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i need a nursing intervention for this scenario Background Information: Mary is a 12 month old...

i need a nursing intervention for this scenario



Background Information:
Mary 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 Mary's father who is caring for the child while his wife is in the hospital ill, is becoming concerned. He calls the primary care office and the nurse recommends that Mary be brought into the office for evaluation. On initial assessment, Mary 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 father says that she has not needed to change her diaper since 7 AM.

Mary 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

Mary's father 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 father wants to know if there is anything that the nurse can give Mary to help stop the vomiting.

• 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
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Answer #1

Nursing intervention:

Provide comfort to the child by administrating intravenous flui therapy -i.v fluid will help to maintain the hydration of the body as babay shows the signs of dehydration.Moreover,she cannot take oral rehydration as she has vomitting.so,first priority is to administer i.v fluid to recover patient from dehydration then give medicines to control vomitting,otherwise child may go to shock.

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