Question

The nurse is caring for Troy, a. 6-year-old boy who has juvenile idiopathic arthritis( JIA) and is being treated with methotrexate daily to control his pain. He was diagnosed with a strep infection four days ago. He now has a low-grade fever, tea colored urine, and some swelling around his eyes. He is admitted for acute glomerulonephritis( AGN). He weight 48 pounds.

1) identify the therapeutic and nursing management that would be included in Troy's plan of care given his diagnoses.

2) define the complications of both his chronic and acute illnesses that are priorities for nursing management and the corresponding interventions.

3) describe how the therapeutic drug management for his JIA may have contributed to Troy's recent strep infection and any nursing interventions that can be suggested

4) Troy is order 40mg/kg/day of amoxicillin BID. The suspension comes in a concentration of 400mg/5ml

calculate the daily dose of amoxicillin Martin will receive in mg.

how many mg will the nurse administer at each dose?

how many milliters will the nurse administer at each dose?

Answer 1

1) Therapeutic & Nursing management

· Assess the general condition & monitor the patient closely for the symptoms of hematuria, decreased urinary output, edema, hypertension & congestive heart failure.

· If the patient is having congestive heart failure and hypertension than position the patient in a propped up & provide oxygen to the patient.

· Provide diuretic usually furosemide to patient it help to reduce edema & fluid overload

· Provide bed rest to the patient.

· Daily record the edema, weight, heart rate, respiratory rate, blood pressure, fluid intake and urine output to get the baseline data of the patient.

· Diet management:- Provide restricted protein, salt & fluid.

· Anti hypertensive (nifedipine, atenolol) and diuretics are administered to control the hypertension and its consequences on the patient.

· Antibiotic (preferably Penicillin) is needed for 7 to 10 days to eradicate streptococci in the throat or skin or to prevent infection among the patient.

Nursing management

· Fluid volume excess related to altered renal function.

Goal is to maintain the fluid volume.

- assess the general condition of the patient

- Monitor the fluid intake and urine output of the patient to get baseline data.

- restrict the fluid and sodium intake.

- daily monitor the weight of the patient.

- administer medication as prescribed by the physician.

· Hyperthermia due to infection

goal is to maintain normal body temperature.

-assess the vital sign of the patient to get the baseline data.

-Provide cool and calm environment to the patient.

- Wash your hand before doing any procedure on the patient

-administer medication as prescribed by the physician.

· Altered skin integrity related to edema goal is to maintain skin integrity

- assess the general condition of the skin of the patient

- encourage him/her for the range of motion exercises.

- Assess the nutritional status of the patient and provide him adequate diet.

- Assess the skin on pressure point.

- Assess the surrounding environment for moisture provide moisture free environment to the patient.

2. Complications of juvenile idiopathic arthritis:- hemolytic anemia, Pericarditis, Growth retardation, Polyarticular arthritis, scaling of the skin, Spondyloarthropathy is also associated with inflammatory bowel disease symptoms of this may include diarrhea and abdominal pain, increased risk of infection due to poor immune system.

Interventions:

-Provide Physical therapy to the patient which includes exercise, application of splints, and heat.

ROM (range of motion)exercises.

-Educate them regarding the proper treatment to prevent further complications.

-Provide Emotional support to the family members

Complications of Acute Glomerulonephritis:- Hypertension, Pulmonary edema, hyperkalemia, acute renal failure, pericarditis, electrolyte disturbance, peptic ulcer, gastroenteritis, nephrotic syndrome.

Interventions:-

· Take prompt treatment of a strep infection with a sore throat or impetigo to prevent worsening of condition.

· Monitor the blood pressure & Control high blood pressure, which cause damage to the kidneys from hypertension.

· Monitor the blood sugar level & Control blood sugar to prevent diabetic nephropathy.

3. Therapeutic drug management for his JIA may have contributed to Troy's recent strep infection because methotrixate cause kidney damage by raising blood pressure levels and putting additional stress on the kidneys .

Nursing intervention:- Assess the blood pressure of the patient regularly.

Ask the patient to maintain the intake and output by taking fluid while on methotrixate.

4. Daily dose of amoxicilline in mg:- 40 mg/kg/day (BID means twice a day so in one day total 80 mg)

how many milliters the nurse administer at each dose = what we want/what we have* volume dissolve

= 40/400*5= 0.5ml