Jackson Weber Post VSim
The nurse is teaching Jackson's caregiver about phenobarbital and medication adherence. Which of the following statements) by Jackson's caregiver indicates) that teaching has been effective? (Select all that apply.).
'Jackson will need to take the medication daily, even if he's not having seizures', 'Jackson needs to take the phenobarbital at the same time daily', 'Jackson will need to have his phenobarbital levels checked regularly' Rationale: Teaching regarding anticonvulsant therapy should include the importance of adherence to the medication administration regimen. Serum levels should be monitored regularly to ensure therapeutic dosing. Phenobarbital should be given as prescribed at the same time daily and should not be discontinued unless instructed by the primary care provider. Withdrawal symptoms can occur if phenobarbital is stopped abruptly. Medication dosage should not be increased or its regimen modified by anyone other than the provider. It is vital to take antiepileptic medication regularly, and it should not be discontinued if there is no seizure activity noted for 3 months. p. 492, Table 16.3
A nurse is explaining to Jackson's caregiver how to respond when Jackson has a seizure at home. Which of the following statements) by the caregiver indicate(s) that teaching has been effective? (Select all that apply.)
'Rolling Jackson to his side will help him breathe better and keep him from choking', 'All toys and other hazards should be moved out of the way to keep Jackson safe', 'Someone should stay with Jackson until he fully wakes up after the seizure' Rationale: Placing the patient in a side-lying position can help to maintain the airway and reduce the risk of aspiration in the event of vomiting or increased secretions. Moving sharp objects and furniture away from the patient will prevent injury. Following the seizure, the patient's respiratory and neurological status should be monitored until the patient is fully conscious. Restraining or holding a patient down, forcibly opening the patient's jaw, or inserting a tongue blade during a seizure can cause further injury to the patient and is contraindicated. EMS should be called only if the child stops breathing, any injury has occurred, if the seizure lasts for more than 5 minutes, if it is the child's first seizure, or if the child is unresponsive to painful stimuli after seizure. p. 494, Teaching Guidelines 16.1
The nurse must assess Jackson's neurologic status closely for signs of a tonic-clonic seizure, which may include ____ and lasts for____.
1. body shaking, stiffening, and jerking, and may involve loss of consciousness 2. 1-3 minutes or longer Rationale: A tonic-clonic seizure is characterized by body shaking, stiffening, and jerking. The seizure may last 1-3 minutes or longer. The patient may lose consciousness or control of bowel or bladder.
The nurse recognizes that ______ is the most likely cause of Jackson's seizure, and it will be necessary to perform _____ list 2 before discharge.
1. medication nonadherence 2. patient/family education Rationale: A common cause of breakthrough seizures is medication nonadherence. Jackson has not seen his neurologist in 15 months and is likely out of medication at home. Adherence to antiepileptic medication therapy is essential and has been shown to have an impact on both short-term and long-term outcomes for children with epilepsy. Patient/family education should include a discussion on the importance of anticonvulsant therapy, barriers to medication adherence, and identifying solutions to avoid these barriers. Included in this discussion should be common adverse effects, the need to continue the medication unless instructed otherwise by the physician or nurse practitioner, and the need to call the physician or nurse practitioner if the child is ill and vomiting makes them unable to take their medication. o. 494
Expected outcomes) when caring for Jackson and his family include which of the following? (Select all that apply.)
He is free from seizures, or seizure activity is diminished., Medications are administered and adhered to properly by Jackson's caregiver., Jackson's caregiver and teachers demonstrate the correct actions to take to prevent injury when a seizure does occur., Jackson experiences minimal side effects of seizure medications., Jackson's caregiver receives adequate support to cope with his condition. Rationale: Instruct parents and family members, along with those in the community who may care for the child, on how to respond in case of a seizure. This will help to empower the parents, family, and other caregivers, and may alleviate some of the anxiety that they may feel. The medication regimen must be continued even in the absence of seizures for a short period, and only the provider can modify the dose of an anticonvulsant. Encourage parents to discuss unwanted adverse effects with the physician or nurse practitioner so that they can be addressed and nonadherence with the medication regimen can be reduced. A common cause of breakthrough seizures is medication nonadherence. Patients and parents should be educated regarding the administration of anticonvulsant therapy and its importance, including the need to be taken as prescribed.
Jackson experiences a generalized tonic-clonic seizure while the nurse is caring for him. Which intervention(s) should the nurse perform initially to ensure Jackson's safety? (Select all that apply.)
Keep side rails raised at all times and padded, Place Jackson in side-lying position, Ensure oxygen and suction are at bedside. Rationale: A child with altered level of consciousness may not be able to manage their secretions and is at risk for aspiration and ineffective airway clearance; providing suction and applying oxygen can help clear secretions and support respiration, and the side-lying position can help secretions drain and prevent obstruction of airway or aspiration. Raised side rails help to keep the environment safe. Nursing management includes administering appropriate medication to reduce seizure activity, but this is not an initial intervention. Although physician notification and reassuring the caregiver would be appropriate interventions, they do not ensure Jackson's safety during a seizure. p. 485
A patient weighing 40 lb has an order for phenobarbital 60 mg twice daily. The safe dose range is 3 to 6 mg/kg/day. Is this order safe?
No, the safe range is 54.6 to 109.2 mg/day. Rationale: Convert pounds to kilograms and round to the nearest 10th: 40 ÷ 2.2 = 18.2 kg. Multiply low end of dosage range by weight: 3 × 18.2 = 54.6 mg/day. Multiply high end of dosage range by weight: 6 x 18.2 = 109.2 mg/day. Safe dosage range equals 54.6 to 109.2 mg/day. Multiply the dose by the number of times administered per day: 60 × 2 = 120 mg/day. The ordered dose of phenobarbital 60 mg twice daily, or 120 mg per day, is above the range of 54.6 to 109.2 mg/dose, so the ordered dose is not safe to administer. p. 355, Box 13.2
