David, a 12 y.o. male has been admitted to the peds unit with a diagnosis of acute asthma exacerbation with secondary pneumonia. You note the following orders:
Admit to peds unit
Spo2 continuous to stay above 95%
O2 via nasal cannula at 2L
Regular diet as tolerated
Activity as tolerated
Start IV
D5LR at KVO per facility policy
CBC STAT
Chest xray STAT
Tylenol 650 mg PO PRN q 6 hrs temperature above 38.5 c (101.5 F)
Aspirin 81 mg tablet PO PRN q 8 hrs temperature above 38.5 c (101.5 F)
Albuterol 1.25 mg via nebulizer q 4 hrs
Albuterol metered inhaler PRN
Prednisone 5 mg PO TID x 5 days
Gentamicin dosed by pharmacy
The patients mother reports that the child also takes a daily Ritalin for his ADHD an has an allergy to amoxicillin. She states that the child uses his rescue inhaler rarely and it is mostly managed with activity and lifestyle adjustments. His weight today is 110 lbs. His history includes tube placement as an infant, birth mother using street drugs during pregnancy, and a broken arm last year while riding his scooter. Symptoms began after being in the woods with his father hunting over the weekend.
- List any and all items noted to need correction or clarification in the order set.
- Provide teaching on how to properly administer the metered dose inhaler for this patient.
- What is the expected dose of gentamicin for the patient?
- What medications are contraindicated for this patient? Why?
- Which medications and doses listed are not considered safe for this patient? Explain.
- What nursing considerations should the nurse account for with a patient receiving gentamicin?
- What is the reason for not prescribing a broad spectrum antibiotic for this patient?