Scenario T.M. is a 3-year-old boy with cerebral palsy (CP) who has been admitted to your unit. He is scheduled for surgery tomorrow morning for a femoral osteotomy and tendon lengthening to stabilize hip joints and to help reduce spasticity. You are orienting the parents to the unit and have a nursing student assisting you. Case Study Progress You and the nursing student finish a health history with the family and determine that T.M. has impaired vision corrected with glasses, a speech impairment, and a seizure disorder and has had poor weight gain and feeding issues since birth. He has a skin-level feeding device (Mic-Key button) and receives supplemental tube feedings in addition to oral intake. He is not able to ambulate without braces and wears ankle-foot orthotics. He receives physical, occupational, and speech therapy on an outpatient basis. T.M. is verbal and able to answer questions with simple phrases and responds to commands. T.M. weighs 12 kg. T.M. returns to your unit the next afternoon from the postanesthesia care unit (PACu). He is in a bilateral spica cast, has a Foley catheter, and has a family-controlled patient-controlled analgesia (PCA) device for pain control. you assess T.M. and chart the following findings. Postoperative Assessment Neurologic: Awake and alert, verbalizes and responds to commands. Periods of agitation and restlessness. Respiratory: RR 25 breaths/min. Bilateral breath sounds, equal, clear, good air exchange. O2 saturation 98% on room air. Cardiovascular: Peripheral IV line to right forearm infusing D5½ normal saline(NS) at 45mL/hr. HR 85 beats/min. Temperature 98.2 (F) (axillary). Gastrointestinal: Positive bowel sounds; taking sips of juice PO; Mic-Key button to abdomen clamped. Mic-Key site clean, no signs of breakdown. Genitourinary: 8 French Foley catheter intact and secured, draining yellow clear urine to collection bag. Diaper to spica cast opening. Neuromuscular: Bilateral spica cast to legs with hip abductor bar intact. Toes warm to touch; able to move, unable to palpate pedal pulses. Cap refill less than 2 seconds. Pain: T.M. occasionally whines and frowns but is comforted by parents. PCA is Y-connected to IV and infusing morphine at 0.01mg/kg continuous and 0.015 mg/kg PCA with 15-minute lockout. Psychosocial: Parents at bedside active in care. Case Study Progress T.M.’s condition is stable throughout the day, and the physician writes the following orders: Patient can PO ad lib. Resume home schedule of 520 mL Pediasure via G-tube from 10 pm to 6 am. Remove Foley catheter. 9. List the steps for setting up a feeding with a Mic-Key button in the correct order. Calculate the hourly rate at which you will set the pump to infuse his feeding.   10. The physician orders the Foley catheter discontinued. What nursing interventions and teaching will you include for T.M. and his family as you implement this order?

Scenario

T.M. is a 3-year-old boy with cerebral palsy (CP) who has been admitted to your unit. He is scheduled for surgery tomorrow morning for a femoral osteotomy and tendon lengthening to stabilize hip joints and to help reduce spasticity. You are orienting the parents to the unit and have a nursing student assisting you.

Case Study Progress

You and the nursing student finish a health history with the family and determine that T.M. has impaired vision corrected with glasses, a speech impairment, and a seizure disorder and has had poor weight gain and feeding issues since birth. He has a skin-level feeding device (Mic-Key button) and receives supplemental tube feedings in addition to oral intake. He is not able to ambulate without braces and wears ankle-foot orthotics. He receives physical, occupational, and speech therapy on an outpatient basis. T.M. is verbal and able to answer questions with simple phrases and responds to commands. T.M. weighs 12 kg.

T.M. returns to your unit the next afternoon from the postanesthesia care unit (PACu). He is in a bilateral spica cast, has a Foley catheter, and has a family-controlled patient-controlled analgesia (PCA) device for pain control. you assess T.M. and chart the following findings.

Postoperative Assessment

Neurologic: Awake and alert, verbalizes and responds to commands. Periods of agitation and restlessness.

Respiratory: RR 25 breaths/min. Bilateral breath sounds, equal, clear, good air exchange. O2 saturation 98% on room air.

Cardiovascular: Peripheral IV line to right forearm infusing D5½ normal saline(NS) at 45mL/hr. HR 85 beats/min. Temperature 98.2 (F) (axillary).

Gastrointestinal: Positive bowel sounds; taking sips of juice PO; Mic-Key button to abdomen clamped. Mic-Key site clean, no signs of breakdown.

Genitourinary: 8 French Foley catheter intact and secured, draining yellow clear urine to collection bag. Diaper to spica cast opening.

Neuromuscular: Bilateral spica cast to legs with hip abductor bar intact. Toes warm to touch; able to move, unable to palpate pedal pulses. Cap refill less than 2 seconds.

Pain: T.M. occasionally whines and frowns but is comforted by parents. PCA is Y-connected to IV and infusing morphine at 0.01mg/kg continuous and 0.015 mg/kg PCA with 15-minute lockout.

Psychosocial: Parents at bedside active in care.

Case Study Progress

T.M.’s condition is stable throughout the day, and the physician writes the following orders: Patient can PO ad lib. Resume home schedule of 520 mL Pediasure via G-tube from 10 pm to 6 am. Remove Foley catheter.

9. List the steps for setting up a feeding with a Mic-Key button in the correct order. Calculate the hourly rate at which you will set the pump to infuse his feeding.

 

10. The physician orders the Foley catheter discontinued. What nursing interventions and teaching will you include for T.M. and his family as you implement this order?

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