Next-Gen Pediatric Case 1: Jackson Weber (Core) Post-Simulation Quiz
Case Scenario/Description
Location: Pediatric Unit Time: 07:30 Report from the Pediatric Unit shift nurse: Situation: Jackson Weber is a 5-year-old male. He was brought to the emergency department (ED) last night by his parent after experiencing four seizures at home within a 12-hour period. Background: Jackson 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 he was brought to the ED. He had one seizure in the ED, and it required the administration of lorazepam. He also received a loading dose of phenobarbital in the ED because his blood levels were low. All other blood work was normal. He has been prescribed phenobarbital twice a day. He has an IV in his left arm running 5% dextrose and 0.9% sodium chloride running at 58 mL/hr. His parent is single and the sole source of financial support. The parent lost their job 3 months ago and has not been able to afford his medications. Assessment: Jackson's vital signs and neurologic assessments 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 parent is at the bedside. He did not experience any seizure activity overnight. Recommendation: Please continue to monitor for any seizure activity. His parent seems a bit sad, so make sure the parent is okay and can manage Jackson's illness when going home. Consider conversation with the parent regarding social support.
5 The nurse is teaching Jackson's caregiver about phenobarbital and medication adherence. Which of the following statement(s) by Jackson's caregiver indicate(s) that teaching has been effective? (Select all that apply.).
Response: '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. Remediation: Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, p. 492, Table 16.3
4 A nurse is explaining to Jackson's caregiver how to respond when Jackson has a seizure at home. Which of the following statement(s) by the caregiver indicate(s) that teaching has been effective? (Select all that apply.)
Response: '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. Remediation: Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, p. 494, Teaching Guidelines 16.1
6 Expected outcome(s) when caring for Jackson and his family include which of the following? (Select all that apply.)
Response: 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. Remediation: Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, p. 494
2 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.)
Response: 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. Remediation: Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, p. 485
1 The nurse must assess Jackson's neurologic status closely for signs of a tonic-clonic seizure, which may include Choose Answer.. and lasts for Choose Answer.. .
Response:body shaking, stiffening, and jerking, and may involve loss of consciousness, 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. Remediation: Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, pp. 490-491
3 The nurse recognizes that Choose Answer.. is the most likely cause of Jackson's seizure, and it will be necessary to perform Choose Answer.. list 2 before discharge.
Response:medication nonadherence, 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. Remediation: Kyle and Carman, Essentials of Pediatric Nursing, 4th Edition, p. 494