Posted: January 28th, 2024

Jackson Weber is a 5-year-old Caucasian male

1}Patient Introduction
Jackson Weber is a 5-year-old Caucasian male. He 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 his mother brought him to the emergency department following a 3-minute tonic-clonic seizure. She is a single mother and the sole source of financial support.
Jackson has not seen his neurologist in 15 months due to his mother’s work schedule. Jackson was seen by his health care provider this morning and currently has an intravenous infusion in his left arm running D5 NS + 20 mEq KCl/L at 58 mL/hr.
He has been eating well, has urine output, and vital signs 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 mother is at the bedside.

Medication: Phenobarbital

2) Patient Introduction
Sabina Vasquez is a 5-year-old Hispanic girl admitted today from the emergency room with a diagnosis of pneumonia. She has a history of asthma and has had several episodes requiring use of an albuterol inhaler at home.
Sabina has had an upper airway infection for the past few days. Earlier today she developed a fever of 39°C (102.2°F), so her mother brought her to the emergency room. She was placed on oxygen via nasal cannula at 2 L/min. She received a 380-mL bolus of normal saline and an albuterol nebulizer treatment at 5:00 PM. This improved her oxygen saturation to 94%. The chest x-ray revealed right lower lobe pneumonia with effusion. An intravenous infusion of D5 ½NS is infusing at 61 mL/hr. Sabina just got settled in bed, and her mother is at the bedside.
Medication: Azithromycin

3) Patient Introduction
Eva Madison is a 5-year-old female who just arrived to the pediatric floor from the emergency department, where she arrived at 7:00 AM with a 3-day history of vomiting and diarrhea, inability to keep fluids down, and no urination since 8:00 PM yesterday.
At her last check-up a few months ago, her weight was 21.2 kg, and today her weight is 20.5 kg. She is pale and listless, and her mucous membranes are dry. An intravenous saline bolus of 400 mL was started in the emergency department and has just finished. Maintenance fluids are to follow.

Medication: Sodium chloride
4) Patient Introduction
Brittany Long is a 5-year-old African American female with a history of sickle cell disease, diagnosed at 6 months old, and has been prescribed regular folic acid supplement.
She was brought into the emergency department during the night by her mother, who stated that the patient has been complaining of right lower leg pain over the last 2 days. Brittany rated her pain as a 5 on the FACES Scale and did not want anyone to touch her leg during assessment. She has not had an appetite in the last 24 hours but has taken small amounts of oral fluids.
She has had pain crises before, mostly managed at home with acetaminophen and ibuprofen. She has been hospitalized twice, once at age 4 years for a vaso-occlusive crisis episode and once at age 3 years for a fever.
Brittany was given oral pain medication in the emergency department at 6:00 AM. She is asleep but is responsive when awakened. She has been taking small amounts of oral fluids and continues to receive intravenous maintenance fluids at 52 mL/hr. When examined this morning, her blood pressure was 101/70 and her temperature was 37.4°C (99°F). She now rates her pain as a 3. New orders have been given.
Medication: Morphine

5) Patient Introduction
Charlie Snow is a 6-year-old Caucasian male staying with his aunt and uncle while his parents are serving overseas in the military. Charlie presents in the emergency department with tachycardia and dyspnea with mild stridor. His aunt and uncle report that he accidentally ate a cookie containing peanuts, and he has peanut allergies. When Charlie began having difficulty breathing, they rushed him to the emergency department.
He is currently able to talk through the dyspnea and is on a nasal cannula at 2 liters. A saline lock has been placed in his left arm. He has been connected to a cardiac/apnea monitor with a SpO2 probe in place. Charlie is in bed, and the health care provider has been notified of Charlie’s arrival.
Medication: Ranitidine hydrochloride

Patient Introduction #1: Jackson Weber
Jackson Weber is a 5-year-old Caucasian male who was diagnosed with generalized tonic-clonic seizures two years ago. His neurologist initially prescribed oral phenobarbital, which kept his seizures controlled. However, he experienced a breakthrough seizure last night which prompted his mother to bring him to the emergency department.
Some key details about Jackson’s case:
Phenobarbital has been his only anti-seizure medication to date. Monotherapy with phenobarbital is a common first-line treatment for pediatric seizures. However, up to 30% of children will require an additional medication for better seizure control.
Jackson has not seen his neurologist in 15 months. Lack of routine follow-up puts him at higher risk for breakthrough seizures since his medication regimen may need adjustment over time. Consistent monitoring is important for pediatric epilepsy patients.
He currently has an IV of D5 NS + 20 mEq KCl infusing. This provides maintenance hydration and electrolyte replacement after his recent seizure. The potassium helps prevent hypokalemia, a potential side effect of phenobarbital.
His neurological exam is nonfocal. No new deficits are noted. This suggests his recent seizure was not prolonged or associated with injury.
He is awake, alert and interacting appropriately. No postictal symptoms are present. This indicates good recovery from his seizure.
His mother is at the bedside for support. Involving family can help pediatric patients feel more at ease during hospital care.
Some factors to consider in Jackson’s ongoing management include:
Scheduling a follow-up with his neurologist to discuss adjusting his anti-seizure regimen. Adding a second medication may provide better control to prevent future breakthrough seizures.
Ensuring his mother understands the importance of medication compliance and follow-up visits. Providing resources to address any barriers to care could help in the long-term.
Continuing his IV fluids and monitoring for any new neurological changes. Early intervention for any issues is important.
Counseling on safety measures at home in case another seizure occurs. Having a plan in place may help reduce his mother’s stress.
Coordinating follow-up after discharge to maintain seizure control. Close monitoring is key, especially after changes to his treatment.

Order | Check Discount