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The patient is 12 months old and her mother is stating that she is unable to stand up on her own or hold her own bottleHer mother may have unrealistic expectations for her sick child.Developmental monitoring and parental counseling may be needed toensure that the safety of the child and to evaluate the need for further testing.Possible consultation for a social worker to come speak with Alison’s mother and evaluate the child/parent relationship.Early Intervention.oMother’s knowledge deficit of developmental levelsAlison’s laboratory values come back as follows: (students will have lab sheet)●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/dLWhat laboratory values are concerning?The most concerning lab values for this patient are the UA and the serumCO2.●Leukocytes present in the urine could indicate a urinary tract infectionAnother urinalysis could be sent to rule out contamination of the specimen.The nurse should also await urine culture results for final verification of bacteria present and sensitivity●Ketones present in the urine indicate dehydration in the child. The doctor will continue IV therapy until the ketones clear.The nurse should be checking for ketones with a urine dipstickon each diaper change.C02-indicates dehydrationHgb/anemia may be related to excessive milk consumption; teaching opportunity with mother.Alison is stabilized at this time. The nurse sends a repeat UA and the doctor orders an antibiotic for the patient. Her temperature is now at 99.2O F rectally and her chest X-ray is positive for left lower lobe pneumonia. The doctor decides to admit Alison for observation and IV fluid therapy. What are the three nursing diagnoses that are priority for this patient? What should the doctor consider when ordering medication for Alison?Diagnoses probably include left otitis media, UTI, pneumonia, and dehydration.The vomiting may be from viral gastroenteritis or the UTI, upper respiratory infection, and otitis media combined.The physician should make sure that the patient is able to tolerate PO intake prior to ordering a PO medication. If she is still vomiting, it will be difficult for her to keep the medication down. He may have to consider IV antibiotics until she is better or Acetaminophen rectally instead of orally.The mother may benefit from increased knowledge about the administrationof antiemetics to a vomiting childThe nurse calls the pediatric unit to give a report. She uses the SBAR technique.Using SBAR communication strategy how does the ER nurse provide a safe handoff of Alison tothe unit nurse? How would the nurse give a report with the SBAR technique for Alison?
S-Situation (Describe what is going on)B-Background (Concise history)A-Assessment (Present status)R-Recommendation (What needs to happen?)