Medication Administration Pediatric Client 

In this activity, you will read the case study and write your thoughts/reflections in response to the questions asked on the template provided below. You will share your responses with your peers and you will provide feedback on your peers' reflections.  

Objectives:

After completing this case study, the student should be able to:

• Identify the key principles of medication administration for a pediatric client
• Interpret important physical parameters and lab values for a pediatric client receiving dextrose for hypoglycemia
• Provide education to the client and family concerning proper medication administration and monitoring
• Reflect on nursing interventions and actions taken to administer medications, monitor for effectiveness, and provide client education 

Step 1: Read carefully the case study presented below. It is a good idea to read it a few times to familiarize yourself with the details. [45 minutes]

Case Presentation

Elena is a 12-year-old female client recently diagnosed with Type I Diabetes. Her mother brought her to the emergency room because Elena “did not seem well this morning. She was very irritable, dizzy, lethargic and perspiring heavily.” Her mother gave her the daily injection of long-acting insulin in the morning. Shortly afterward, Elena complained of a severe sore throat and feeling very shaky, which alarmed her mother. Elena seemed unable to concentrate when answering questions, so her mother answered most of the questions posed by the nurses in the emergency room.  Elena’s mother was visibly upset and tearful and was blaming herself for Elena’s condition. Elena’s mother appeared overwhelmed, noting that adjusting to Elena’s new diagnosis was complicated and confusing. Elena did not make eye contact with her mother or the nurses in the emergency room. She admitted that she had a binge-eating and consumption episode of chocolates and Lipovitan energy drink last night  to keep her awake as she needed to study for a Math test. She eventually asked if she could lay down and rest. The noise and activity in the hospital emergency room upset Elena, and she began to cry quietly. Elena stated that she was concerned about missing a math test she had studied for all night. Being a good student, she feared having to make up work because of not attending school today.  

Medical History 

Elena was diagnosed with Type I Diabetes 10 months ago. Prior to that, she is also diagnosed with binge-eating disorder. She was taught about her diagnosis, medications, diabetic diet, physical activity, and potential complications by her community health nurse. She has no other medical diagnoses. (Although her mother says that Elena seemed slightly depressed with all the new medications and treatments and she worries that it makes her feel different from her friends.)  

Physical Assessment Findings

Elena’s vital signs are as follows: 

Elena’s electrocardiogram shows sinus tachycardia with a regular rate. Her lungs are clear to auscultation bilaterally. Her throat is red with some white patches. She has a dry cough. The rest of the exam is unremarkable. Her weight is 50 kg. She is 65 cm in height.

Laboratory and Diagnostic Testing and Results

Recent lab values reveal the following information with normal values included:   

Medical orders 

The provider’s orders include an intravenous line placement with a bolus of 50% dextrose slow injection followed by a maintenance of D5NS IV infusion at 50 cc/her.  

Step 2: Read and answer each of the questions below. Organize your thoughts/reflections and write them on this template. You may need to move the boxes around to accommodate your text. [180 minutes]

See the instructional template below for guidance:  

Noticing 

1. Describe what you think about your client’s current presentation today.
2. How does the client appear clinically to you? Provide specific examples.
3. How does the client appear socially to you? Provide specific examples.
4. How does the client appear psychologically to you? Provide specific examples. 
5. What is the prescribed treatment for hypoglycemia?    
6. What do you notice about Elena’s mother’s coping and involvement in her daughter’s care?  

Interpreting

1.  Are there any clinical, social or psychological factors that need to be addressed? 
2. Identify the client's educational needs, readiness to learn,  preferences, barriers to treatment, and expectations. 
3. Review the findings from the client’s assessment and laboratory data that are out of the normal range. How do you interpret these findings?  

 Responding

1.  Describe the interventions to be taken by the nurse in this type of situation.
2. What interventions will you do first and why?  
3. Identify the ‘5 rights and 3 checks’ of proper medication administration. 
4. Explain the reason for asking clients about allergies before administering medications.  
5. How will you evaluate whether your interventions are effective? 
6. What medication education is essential to provide to Elena and her mother? 
7. Develop an educational plan to help Elena and her mother understand diabetes self-care management.  

Reflection

Reflection in-practice: 

1. What are some of the initial thoughts you had about your client’s condition?
2. Did your thoughts change as you learned more about this condition or test results?
3. What is it that you think you want for this client?
4. Describe the stresses you believe clients experience when they are diagnosed with Type 1 Diabetes. 

Reflection on-practice

1. What might you do in your future practice to prepare for this type of situation?
2. Describe three ways that you can increase your knowledge/skills/attitudes about caring for a client who needs diabetes management.
3. Describe some of the stresses you believe nurses might experience as they care for clients who have chronic care needs. 
4. In reflection, would you have done anything differently in this situation?
5. Write a paragraph with no more than 200 words that discuss what it may be like to be the nurse, the client, and the mother in this scenario? Please type your answer to this question outside of the template but on the same document provided in Step 2.

Make sure to reference others’ intellectual property when necessary. All references should follow 7th Edition APA formatting. For further instructions, see the resource on the Himmelfarb Health Sciences Library: APA citation resource (References are excluded from word counts). 

Step 4: To complete this activity, you will need to reply to at least one post made by your peers  respectfully and professionally. Be sure that your post engages your peers' ideas by providing feedback on their comments, sharing ideas of other potential problems/solutions, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion list below, write your feedback and then click on “Post to forum.” [10 minutes]

OPTIONAL Step 5: Interact (10 minutes)

If you would like to, you can reply to your peers' posts in a respectful and professional manner. Ensure that your post engages your peers' ideas by including a reflection on their comments, sharing ideas of other potential difficulties and parties involved, or asking thought-provoking questions. If a peer comments on your posting, please reply. To post a reply, click “Reply” on a particular discussion, write your feedback and then click on “Post to forum.”