Question

Background Information: Alison is a 12 month old who has been vomiting for the past 12 hours. Since waking at 6 AM she has "not held anything down." It is now 5:30 PM and Alison's mother is becoming concerned. She calls the primary care office and the nurse recommends that Alison be brought into the office for evaluation. On initial assessment, Alison is lethargic and very quiet. Her lips and skin are dry. She is crying at times, but does not produce tears. Her diaper is dry; her mother says that she has not needed to change her diaper since 7 AM.

Alison lies very quietly on the examination table. Her vital signs are: Temperature: 101O F Apical Rate: 150 bpm Respiratory Rate: 40 breaths per minute Blood pressure 90/48 Birth weight: 8 lbs Current weight: 21 lbs 6 oz Weight at 12 month visit 2 weeks ago: 24 lbs 2 oz

Alison's mother reports that she loves her milk and usually drinks about 40 ounces per day. However, for the past 24 hours she has not wanted anything to eat or drink. Her mother wants to know if there is anything that the nurse can give Alison to help stop the vomiting.

The nurse obtains the additional physical assessment data and completes dependent nursing interventions:
o Patient ID band placement
o Patient weight and vital signs
" Weight is 21 lbs or 9.5 Kg
" Temperature 102O F rectally, Heart rate 145, Respiratory rate 39, BP 92/45
" Physical assessment of patient
" Chest congestion and bilateral coarseness with a slight expiratory wheeze, dry cough, nasal congestion, left tympanic membrane is bulging and erythematous and Alison seems bothered when the nurse touches her ears
o Urine catherization
o Assess for need of antipyretics at this time
o Draw lab work as ordered
" CBC, CMP, blood cultures, sed rate, urinalysis, urine culture
o Obtain peripheral IV access
o Spinal tap with proper preparations and aseptic technique prior to collecting cultures

During the insertion of a peripheral IV, Alison lies quietly throughout the procedure.

A fluid bolus is ordered by the physician and after administration of the bolus; Alison perks up a little bit. The doctor then orders Tylenol for the patient. The order reads as follows:

Acetaminophen 650.0mg prn pain/fever q 4 hours   

After notifying the doctor of the medication dosage, he changes the order to read:

Acetaminophen 120 mg prn for pain/fever q 4 hours; NSS bolus.

After administering the Acetaminophen, the nurse discovers that Alison's temperature is now at 100.4o F rectally and she has a wet diaper. She is beginning to cry and her mother asks for a bottle. She hands the bottle to Alison and Alison refuses to hold her own bottle. When asked, her mother says, "Oh she is just lazy. She won't stand up on her own either!"

Why does this concern the nurse?

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Answer 1

Alison having chest congestion, bilateral coarseness, with slight expiratory wheezing, dry cough and nasal congestion and left tympanic membrane is bulging and erythEmatous on physical examination. And also ear tender ness(mastoiditis).

* it indicate child is having Acute serous otitis media, and pneumonia.

* these diseases mainly come or occurs due to faulty feeding techniques.

* like bottle feeding, improper position while feeding and due to unhygienic practices.

Nurse must concern regarding mothers words:

* mother need health education regarding

* baby is already sick she wants to help during her feeds.

* during sick time they won't feel good taste.

* avoid bottle feeding. Because it will increases infections.

* up to 2 years complementary feeding along with breast feeding.

* good position should be maintained while feeding. (Sitting)

* maintain hygienic practices. To reduce infections.

* According doctor proscription only she must have follow feeding techniques.

By these education mother may understand some what regarding infections due to faulty feeding techniques which may cause otitis media and pneumonia and asphyxia and death also. So nurse must be concerned.