Periodic lab tests and eye exams

medical history.

may be needed. 

Long-term Therapy: Encourage patient to eat a diet high in protein, calcium, and potassium, and low in sodium and carbohydrates

PATIENT EDUCATION WORKSHEET

NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE  

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Clinical Worksheet

MEDICATION: 0.3 mg of epinephrine 1:1000 IV o High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error. CLASSIFICATION: o Therapeutic: anti-asthmatics, bronchodilators, vasopressors o Pharmacologic: adrenergic PROTOTYPE:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE

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Patient Dose: 0.3 mg of epinephrine IV  SAFE DOSE: .3–0.5 mg (single dose not to exceed 0.5 mg); may repeat every 10–15 min as needed (per lecture) SC IM (Adults and Children ≥30 kg): Severe anaphylaxis– 0.3–0.5 mg (single dose not to exceed 0.5 mg); may repeat every 10–15 min as needed. SC (Children 1 mo): 0.25–0.5 mL of 2.25% racemic epinephrine solution diluted in 3 mL normal saline. Inhaln (Adults and Children ≥12 yr): Over-the-counter inhaler– 1–2 inhalations every 4 hr as needed (max = 8 inhalations/day). IV Intratracheal: Neonates: 0.01–0.03 mg/kg every 3–5 min as needed. Topical (Adults and Children ≥6 yr): Nasal decongestant– Apply 1% solution as drops, spray, or with a swab. Intraspinal: (Adults and Children): 0.2–0.4 mL of 1:1000 solution. With Local Anesthetics: (Adults and Children): Use 1:200,000 solution with local anesthetic.

PURPOSE FOR TAKING THIS MEDICATION 

Bronchodilation.

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Maintenance of heart rate and BP.

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Localization/prolongation of local/spinal anesthetic..

PATIENT EDUCATION WHILE TAKING THIS MEDICATION  

Instruct patient to take medication exactly as directed Instruct patient to contact health care professional immediately if shortness of breath is not relieved by medication or is accompanied by diaphoresis, dizziness, palpitations, or chest pain.  Advise patient to consult health care professional before taking any OTC medications or alcoholic beverages concurrently with this therapy. Caution patient also to avoid smoking and other respiratory irritants. Inhaln Review correct administration technique (aerosolization, IPPB) with patient.  Do not spray inhaler near eyes.  Advise patients to use bronchodilator first if using other inhalation medications, and allow 5 min to elapse before administering other inhalant medications, unless otherwise directed.  Advise patient to rinse mouth with water after each inhalation dose to minimize dry mouth.  Advise patient to maintain adequate fluid intake (2000–3000 mL/day) to help liquefy tenacious secretions.  Advise patient to consult health care professional if respiratory symptoms are not relieved or worsen after treatment or if chest pain, headache, severe dizziness, palpitations, nervousness, or weakness occurs. Autoinjector: Instruct patients using auto-injector for anaphylactic reactions to remove gray safety cap, placing black tip on thigh at right angle to leg. Press hard into thigh until auto-injector functions, hold in place for 10 sec, remove, and discard properly. Massage injected area for 10 sec. Pedi: Teach parents or caregivers signs and symptoms of anaphylaxis, how to use auto-injector safely, and to get the child to a hospital as soon as possible. Instruct parents or caregivers to teach child how to manage his or her allergy, how to self-inject, and what to do in an emergency. For children too young to self-inject and who will be separated from parent, tell parents to always discuss allergy and use of auto-injector with responsible adult

PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION, AND INCLUDE PROTOTYPE

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MEDICATION: diphenhydramine IV.

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CLASSIFICATION: o Therapeutic allergy, cold and cough remedies, antihistamines, antitussives PROTOTYPE:

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Clinical Worksheet

SAFE DOSE OR DOSE RANGE, SAFE ROUTE Patient Dose: 25 mg of diphenhydramine IV  SAFE DOSAGE 21kg*1.25mg = 26.25  Recommended dosage is 1.25 mg/kg (37.5 mg/m2 ) 4 times daily (not to exceed 300 mg/day PO (Adults and Children >12 yr): Antihistaminic/antiemetic/antivertiginic– 25–50 mg every 4–6 hr, not to exceed 300 mg/day. Antitussive– 25 mg every 4 hr as needed, not to exceed 150 mg/day. Antidyskinetic– 25–50 mg every 4 hr (not to exceed 400 mg/day). Sedative/hypnotic– 50 mg 20–30 min before bedtime. PO (Children 6–12 yr): Antihistaminic/antiemetic/antivertiginic– 12.5–25 mg every 4–6 hr (not to exceed 150 mg/day). Antidyskinetic– 1–1.5 mg/kg every 6–8 hr as needed (not to exceed 300 mg/day). Antitussive– 12.5 mg every 4 hr (not to exceed 75 mg/day). Sedative/hypnotic– 1 mg/kg/dose 20–30 min before bedtime (not to exceed 50 mg). PO (Children 2–6 yr): Antihistaminic/antiemetic/antivertiginic– 6.25–12.5 mg every 4–6 hr (not to exceed 37.5 mg/day). Antidyskinetic– 1–1.5 mg/kg every 4–6 hr as needed (not to exceed 300 mg/day). Antitussive– 6.25 mg every 4 hr (not to exceed 37.5 mg/24 hr). Sedative/hypnotic– 1 mg/kg/dose 20–30 min before bedtime (not to exceed 50 mg) IM IV Children: 1.25 mg/kg (37.5 mg/m2 ) 4 times daily (not to exceed 300 mg/day). Topical (Adults and Children ≥2 yr): Apply to affected area up to 3–4 times daily PURPOSE FOR TAKING THIS MEDICATION 

Decreased symptoms of histamine excess (sneezing, rhinorrhea, nasal and ocular pruritus, ocular tearing and redness, urticaria).

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Relief of acute dystonic reactions.

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Prevention of motion sickness. Suppression of cough.

PATIENT EDUCATION WHILE TAKING THIS MEDICATION 

May cause drowsiness.

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May cause dry mouth. Inform patient that frequent oral rinses, good oral hygiene, and sugarless gum or candy may minimize this effect. Notify health care

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Teach sleep hygiene techniques (dark room, quiet, bedtime ritual, limit daytime napping, avoidance of nicotine and caffeine) to patients taking

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Advise patient to use sunscreen and protective clothing to prevent photosensitivity reactions.

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Caution patient to avoid use CNS depressants concurrently with this medication.

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Pedi: Can cause excitation in children. Caution parents or caregivers about proper dose calculation; overdose, especially in infants and children, can

professional if dry mouth persists for more than 2 wk.

diphenhydramine to aid sleep.

cause hallucinations, seizures, or death. Caution parents to avoid OTC cough and cold products while breast feeding or to children...