Discharge Plan for the Patient
The recovery and health restoration of the 5-year-old multiracial male patient is determined by discharge efforts that comprise nursing-based interventions to strengthen the quality of care and improve the child’s quality of life (Weiss et al., 2017). The discharge goals should be based on a set of factors that the patient portrayed before the hospital admission. First, the patient was admitted due to a fall from the bed due to jerky movement. This occurrence is a clear indication that the child is still at risk of repetitive episodes of seizure. Second, the patient’s Ulnar fracture is another point of concern that would determine the discharge plan. Lastly, the patient is under a strict medication regime; therefore, compliance would also be crucial when the patient is being monitored from home.
Goal 1: Monitoring the Child Closely while at Home
The parents have a special responsibility to keep a close eye on their five-year-old child; this is the priority in the discharge plan to ensure that the patient is not readmitted due to an injury or a fall, which may detrimentally affect the efforts to restoring their health (Weiss et al., 2017). The repetitive episodes of seizure would be the main reasons for prioritizing this goal after the child is discharged. Nursing-based interventions could also be critically important in supporting this goal to ensure that caregivers’ actions align with medical care principles.
Inform the Patient’s Family on Using Non-Slip Footwear
The nursing approaches in this aspect primarily aim at preventing the child from falls and at the same time expands the opportunity for returning to normalcy (Weiss et al., 2017). Therefore, the nurse provider can recommend using comfortable and non-slippery shoes, especially when the child moves from one room to another or while visiting the bathroom. This recommendation would reduce the parents’ responsibility of carrying the child from one point to another.
Recommend the Use of Call Light
Not all the time, the patient has a person monitoring them closely, especially after discharge. However, the first goal recommends the need for increased surveillance to prevent the patient from injuring himself during the seizure episodes; therefore, interventions should be optimized to fit both the parents’ and the patient’s convenience. Call light creates a form of patient independence and only requires an alert when the patient needs urgent help; therefore, a buzzer at the patient’s bedside would increase monitoring capabilities (Weiss et al., 2017).
Install Locks on the Beds and Chairs Used by the Patient
The primary target for the above goal is to restrain the patient from injuring themselves; therefore, an option for controlling their movement while sited or sleeping would prevent another occurrence that led to the severe injury (Stephens et al., 2017). The locks on the beds and chairs would restrict the movements and train the patient to consult with parents before performing an activity.
Goal 2: Prevent any Physical Movement Due to Ulnar Fracture
Recommend Baby Feeding Exercises for the Child
The nurse practitioner should suggest the need for either employing a house-help to assist with feeding the child or doing it by themselves. Engagement of the child in any physical activity may contribute to the prevalence of the fracture; therefore, efforts to promote maximum rest for the child would be pertinent, especially in enhance callus formation, which supports the healing process (Stephens et al., 2017).
Create Social Support Avenues
The child’s restriction from movement may assist in healing the fracture but may affect his social life. Therefore, parents should provide the child with adequate social support by watching television and being visited by friends to ensure that he recuperates holistically (Stephens et al., 2017).
Recommend Fitting the Child with Loose Nightwear
The restriction of movements may sometimes make the child uncomfortable; therefore, there is a need to promote relaxation and comfort by encouraging the parents to put them in loose-fitting nightwear (Stephens et al., 2017). This intervention would enhance his quality of life even as he recovers from the previous fall.
Goal 3: Promote Compliance to Treatment Regime
Set Alerts and Reminders
The parents should be advised to develop a schedule for medication by setting alerts and reminders using their phones to ensure that the child does not miss out on any dosage that is crucial for his recovery process (Kini & Ho, 2018). In addition, the reminders would subject the caregivers to a periodical timetable that promotes the patient’s compliance with the treatment regime.
Educating the Parents on Consequences of Non-Compliance
The parents should be informed of the potential consequences for not complying with the medication regime to ensure that they are well-informed on their course of action (Kini & Ho, 2018). This intervention promotes personal responsibility and the patient’s family engagement in case management.
Encourage Open Communication
The nurse should encourage open communication between the parents and the child whereby the patient would be free to communicate their concerns and preferences. An engagement session with the child will allow the parents to liaise with the healthcare providers to find the most effective and convenient care plan for the child that would promote compliance to medication (Kini & Ho, 2018). Effective collaboration between the child, his family, and the providers create an opportunity for integrating the treatment regime with personal preferences, values, and interests.
Dosage Amounts For:
Acetaminophen: Three Chewable tablets of 80 mg or 7.5 ml syrup of 160mg/5ml label. Taking this medication in large doses is dangerous as it can lead to acute liver failure at the early stages of children’s development (US National Library of Medicine, 2021).
Ibuprofen: Four tablets of 50 mg or 5 ml dose for an infant drop of 50mg/1.25ml. Ibuprofen should only be administered based on the recommended dosage as an overdose may lead to damaged intestines and stomach (US National Library of Medicine, 2021). Small amounts should be used to relieve the pain.
Cefuroxime: 30 mg/kg for recommended daily dose and 1000 mg for the maximum daily dose for ten days (Thønnings et al., 2020). Skipping the dosage for this medication may result in body resistance, subjecting the patient to another round of different antibiotics. Additionally, the continuous use of this medication above the prescription recommendations or use of a large amount of dosage may result in diarrhea and, in rare cases, can lead to a fatal inflammation of the colon.
References
Kini, V., & Ho, P. M. (2018). Interventions to improve medication adherence: a review. Jama, 320(23), 2461-2473.
Stephens, J. R., Kimple, K. S., Steiner, M. J., & Berry, J. G. (2017). Discharge interventions and modifiable risk factors for preventing hospital readmissions in children with medical complexity. Reviews on recent clinical trials, 12(4), 290-297.
Thønnings, S., Jensen, K. S., Nielsen, N. B., Skjønnemand, M., Hansen, D. S., Lange, K. H., & Frimodt-Møller, N. (2020). Cefuroxime pharmacokinetics and pharmacodynamics for intravenous dosage regimens with 750 mg or 1500 mg doses in healthy young volunteers. Journal of medical microbiology, 69(3), 387-395.
US National Library of Medicine. (2021). Acetaminophen dosing for children: MedlinePlus Medical Encyclopedia. Medlineplus.gov. Retrieved 20 May 2021, from https://medlineplus.gov/ency/patientinstructions/000783.htm.
US National Library of Medicine. (2021). Ibuprofen dosing for children: MedlinePlus Medical Encyclopedia. Medlineplus.gov. Retrieved 20 May 2021, from https://medlineplus.gov/ency/patientinstructions/000772.htm.
Weiss, M. E., Sawin, K. J., Gralton, K., Johnson, N., Klingbeil, C., Lerret, S., … & Schiffman, R. (2017). Discharge teaching, readiness for discharge, and post-discharge outcomes in parents of hospitalized children. Journal of pediatric nursing, 34, 58-64.
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