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.   What concerns does the nurse have? Why?
B.   Why does the nurse need to repeat the weight when she just had one done in the office?

What diagnostic tests are warranted by these findings? Why?

Answer 1

Vomiting that persist for more than 12 hours is a matter of concern , the child become lethargic, exhausted and weak as there is no fluid in the body , continuos vomiting causes dehydration, dry skin , no response to sound , etc

( A.) Nurses concern are:

1. Calm parents

Tell the parent or the mother that there will be relief in 24 hours and baby will feel better .

2. Tell parents to wash hands:

Vomiting is may be because of infections such as viral or bacterial infections, so before and after handling baby instruct parents to wash hands.

3. Explain the causes of vomiting and fever.

Vomiting and fever is may be because of infections and fever is the initial indicator of infection , a nurses may pinch baby's ear in order to check baby is responding or not ,

If baby is not responding to ear stimulation , then it is possible that the infection has started from the ear ,as ear infection can pass to the gastrointestinal tract and cause infection which leads to vomiting and causes fever.

Viral infection causes so many symptoms as, fever, febrile seizures, dry cough, nasal congestion etc.

If the baby is febrile then acetaminophen can be given but not aspirin as it leads to Reyes syndrome.

4. Preventi baby from hypovolemia shock.

Hypovolemic shock can occur in babies if persistent vomiting occurs for long time , to prevent from that nurse has to hydrate the baby by proving oral rehydration solution and IV fluids .

5. Monitor consiousness.

A dehydrated baby may be confused and fontanelle may be sunken , the nurse should continuously monitor the consciousness as baby has already lost body fluids as evidenced by dry napkins and no years while crying.

(B) Answer

nurses need to repeat weight checking because

The initial weighing of baby was to collect a base line data , after admission the baby is being provided with fluids through IV cannula and oral rehydration solution, to check the effectiveness of these fluids the nurse has to keep on monitoring weight of the baby , if the baby is getting hydrated her weight will increase , tears will also be produced from eyes while crying and diapers will also be wet .

Diagnostic test to be concerned are

Imbalanced CMP that is comprehensive metabolic rate is used to monitor protein and metabolism of individual, it also provides information about functioning of liver and kidney, which regulates electrolytes , when there is alteration in values of CMP abnormally there may be chances of liver failure or kidney failure .

Blood culture may reveal the presence of pathogens and the type of pathogens in the child's body , so that the early treatment can be started and complications can be prevented.

Urine analysis reveals upper urinary tract infection that may affects child's kidneys which leads to chills , fever, vomiting etc.

CBC count may reveal increase WBC because of infection , it gets increases when vomiting occurs because of infection.

Normal WBC in infants are 5000 to 10000, if the level is above 10000 then it is the sign of infection.

Sedimentation rate when increases ,it indicates there is inflammation.