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.

He also orders a 250 cc NSS IV bolus stat.

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!"

Alison's laboratory values come back as follows: (students will have lab sheet)

"   Hgb-11 Gm
"   WBC-10,000 mm3
"   Potassium- 4.2 mEq/L
"   Sed rate- 10 mm/hr
"   Creatinine-5 mg/dL
"   BUN-7 mg/dL
"   CO2-15 mEq/L
"   UA-small amount of leukocytes, negative nitrites, large ketones
"   Blood and Urine cultures-pending
"   Blood glucose-75 mg/dL

What laboratory values are concerning?

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Alison is stabilized at this time. The nurse sends a repeat UA and the doctor orders an antibiotic for the patient. Her temperature is now at 99.2O F rectally and her chest X-ray is positive for left lower lobe pneumonia. The doctor decides to admit Alison for observation and IV fluid therapy. For which diagnoses is Alison being admitted? What should the doctor consider when ordering medication for Alison?

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The nurse calls the pediatric unit to give report. She uses the SBAR technique.
Using SBAR communication strategy how does the ER nurse provide a safe handoff of Alison to the unit nurse? How would the nurse give report with the SBAR technique for Alison?

"   S-Situation (Describe what is going on)
"   B-Background (Concise history)
"   A-Assessment (Present status)
"   R-Recommendation (What needs to happen?)
"   Please type up an SBAR report on Allison
After receiving report, the floor nurse admits Alison to the pediatric unit. What assessments and immediate interventions should be performed with Alison? What education or teaching should the nurse give to the mother?

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Alison is stabilized and she is now napping in the room. Her mother is settled and the nurse goes to the Nurses' Station to fill out the correct admission paperwork. A secretary at the front desk looks at the chart and says, "Hey, I know this family. They live right up the street from me. What is she here for?"
What would be an appropriate answer for the nurse to give? Explain your answer.

Answer 1

1. The lab value that are concerning are :-

- Hb is low

- WBC's at higher side

- Creatinine at higher side

- UA is having leukocytes

- CO2 less than the normal range 35 to 45 mEq/l

2. The doctor is admitting Alison for the diagnosis of Pneumonia . When the doctor should prescribe medication according to the microorganism found in culture and should start antibiotics or antivirals or antifungal once the culture is sent for investigation .

3. SBAR is a method used by nurses for effective communication . SBAR stands for situation , background , assessment and recommendation.

In this case, Situation - Alison is diagnosed with pneumonia in left lower lobe in chest X- ray. The doctor has orders for IV fluids and antibiotics . Alison is stable and has no fever . Her UA is send , report is awaited .

Background - Alison is a 12 month old infant who has been vomiting for the past 12 hours . Her mother was concerned and called to health center ,she was advised to bring the child . On examination child was lethargic , quite and was crying but no tears ,her diaper was dry and oral intake nil .Fever of 101 , tachycardia ,and tachypnea . On auscultation she was having wheezes , and nasal congestion . Her left tympanic membrane was bulging .

All blood investigations , blood and urine culture was send , urine catheterization , IV line access was done and assessment for antipyretics were done .

Assessment - on initial assessment patient was lethargic , quite , dehydrated , her diaper was dry . On examination she was having wheezes, nasal congestion , tachycardia and tachypnea . Fever of 102 was present and oral intake was nil After the initial management with antipyretics and I fluids her fever came down to 99 degree fahrenheit and was clinically stable .

Recommendation - Monitor for any respiratory distress ,tachycardia , nasal flaring as she is diagnosed with pneumonia and it might be the warning signs .

4. Basic vitals signs and auscultation would be done , blood investigation will be send .

Teaching given to the mother are :-

- monitor for any lethargic sign

-monitor the feed intake

- monitor for nasal flaring and difficulty in breathing

- when to reach the doctor or nurses

- what are the alarming signs

- teaching about hygiene maintenance

- less visitors as the child has infection

Answer 2

Alison is stabilized at this time. The nurse sends a repeat UA and the doctor orders an antibiotic for the patient. Her temperature is now at 99.2O F rectally and her chest X-ray is positive for left lower lobe pneumonia. The doctor decides to admit Alison for observation and IV fluid therapy. 17. For which diagnoses is Alison being admitted?