Karen Quero, SN
It took me 9 hours to complete this case study.
Pediatric Gastroenteritis
SKINNY Reasoning : Harper Anderson, 5 months old
Primary Concept
Infection
Interrelated Concepts In order of emphasis
Inflammation
• Perfusion
Fluid and Electrolyte Balance
Acid-Base Balance Clinical
Judgment
NCLEX Client Need Categories Percentage of Items from Each Cate o Covered in Case Study
/Subcategory
Safe and Effective Care Environment
• Management of Care 17-23%
• Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
• Basic Care and Comfort 6-12%
Pharmacological and Parenteral Thera les 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
1
, SKINNY Reasoning
Part 1: Recognizing RELEVANT Clinical Data
Patient Care Begins:
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 two days. She had two loose large loose stools the first day and now her mother reports that she has been less active,
is not interested in playing, and has been more sleepy today. She is unable to keep any feedings down today. She has had
four loose, watery stools and emesis x3 this morning. She has not had a wet diaper since yesterday evening. She is 25
inches (63.5 cm) in length and weighs 14 pounds, 2 ounces (6.4 kg). She weighed 15 pounds, 2 ounces (6.86 kg) at her
Last office visit two weeks ago. Harper is a direct admit to the pediatric unit where you are the nurse responsible for her.
Personal/Social History:
Harper's mother Nicole is 21 years old. She is a single mother and this is her first child. Nicole is not currently working
und lives with her parents. Though she has strong social support from her parents, she feels constantly overwhelmed as a
new mother.
Past Medical History (PMH):
● Healthy full-term infant that weighed 6 pounds 10 ounces (3.0 kg) at birth. No current health problems. Mom is
no longer breast feeding and Harper is on formula.
● Mother had no complications with pregnancy.
● Has not had any immunizations from birth, including rotavirus
RELEVANT Data from Present Problem: Clinical Significance:
1. She has had diarrhea and vomiting over 1 & 2. By vomiting and having loose stools over the course of two days,
the past two days. that is a short amount of time. Such a short amount of time can alter her
2. She has had four loose and watery hydration and electrolyte balance. Having loose stools removes the body
from fluid which is being excreted. By vomiting 3 times, Harper is
stools. She has vomited 3 times in the
diminishing her potassium (3.5-5), sodium (135-145), and chloride levels
morning. (99-109). Her body is removing electrolytes without replenishing which
3. She is less active, lethargic, and will cause her body to become lethargic and could potentially create
uninterested in play. Unable to keep cardiac issues like dysthymias.
feedings down. 3. Her becoming lethargic, less active, and uninterested in playing is
4. Has not had a wet diaper since concerning because it can alter her level of consciousness. An altered
yesterday in the evening. level of consciousness can result from decreased electrolytes like sodium
5. She currently weighs 14 lbs. and 2 oz. or potassium. Due to Harper vomiting 3 times a day, she is becoming
She has previously weighed 15 lbs. and 2 dehydrated and unable to keep food down which can explain her lethargy
oz two weeks ago. since she has no energy after expelling.
4. Not obtaining a wet diaper indicates decreased urine output. A
decreased urine output signifies an increase in dehydration. The kidneys
are not receiving an adequate supply of nutrients and water which limit
the production of urine within the kidneys. Kidney labs should be
assessed to note functionality and filtration.
5. This weight fluctuation is abnormal. For every 1 lb. a child loses, it is
significant in the loss of hydration of a child. Losing a pound within 2
weeks is about 7% of the child’s weight. This finding is abnormal and
could be due to dehydration since the child has been vomiting and has
had frequent loose stools.
RELEVANT Data from Social History Clinical Significance:
2
It took me 9 hours to complete this case study.
Pediatric Gastroenteritis
SKINNY Reasoning : Harper Anderson, 5 months old
Primary Concept
Infection
Interrelated Concepts In order of emphasis
Inflammation
• Perfusion
Fluid and Electrolyte Balance
Acid-Base Balance Clinical
Judgment
NCLEX Client Need Categories Percentage of Items from Each Cate o Covered in Case Study
/Subcategory
Safe and Effective Care Environment
• Management of Care 17-23%
• Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
• Basic Care and Comfort 6-12%
Pharmacological and Parenteral Thera les 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
1
, SKINNY Reasoning
Part 1: Recognizing RELEVANT Clinical Data
Patient Care Begins:
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 two days. She had two loose large loose stools the first day and now her mother reports that she has been less active,
is not interested in playing, and has been more sleepy today. She is unable to keep any feedings down today. She has had
four loose, watery stools and emesis x3 this morning. She has not had a wet diaper since yesterday evening. She is 25
inches (63.5 cm) in length and weighs 14 pounds, 2 ounces (6.4 kg). She weighed 15 pounds, 2 ounces (6.86 kg) at her
Last office visit two weeks ago. Harper is a direct admit to the pediatric unit where you are the nurse responsible for her.
Personal/Social History:
Harper's mother Nicole is 21 years old. She is a single mother and this is her first child. Nicole is not currently working
und lives with her parents. Though she has strong social support from her parents, she feels constantly overwhelmed as a
new mother.
Past Medical History (PMH):
● Healthy full-term infant that weighed 6 pounds 10 ounces (3.0 kg) at birth. No current health problems. Mom is
no longer breast feeding and Harper is on formula.
● Mother had no complications with pregnancy.
● Has not had any immunizations from birth, including rotavirus
RELEVANT Data from Present Problem: Clinical Significance:
1. She has had diarrhea and vomiting over 1 & 2. By vomiting and having loose stools over the course of two days,
the past two days. that is a short amount of time. Such a short amount of time can alter her
2. She has had four loose and watery hydration and electrolyte balance. Having loose stools removes the body
from fluid which is being excreted. By vomiting 3 times, Harper is
stools. She has vomited 3 times in the
diminishing her potassium (3.5-5), sodium (135-145), and chloride levels
morning. (99-109). Her body is removing electrolytes without replenishing which
3. She is less active, lethargic, and will cause her body to become lethargic and could potentially create
uninterested in play. Unable to keep cardiac issues like dysthymias.
feedings down. 3. Her becoming lethargic, less active, and uninterested in playing is
4. Has not had a wet diaper since concerning because it can alter her level of consciousness. An altered
yesterday in the evening. level of consciousness can result from decreased electrolytes like sodium
5. She currently weighs 14 lbs. and 2 oz. or potassium. Due to Harper vomiting 3 times a day, she is becoming
She has previously weighed 15 lbs. and 2 dehydrated and unable to keep food down which can explain her lethargy
oz two weeks ago. since she has no energy after expelling.
4. Not obtaining a wet diaper indicates decreased urine output. A
decreased urine output signifies an increase in dehydration. The kidneys
are not receiving an adequate supply of nutrients and water which limit
the production of urine within the kidneys. Kidney labs should be
assessed to note functionality and filtration.
5. This weight fluctuation is abnormal. For every 1 lb. a child loses, it is
significant in the loss of hydration of a child. Losing a pound within 2
weeks is about 7% of the child’s weight. This finding is abnormal and
could be due to dehydration since the child has been vomiting and has
had frequent loose stools.
RELEVANT Data from Social History Clinical Significance:
2
