You are a staff nurse on a busy pediatric unit on a Friday morning. You just received
Question:
You are a staff nurse on a busy pediatric unit on a Friday morning. You just received report from the night nurse. One of your patients is Rivka Schwartz, an 18-month-old, 9 kg girl with an asthma exacerbation. Her family is orthodox Jewish and from Israel. They are staying in St. Louis for several weeks with family. The child does not speak English. The patient’s mother is 21 years old and is 6 months pregnant with her second child. This is the child’s third hospitalization for asthma in the last 4 months. She has been improving since admission and her albuterol treatments were advanced to every 4 hours last night. Overnight, she had minimal wheezing. Her oxygen saturations are 94% on room air. The child breastfed overnight, but refused solid food yesterday.
When you enter the room for your initial nursing assessment, the child is awake and watches you but does not respond to your smiling face or your friendly comment: “Hi, how are you this morning? You look pretty in your pink pajamas.” Since her mother is already up and dressed you introduce yourself. The mother tells you that she needs to go home early today because she needs to prepare for Shabbat (the Sabbath). She says her child is getting better and should be discharged this morning. She further states her absolute deadline for discharge today is 2:30 p.m. in order for her to get home in time. You explain that the physicians will make rounds this morning and will make decisions about discharge. She asks you if the physicians can see her daughter first, prior to the other patients.
Later in the morning after rounds, the physician in charge of Rivka’s care tells you she can be discharged home today after she eats lunch. Lunch will be served at noon.
Discharge orders for Rivka Schwartz:
Reason for admission: asthma exacerbation
Medications: Continue albuterol nebulizer treatments 1.25 mg every 4 hours at home for 48 hours and then every 4 hours PRN after that.
Start Montelukast sodium (Singulair) 4 mg PO at bedtime once a day
Make appointment to see primary care provider next week for nutrition assessment
RN to provide asthma teaching with action plan
As you review the discharge order with the mother, she interrupts you to say she is not allowed to touch anything that requires electricity on the Sabbath. She cannot give the albuterol inhalation treatments with the nebulizer but will be taking Rivka home with her. She asks you how else she can give this medication.
Fraud examination
ISBN: 978-0538470841
4th edition
Authors: Steve Albrecht, Chad Albrecht, Conan Albrecht, Mark zimbelma