Question

Case Study 124 Class/Group Date Name Group Members Scenario R.O. is a 12-year-old girl who lives with her family on a farm in a rural community. R.O. has four siblings who have recently been ill with stomach pains, vomiting, diarrhea, and fever. They were seen by their pri- mary care provider (PCP) and diagnosed with viral gastroenteritis. A week later, R.O. woke up at 0200 cry- ing and telling her mother that her stomach "hurts really bad!" She had an elevated temperature of 37.9° C(100.2°F). R.O. began to vomit over the next few hours, so her parents took her to the local emergency department (ED). R.O.'s vital signs, complete blood count, and complete metabolic panel were normal, so she was hydrated with IV fluids and discharged to home with instructions for her parents to call their PCP or to return to the ED if her condition did not improve or if it worsened. Over the next 2 days, R.O's abdominal pain localized to the right lower quadrant, she refused to eat, and she had slight diarrhea. On the third day, she began to have more severe abdominal pain, increased vomiting, and fever that did not respond to acetaminophen. R.O. has returned to the ED. Her VS are 128/78, 130, 28, 39.5°C (103.1 ° F). R.O. is guarding her lower abdomen, prefers to lie on her side with her legs flexed, and is crying. IV access is established, and morphine sulfate 2 mg IV is administered for pain. An abdominal CT scan confirms a diagnosis of appendicitis. R.O's white blood count is 12,000 mm?.

Answer 1

1. The diagnosis was difficult for the patient because,there are several other conditions that shows similar clinical manifestations.two such conditions include; diverticulitis, irritable bowel syndrome or pelvic inflammatory disease.

2.The maintenance dosage calculation is ; 100mlx for the first 10 kg + 50 ml for the next 11-20 kg+ 20ml for each additional kg /24

here, the patient weight is 42kg. So as per the formula,

100x10+50x10+20x22/24=1940/24=80.83 ml/hr=81ml/hr.

3.Since, the patient is pediatric, she is unable to give informed consent. So, we have to obtain assent form the patient which means , she agrres to take part in the procedure that is to be carried out.

4. preoperative teaching;

• the nurse should first develop good interpersonal relationship with the patient and family members
• explain completely about the procedure to be done
• ba a patient listener to their doubts
• get informed consent and assent
• she should be advised that nil per oral by 12MN
• shave the area to be operated
• explain the mode of surgery
• give preop medicines and advise her to take those without fail.
• advise them to wear the OT gown before shifting
• remember them to bring all blood investigations and x-ray and usg
• collect properly from the patient regarding medical history and allergies.