Working a tough shift this week because I get home just in time to go to bed and get up to do it again. Makes posting tough. I’m working with pediatric patients this week. My last shift looked like this:
- a 14 year old with developmental delays who admitted to being sexually active. Her mother knew and was OK with it. She was my sickest patient of the day.
- an entire family (2 adults, 3 kids aged 9 months to 8 years) who came in with body lice because they are homeless
- a 15 year old and her mother who came in with bed bugs from the long stay motel they are living in
- A 3 year old who fell out of bed and broke her collarbone.
- A 17 year old who had a bruise across his abdomen from a dirtbike accident
- a 16 year old with chest pain that gets worse when he breathes in
- plus a parade of sniffles, fevers, and sneezes that cause screaming children, which are the reason why I don’t like working pediatrics, but it’s my turn. I think I had around 25 or 30 patients overall, but I lost count. Most were easy- in and out in about 90 minutes or so.
One of the things that makes pediatrics hard is that all of the medication dosages are weight based. Because of that, it’s easy for people to screw up. Last night, 5 minutes before my quitting time, a Doctor ordered medication and discharge orders for a child. The dose appeared to be too large. I sat down and did the math. This is what my day was like:
The Drug Reference says that the dose is supposed to be 20-50 milligrams per kilogram of body weight per day, divided into three doses. The ordered dose was 1080 milligrams to be administered to a 5 year old child who weighed 27 kilograms. It required calls to the pharmacist, messages to the doctor, cancelling the original order, getting a new order, administering the medication, returning the excess to the pharmacy, processing the discharge, and I finally got off work, 30 minutes past my scheduled time.