Nursing 207-Pediatric Gastroenteritis SKINNY Reasoning : Harper Anderson, 5 months old- UPDATE A+ GURANTEED

Nursing 207-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 /Subcategory Covered in Case Study 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 the past two days. 2. She has had four loose and watery stools. She has vomited 3 times in the morning. 3. She is less active, lethargic, and uninterested in play. Unable to keep feedings down. 4. Has not had a wet diaper since yesterday in the evening. 5. She currently weighs 14 lbs. and 2 oz. She has previously weighed 15 lbs. and 2 oz two weeks ago. 1 & 2. By vomiting and having loose stools over the course of two days, that is a short amount of time. Such a short amount of time can alter her hydration and electrolyte balance. Having loose stools removes the body from fluid which is being excreted. By vomiting 3 times, Harper is diminishing her potassium (3.5-5), sodium (135-145), and chloride levels (99-109). Her body is removing electrolytes without replenishing which will cause her body to become lethargic and could potentially create cardiac issues like dysthymias. 3. Her becoming lethargic, less active, and uninterested in playing is concerning because it can alter her level of consciousness. An altered level of consciousness can result from decreased electrolytes like sodium or potassium. Due to Harper vomiting 3 times a day, she is becoming dehydrated and unable to keep food down which can explain her lethargy 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: 1. Her mother is 21 years old and Harper is her first child. 2. Harper’s mother is unemployed. She also lives with her parents. She is constantly feeling overwhelmed with motherhood. 3. Harper has not been immunized since she was born. 1. Harper’s mother being young and having her first child can be a lot to process and overwhelming due to not having a partner. Being so young, there are many aspects of motherhood that are difficult and she may be suffering from lack of knowledge when taking care of her child. She may be unaware of how to help her child with her vomiting and diarrhea episodes. 2. Being constantly overwhelmed is very stressful. She may not know how to cope with her daughter’s medical issues and may need support from her family and other resources to best aid her daughter’s future diagnosis. Some resources include support groups in the community, therapy, or parenting classes to better take care of her child. 3. Harper not being immunized creates a problem because younger children are more susceptible to bacteria and viruses. Having not been immunized, the child’s defense and immunity is not matured so she is more at risk of developing an illness or infection. Education on immunization should be discussed with the mother as immunizations can prevent further infection and protection for future health as Harper keeps developing and coming in contact with other children and pathogen