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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-dayAlison lies very quietly on the examination table. Her vital signs are:Temperature: 101OFApical Rate: 150 bpmRespiratory Rate: 40 breaths per minuteBlood pressure 90/48Birth weight: 8 lbsCurrent weight: 21 lbs 6 ozWeight at 12-month visit 2 weeks ago: 24 lbs 2 ozWhat 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 1Alison’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 toknow 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 dehydratedand 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 lyingdown, waking frequently during sleep, foul-smelling urine, any new-onsetrashes, 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 immunizationsDoes Alison have any allergies, and if so, what are her reactions like?●This will help to prevent any further injury to the patient and alertphysicians and nurses while ordering treatments and medications forAlisonDoes Alison take any medications at home on a daily basis?●To complete a medication reconciliation as defined by Quality andSafety Education for NursesHas Alison traveled outside of the United States in the past few weeks?