History:
-Umbilical Hernia (dx 5/26/2011)
-Congenital Hydrocele (dx 5/26/2011)
Epilepsy: First seizure in 10/2011; started levitiracetam,
discontinued on 4/06/2014, pt experienced tonic-clonic
seizures on 4/06/2014 lasting approximately 5 minutes. Pt
stopped seizing after administration of lorazepam. Pt was
flown to CHOP and the levitracetam was restarted on
4/9/2014. Pt has not experienced seizures since.
Nursing Diagnoses:
1) Caregiver role strain r/t complex care requirements secondary to
caring for a child with multiple health disorders
2) Risk for falls r/t convulsions
3) Risk for ineffective respiratory function r/t frequent respiratory
infections
4) Risk for aspiration r/t convulsions
5) Impaired verbal communication r/t delayed speech development
AEB inability and difficulty speaking despite understanding
commands
Lindsey Indovina
Medications:
Levetiracetam (Keppra): 100mg/ml PO Solution
-Tx of epilepsy; anti-epileptic drug
-3.2 mL oral q12hours
-Side Effects: drowsiness, mood changes, rash
-Pt experiences drowsiness and moodiness from medication. Mother offers longer
rest periods for child.
Albuterol Sulfate: (2.5mg/3ml) 0.083% in Nebulizer
-Tx of wheezing associated with pt frequent upper respiratory infections
-Class of drugs known as bronchodilators. Bronchodilators open breathing passages
and relaxing muscles.
-One vial in nebulizer q4hours as needed for wheezing
-Side effects: nervousness, shakiness, tremors, headache, nausea, dizziness, pounding
heart rate
-Mother states that patient has not used albuterol in several months
Diastat Acudial: 10mg PR Gel
-5mg rectally if a seizure lasts longer than 5 minutes
-Diazepam rectal gel; benzodiazepine  enhance effects of GABA
-Side effects: shakiness, unsteadiness, tremors, anxiety
-Mother states that patient has not had to have Diastat Acudial administered but that
she carries it with her
3 years old, Male
Dx: Wheezing, Gross motor delay, seizures
(epilepsy), esotropia, expressive language delay
Vital Signs:
BP: 90/70 P: 106
All VS WNL
Erikson’s Stage of Development:
Initiative vs. Guilt:
Pt is trying to work on pleasing by improving skills and following instructions but struggles to have his way as well. Ex:
pt wanted his water cup but it was in the car. When mother promised he could have when the PA was done, the patient
settled down and cooperated.
Education
-Bike safety – pt expresses interest in riding tricycle. Should discuss helmet
safety and use of sidewalks
-Medication administration – both for immediate family as well as other
caregivers. Ensure that all caregivers can administer Diastat Acudial and stress
importance of timely administration of Keppra.
-Nutrition – ensure that pt is maintaining fluid balance with frequent upper
respiratory infections and maintaining a balanced diet
Wellness
Ht: 3’ 1” Wt: 37lb 14.4oz BMI: 19.46 kg/m2
**Pt could not perform vision or hearing test
Mom states pt is active and developing gross and fine motor skills but expresses
concerns about language development. PA assured mother that pt is doing well
for child with epilepsy and that he is developing normally.