Question

Case Study:
Yasmin is a 12 month old female who was brought to the Emergency Department by her aunt. Yasmin’s aunt anxiously reports that the child has been having diarrhea for the past two days and “is not her usual self”. She adds that the child is fussy, lethargic, not feeding well and when she attempted to give Yasmin acetaminophen
she spit it out. Yasmin’s aunt reports that her parents are out of town, but that she does have the phone number of the hotel in which they are staying.
Assessment:
Weight: 11 kg Vital Signs Heart Rate: 115
Blood pressure: 85/50
Respiratory rate: 30 deep and rapid breathing Oxygen saturations: 95% on room air Temperature: 39.0 Degrees Celsius
General Appearance: Appears stated age. Height and weight proportional
Cardiovascular: Sinus tachycardia Respiratory: Clear breath sounds GI: Hypoactive bowel sounds
Gastrointestinal and Urinary: Has not voided in 8 hours, and is refusing fluids
Integumentary: Warm and dry to touch. Dry lips. Eyes appear sunken. No tears. Poor skin turgor
Neurological: Awake, but lethargic and irritable. Pupils equal, round and reactive to light, weak movements present in all four limbs
1. Identify three communication techniques that could be utilized to support and help build a therapeutic relationship with Yasmin and her aunt. (3 marks)
2. Discuss three safety concerns related to Yasmin’s developmental stage and hospital admission. (3 marks)
3. Describe and give rationale explaining what findings in Yasmin’s assessment are of concern. (4 marks)
4. Identify two early and two late signs and symptoms of dehydration in pediatric patients. (4 marks)
5. Differentiate between mild, moderate and severe dehydration in the pediatric patient. (3 marks)
6. Outline four priority nursing actions while caring for Yasmin. (4 marks)
7. Explain how diarrhea causes electrolyte imbalances and dehydration. (4 marks)
8. Describe 3 common methods of treatment for dehydration and diarrhea in young children. (3 marks)
9. Describe what actions should be taken to administer an antipyretic to Yasmin considering she is spitting up the medication. (2 marks)
10. Identify 3 assessment findings that indicate improvement in the dehydrated child. (3 marks)

Answer 1

1. Three communication techniques that could be utilized to support and help build a therapeutic relationship with Yasmin and her aunt are :-

a) open ended questions

- communication starter

- requires more than a yes or no answer

ex: how have you been feeling lately? what brought you to the hospital?

b) offering general leads

- encourage patient to verbalize, take direction in convo

ex: go on, tell me about it, continue, where would you like to begin?, nodding

c) giving broad opening

- encourages patient to take the lead in the interaction

ex: where would you like to begin? is there something you would like to talk about?

d) using silence

- helps patient collect thoughts or think through a point

- patiently waiting attentively

2. Three safety concerns related to Yasmin’s developmental stage and hospital admission are :-

- prevention of fall

- entrapment in cribs /beds

- hospital acquired infection

3. The findings in Yasmin which are of concern are :-

- temperature of 39°C

- Has not voided in 8 hours, and is refusing fluids

- Warm and dry to touch. Dry lips. Eyes appear sunken. No tears. Poor skin turgor

Neurological: Awake, but lethargic and irritable , weak movements present in all four

All these signs and symptoms are of dehydration .

4. Two early signs of dehy are :-

- dry skin

- irritability

2 late signs of dehydration are :-

- sunken fontanel and eyes

- Decreased LOC