# A fluid bolus is ordered by the physician and after

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A fluid bolus is ordered by the physician and after administration of the bolus; Alison perks up a little bit. The doctor then orders Tylenol for the patient. The order reads as follows: Acetaminophen 650.0 mg prn pain/fever q 4 hours Is this order appropriate for Alison? The order is appropriate r/t her fever/pain, but it is not a safe dose (Vallerand & Sanoski, 2015). Using the pediatric reference guide, determine if this is a safe dosage for Alison? A safe IV dose for Alison’s weight is 69.75-139.5 mg/d q6h, but it is not to exceed 60 mg/kg/d (Vallerand & Sanoski, 2015). Therefore, 650 mg PRN q4h is not a safe dose because the max
Pediatric Case Scenario 7 daily dose for Alison is 558 mg/d, which makes this one dose more than her daily limit (Vallerand & Sanoski, 2015). What would be appropriate actions for the nurse to take at this time? Currently, the nurse needs to question the PCP’s order because it is not safe to administer. The nurse should contact the PCP saying “I am concerned about the higher than suggested dose of Acetaminophen that you have ordered for Alison because the dose is 650 mg PRN q4h, but her max daily dose is 558 mg. I am uncomfortable with administering this unsafe dose” (Vallerand & Sanoski, 2015). Calculate Alison’s daily maintenance fluid requirements and expected hourly output. The daily maintenance fluid requirement is for Alison at 9.3 kg is 100 mL/kg/24h (London et al, 2017, p 1087). 100 mL x 9.3 kg= 930 mL/24h The hourly output for Alison’s age is 2 mL/kg/h (London et al, 2015). 2mL x 9.3 kg= 18.6 mL/h After notifying the doctor of the medication dosage, he changes the order to read: Acetaminophen 120 mg prn for pain/fever q 4 hours. What actions would the nurse take? Are there any factors to consider if the physician orders IV fluids with additives in them such as K + ?
Pediatric Case Scenario 8 The nurse first needs to compare orders and recalculate the safe dose range in order to determine whether it is safe or unsafe. Once recalculation is done, it is found that this order is a safe dose as a PRN dose and as long as it is not given ATC because 120 mg q4h x 6 = 720mg/d, which exceeds Alison’s limit of 558 mg/d (Vallerand & Sanoski, 2015). Yes, there are factors to consider when the PCP orders IV fluids with K+. First, it needs to be ensured that the Acetaminophen is not given with the K+ because it is contraindicated to do so (Vallerand & Sanoski, 2015). Also, Alison’s renal functions (BUN/Creatinine) need to be checked before administering any K+ (Vallerand & Sanoski, 2015). What are the nursing responsibilities when administering medications? When it comes to administering medications, the nurse is responsible for ensuring the medication order is correct by comparing it to the order and to the MAR (London et al, 2017). The nurse is also responsible for ensuring that the medication dose is a safe dose for the patient based on weight, age, and purpose of administration (London et al, 2017). The nurse is then responsible for ensuring that it is the right patient, medication, dose, route, time, documentation, reason, response (London et al, 2017). Lastly, the nurse is responsible for monitoring for effectiveness and side effects (London et al, 2017).