Pediatric_case_study_due_416 - Background Information...

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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. What are the nurse’s primary concerns based on these findings? Dry diaper for greater than 8 hours absence of tears and dry mucous membranes lethargic and quiet while in the office unable to keep anything down all-day Alison lies very quietly on the examination table. Her vital signs are: Temperature: 101 O 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 What is the nurse concerned with now? Temperature of 101F Could indicate infection or virus Apical Rate and respiratory rate elevated Recent weight loss Birth weight should be tripled by year 1 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.
What questions does the nurse need to ask the mother at this point? When was the last time the nurse received a wet diaper from Alison? This will determine how long the child has been dehydrated and the severity level of her condition. Has she been showing any signs or symptoms in the past 24 to 48 hours such as pulling on ears, increased irritability, inability to get comfortable when lying down, waking frequently during sleep, foul-smelling urine, any new-onset rashes, respiratory distress, cough? All of these symptoms could indicate another underlying illness such as ear infection, urinary tract infection, pneumonia, etc . All of these diagnoses could be the reason for her vomiting. What vaccinations did Alison receive at her 12-month visit 2 weeks ago? To verify if her fever could be from recent immunizations Does Alison have any allergies, and if so, what are her reactions like? This will help to prevent any further injury to the patient and alert physicians and nurses while ordering treatments and medications for Alison Does Alison take any medications at home on a daily basis? To complete a medication reconciliation as defined by Quality and Safety Education for Nurses Has Alison traveled outside of the United States in the past few weeks?

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