FUNDAMENTAL Reasoning: STUDENT Pediatric Gastroenteritis

FUNDAMENTAL Reasoning: STUDENT Pediatric Gastroenteritis I. Developing Nurse Thinking by Identifying Clinical Relevance/Significance History of Present Problem: Harper Anderson is a 5-month old female who was brought into the physician’s office for diarrhea and vomiting over the past 2 days. Her mother reports that she has been less active and not interested in playing and has been more sleepy today. She is unable to keep any feedings down today. She has had 4 loose, watery stools and emesis x3 since this morning. She has not had a wet diaper since yesterday evening. She is 25 inches in length and weighs 14 pounds 2 ounces. She weighed 15 pounds 2 ounces at her last office visit 2 weeks ago. Harper is a direct admit to the pediatric unit where you are the nurse responsible for her care. Personal/Social History: Harper’s mother Nicole is 21-years old. She is a single mother and this is her first child. Nicole is a first year nursing student who is living at home with her parents until she completes her degree. Past Medical History (PMH): *Healthy full term infant that weighed 6 pounds 10 ounces at birth. *No current health problems. Mom is no longer breast feeding and Harper is on formula. *Mother had no complications with pregnancy. What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse? RELEVANT Data from Present Problem: Clinical Significance: 1. Diarrhea and Vomiting for the past 2 days 2. Less Active 3. More sleepy 4. Unable to keep feedings down 5. 4 loose watery stools 6. Emesis x 3 7. No wet diaper since yesterday evening 8. 1lb lost in 2 weeks Diarrhea and vomiting are the primary signs and symptoms of Gastroenteritis and leads to dehydration. Pt. mental status and activity are decreased which can be caused by the decrease in fluids. Decrease fluids means that electrolytes may increase or decrease. Pt. inability to keep feedings down may further increase dehydration. Urinary output can assist with evaluating degree of dehydration. Stool assist with the diagnose and severity of disease. Weight loss is a sign of dehydration The amount of urine output and the presence or absence of tears as well as the presence of documented weight loss, can help determine the severity of dehydration present. RELEVANT Data from Social History: Clinical Significance: Mother is 21 years of age Mother age may be relevant because she is young and inexperienced Single Mother 1st Child Being a single mother may mean she doesn’t receive the extra help so she’s doing everything on her own Nursing student With it being her 1st child might have lack of experience Lives with parents As a nursing student her critical thinking may help when it comes to nursing care. Living at home with parents might be useful to include them in the teaching. Ask © 2014 Keith Rischer/www.KeithRN.com Lab/diagnostic Results: Basic Metabolic Panel (BMP): Current: High/Low/WNL? Sodium (135-145 mEq/L) 151 High Potassium (3.5-5.0 mEq/L) 3.1 Low Glucose (70-110 mg/dL) 102 WNL Creatinine (0.6-1.2 mg/dL) 1.4 High Complete Blood Count (CBC): Current: High/Low/WNL? WBC (4.5-11.0 mm 3) 19.8 High Hgb (12-16 g/dL) 15.2 WNL Hematocrit (30–49%) 54 High Platelets(150-450x 103/µl) 225 WNL Neutrophil % (42-72) 88 HIgh © 2014 Keith Rischer/www.KeithRN.com What lab results are RELEVANT that must be recognized as clinically significant to the nurse? RELEVANT Lab(s): Clinical Significance: 1. Sodium (High) 2. Potassium (Low) 3. Creatinine (High) 4. WBC (High) 5. Hematocrit (High) 6. Neutrophil (High) 1. Indicates dehydration which can have many causes, from the child not drinking enough fluids and having diarrhea. 2. Indicates from the child vomiting and having diarrhea 3. Indicates that the kidneys are not working too well which creatinine builds up high levels into the blood. 4. Indicates infection is present 5. Indicates Dehydration which can be d/t the child not drinking and having diarrhea. 6. Indicates that there is an infection present II. Nurse Collected Clinical Data: Current VS: T: 102.2 (axillary) P: 158 R: 38 BP: 62/42 O2 sat: 95% RA ……………………………………………CONTINUED……………………………………….