Inpatient and Outpatient Settings

Jordan is 9-year-old male who is a direct admit for observation. He has a history of vomiting and diarrhea for 48 hours.

Subjective Data

· Nausea and vomiting for 24 hours

· Has not voided today

· Unable to tolerate oral fluids

Objective Data

· Vital signs: T 37.8° C, P 120, R24, BP 110/60

· Weight: 34 kg

· Hyperactive bowel sounds to auscultation

Question 1

When should the discharge teaching begin for Jordan and his family?

Question 2

What is the best way to approach Jordan regarding the IV that has been ordered.

Question 3

What would be good distractions for a child of Jordan’s age?

II- Case Study: Pediatric Cancer

Mario is a 7-year-old male who presents with a 1-week history of body aches and pallor. He has a 2-day history of fever to 103° F and a 1-day history of bruising and lethargy.

Subjective Data

· Complains of hurting all over

· States he feels very tired

· States he feels dizzy when he stands up

Objective Data

· Weight 26.1 kg

· Vital signs: T 38.9° C, P 140, R 40, BP 108/54, O2 sat 100%

· Purpural rash on extremities

· WBC 0.7

· HGB 3.1

· Hct 8.5

· Plt .08

· ANC 0.1

Question 1

Which of Mario’s presenting symptoms must be treated and stabilized before chemotherapy induction?

Question 2

What testing is required for a definitive diagnosis of meningitis?

Question 3

What should the nurse do in this clinical situation? Prioritize actions.

III- Case Study: Pediatric Respiratory System

Will is a 4-month-old infant born at 34 weeks of gestation. Will’s mother states that he has not been able to go to day care because he has been coughing with a fever for the past 3 days. She states today he is unable to feed well from the bottle because of nasal secretions.

Subjective Data

· Mother complains that infant has had cough for 3 days

· Mother states that infant is having trouble sleeping

· Not voided in past 6 hours

Objective Data

· Birth Weight: 1.9 kg

· Today’s Weight: 5.5 kg

· Vital Signs: T 38° C, P 186, R 60, BP 90/52, Pulse Oximetry 93%

· Thick yellow nasal secretions

· Nasal flaring with moderate intercostal retractions

· Breath sounds decreased with crackles bilaterally to auscultation

Question 1

What risk factors does Will have for contracting bronchiolitis?

Question 2

What is the first priority for Will’s treatment?

Question 3

What should the nurse do in this clinical situation? Prioritize actions.

IV- Case Study: Pediatric Gastrointestinal System

Lucy is a 44-day-old formula-fed infant who presents with a 4-day history of vomiting.

Subjective Data

1. Mother states infant has been vomiting undigested formula after feedings

2. Mother states that infant has not had fever or diarrhea

3. Mother states that infant has had 8 wet diapers in the past 24 hours

Objective Data

1. Weight 4.8 kg (birth weight 3.5 kg)

2. Vital signs: T 37.1° C (rectal), P 130, R 30, BP 92/52

3. Mucous membranes moist, anterior fontanel flat and soft

4. Awake and alert, lusty cry

5. Good muscle tone

6. Olive-sized mass palpated at epigastrium

Question 1

What test will be used to diagnose pyloric stenosis?

Question 2

What should the nurse do in this clinical situation? Using the case study above, the first prioritization step the nurse would take is ____.

Question 3

The second prioritization step the nurse would take is ____.

Question 4

The third prioritization step the nurse would take is ____.

Question 5

The fourth prioritization step the nurse would take is ____.

Question 6

The fifth prioritization step the nurse would take is ____.

Question 7

The sixth prioritization step the nurse would take is ____.

Question 8

The seventh prioritization step the nurse would take is ____.

Question 9

The eighth prioritization step the nurse would take is ____.

V- Case Study: Pediatric Cardiovascular System

Michael is a 7-week-old breastfed infant who presents with a 2-day history of irritability and poor feeding.

Subjective Data

· Mom states patient has been “fussy” for past 2 days

· Only feeds for a “few” minutes at a time

· Breathing heavily and fast for 2 days

Objective Data

· Weight: 4.8 kg

· Vital Signs: T 36.8° C, P 250, R 65, BP 84/58

· Breath sounds clear to auscultation

· Oxygen Saturation 95%

· Central capillary refill 4 sec

Question 1

What is the treatment for an unstable patient with SVT?

Question 2

Decreased cardiac output from prolonged SVT will produce what complication?

Question 3