A mother brings her 14 month old child to the clinic after suffering from a week

Question

A mother brings her 14 month old child to the clinic after suffering from a weekend of nausea, vomiting, and diarrhea. The child is slightly febrile, appears lethargic and is lying in her mother’s arms. She is attentive to noises and faces, but does not make an effort to move around the exam room. Her mother reports she has not vomited or had any loose stools since the previous evening, but she still does not want to take her regular bottles. According to the history provided, she did not keep any food or liquids down for more than 48 hours. Based on initial clinical observations and reported history, the clinician assumes that the child is suffering from dehydration and hypovolemia. Answer the following 1. What questions would be helpful to ask this mother to help the nurse determine the pathophysiology causing this child’s GI distress and dehydration? (What is the pathophysiology? What are the other questions to assist in identifying the diagnosis?)
2. What physical assessments does then nurse perform to confirm this suspicion? (clinical manifestations)

3. What orders does the nurse anticipate for blood work for this patient? (what labs?)
4. What values does the nurse anticipate will be out of normal range in this patient? (what are the lab values for #3 that you would anticipate?)

5. A decision is made to give a small fluid bolus in the office for rehydration. For fluid resuscitation, the nurse anticipates an order for what type of IV fluid? (to assist in re-hydration)
6. As the nurse completes the physical assessment, pharyngeal erythema is noted. Patchy white exudate is visible on the bilateral tonsils. What bedside testing does the nurse anticipate will be ordered for this patient? (Other labs? Other tests?)

7. After a fluid bolus and a dose of Acetaminophen, the child is observed babbling and playing in her mother’s lap. She is taking sips of Pedialyte from her bottle. Amoxicillin in ordered for the patient to take at home. What education will the nurse provide this mother about the strep throat and it’s treatment? What education will the nurse provide about the continued management of the child’s dehydration? (best thoughts based upon the pathophysiology of the disease process.)

A mother brings her 14 month old child to the clinic after suffering from a weekend of nausea, vomiting, and diarrhea. The child is slightly febrile, appears lethargic and is lying in her mother’s arms. She is attentive to noises and faces, but does not make an effort to move around the exam room. Her mother reports she has not vomited or had any loose stools since the previous evening, but she still does not want to take her regular bottles. According to the history provided, she did not keep any food or liquids down for more than 48 hours. Based on initial clinical observations and reported history, the clinician assumes that the child is suffering from dehydration and hypovolemia. Answer the following 1. What questions would be helpful to ask this mother to help the nurse determine the pathophysiology causing this child’s GI distress and dehydration? (What is the pathophysiology? What are the other questions to assist in identifying the diagnosis?)
2. What physical assessments does then nurse perform to confirm this suspicion? (clinical manifestations)

3. What orders does the nurse anticipate for blood work for this patient? (what labs?)
4. What values does the nurse anticipate will be out of normal range in this patient? (what are the lab values for #3 that you would anticipate?)

5. A decision is made to give a small fluid bolus in the office for rehydration. For fluid resuscitation, the nurse anticipates an order for what type of IV fluid? (to assist in re-hydration)
6. As the nurse completes the physical assessment, pharyngeal erythema is noted. Patchy white exudate is visible on the bilateral tonsils. What bedside testing does the nurse anticipate will be ordered for this patient? (Other labs? Other tests?)

7. After a fluid bolus and a dose of Acetaminophen, the child is observed babbling and playing in her mother’s lap. She is taking sips of Pedialyte from her bottle. Amoxicillin in ordered for the patient to take at home. What education will the nurse provide this mother about the strep throat and it’s treatment? What education will the nurse provide about the continued management of the child’s dehydration? (best thoughts based upon the pathophysiology of the disease process.)

A mother brings her 14 month old child to the clinic after suffering from a weekend of nausea, vomiting, and diarrhea. The child is slightly febrile, appears lethargic and is lying in her mother’s arms. She is attentive to noises and faces, but does not make an effort to move around the exam room. Her mother reports she has not vomited or had any loose stools since the previous evening, but she still does not want to take her regular bottles. According to the history provided, she did not keep any food or liquids down for more than 48 hours. Based on initial clinical observations and reported history, the clinician assumes that the child is suffering from dehydration and hypovolemia. Answer the following 1. What questions would be helpful to ask this mother to help the nurse determine the pathophysiology causing this child’s GI distress and dehydration? (What is the pathophysiology? What are the other questions to assist in identifying the diagnosis?)
2. What physical assessments does then nurse perform to confirm this suspicion? (clinical manifestations)

3. What orders does the nurse anticipate for blood work for this patient? (what labs?)
4. What values does the nurse anticipate will be out of normal range in this patient? (what are the lab values for #3 that you would anticipate?)

5. A decision is made to give a small fluid bolus in the office for rehydration. For fluid resuscitation, the nurse anticipates an order for what type of IV fluid? (to assist in re-hydration)
6. As the nurse completes the physical assessment, pharyngeal erythema is noted. Patchy white exudate is visible on the bilateral tonsils. What bedside testing does the nurse anticipate will be ordered for this patient? (Other labs? Other tests?)

7. After a fluid bolus and a dose of Acetaminophen, the child is observed babbling and playing in her mother’s lap. She is taking sips of Pedialyte from her bottle. Amoxicillin in ordered for the patient to take at home. What education will the nurse provide this mother about the strep throat and it’s treatment? What education will the nurse provide about the continued management of the child’s dehydration? (best thoughts based upon the pathophysiology of the disease process.)

Explanation / Answer

1. What questions would be helpful to ask this mother to help the nurse determine the pathophysiology causing this child’s GI distress and dehydration? (What is the pathophysiology? What are the other questions to assist in identifying the diagnosis?)

Pathophysiology is due to nausea the baby didnot drink any fluids and because of vomiting & diarrhea fluid loss has occured leading to dehydration and less active state of the child . Loss of fluids may be a reason for fever or any infection if baby is bottlefed.

2. Percussion , palpation of abdomen , physical assessment .

Look for sunken eyes , pale tongue and dry lips

3.Complete blood count , look for leucocytosis and serum electrolytes

4. Electrolyte levels may be decreased because of dehydration

5. IV fluid 100ml of normal saline can be given. If no vomiting oral rehydration therapy can be given

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