PEDIATRICS- GI, GU, FLUID & ELECTROLYTE ALTERATIONS You are an RN…

PEDIATRICS- GI, GU, FLUID & ELECTROLYTE ALTERATIONS

 

You are an RN working the 7a-7p shift on a Renal/GI Pediatric Unit in a community hospital.  The Renal/GI Pediatric Unit has 22 beds.  The day staff consists of a Nurse Manager, 6 RNs, 4 PCTs (Patient Care Technicians), a Child Life Specialist, and a Unit Clerk.  Patient rounds with the pediatricians, nurse practitioners, physician specialists, and charge nurse occur daily at 0800.  After rounds, the charge nurse and nurse practitioner meet with the Nutritionist, PT and OT, Child Life, Certified Teacher, Nurse Case Manager and Social Work to discuss each patient’s daily plan of care. A satellite Pharmacist is assigned to the pediatric unit.

 

You arrive and receive report from the RN on night shift:

 

100      David York    Age:  5 months

Weight:  12 lbs

Admitting Dx:  Diarrhea/Dehydration

PMH:  Asthma, Failure to thrive

Third admission for dehydration and failure to thrive

EGD and colonoscopy scheduled today at 1100

02 Sats 97% on 2L humidified FiO2 via NC, lungs clear

AM lab results:  Hgb 10, Hct 32.0, NA 134, K 5

NPO since 12MN except breast milk, full NPO at 0600

No wet diapers since 2200, No BM

D5 ½ NS @ 15cc/hr stopped due to IV infiltrate @ 0200 (attempts to replace IV   unsuccessful)

Consent signed

Pre-procedure checklist on chart

Pre-procedure medications ordered

Mother at the bedside. Father at home with 2 yr old sister

 

102      Charity Williams      Age: 9 yo

Weight:  110 lbs

Admitting Dx:  Gastroesophageal Reflux Disease (GERD), R/O aspiration

PMH:  pneumonia 2x within last year, Cerebral Palsy, developmental delay

CXR: hazy infiltrate RML

Current medications:  Nexium 10mg PO once a day

Diet:  bland thickened liquid feedings in upright position

02 Sats 96% on 2 L 02 via NC

Hgb 11.4, Hct 36.4

No emesis last night

Abd soft BM x2 yesterday

IV Saline lock

OOB to wheelchair as tolerated

Mother primary caregiver and is overwhelmed with Charity’s care.

Consults:  Surgery to evaluate for Nissen Fundoplication and GT insertion                                                      Dietary to evaluate caloric needs and feeding frequency

 

103      Yolanda Martinez     Age: 15 yo

Wt: 110 lbs

Admitting Dx:  Hemolytic Uremic Syndrome (HUS)

No past medical history

Identifies as transgender

PHI:  Seen by PMD (primary medical doctor) 5 days ago and diagnosed with viral             gastroenteritis.  Symptoms did not improve and parents brought child to ED after 12 hrs

of no urine output

+ Ecoli from stool culture

lethargic, voided x1 last night 20ml dark urine

Hgb 8.7 Hct 28.2

Plt 67,000

BUN 104  Creatinine 3

Received 1 unit PRBC yesterday after dialysis

Labs drawn this AM @ 0600

IV saline lock

Diet:  as tolerated protein restricted diet (restrict protein intake to 20% of caloric intake)

No family at bedside, father a single parent and is at work

 

106      Samuel Penn  Age 16 months

Wt: 18.5 lbs

Admitting Dx: Acute Abd pain, R/O Intussusception

Just arrived from ED

PHI:  parents brought child into ED early this AM after several episodes of child drawing            his knees to his chest and screaming, mom stated that child has had vomiting and diarrhea      for 2 days, mom noticed that two stools were mixed with blood and mucus (currant jelly      stool), no PO intake since yesterday evening

PMH: Cystic Fibrosis (CF)

Lethargic, irritable, diaphoretic

Palpable, tender abdominal mass

#24 G IV to R hand – D5 NS @ 53cc/hr

Received NS bolus (20ml/kg) in ED x1

Abd x-ray ordered for 0800

HR 180, RR 28, BP 88/41, Axillary T=101

Mom names daily medications for CF management but cannot remember dosages

N-acetylcysteine, Albuterol, Creon, Vitamins ADEK, and Motrin as needed for                             pain.

Father lost job and will lose insurance benefits in a month.

 

Questions

 

A. Health problem(s): General Overview Not Patient Specific 

1. Etiology (include genetic/genomic assessment as appropriate)

2. Incidence 

3. Pathophysiology