Pediatric Unit

APPLY THE LEARNING.
1. IT’s 0700 you are the nurse assigned to care for a 12 month old baby who is admitted to the pediatric unit diagnosed with gastroenteritis and dehydration. The baby’s has 3 older siblings ages 2 1/2, 6 and 8 years old. The 12 month old and the 2 1/2 year old attend a community daycare center 4 days a week. The 5 and 7 year old are in a local elementary school. The children parent are legally separated and pursuing a divorce. The mother tells the nurse that the 7 month old has been sick for 2 days with vomiting and has foul smelly green watery diarrhea stool several times a day.
On assessment the nurse notes that the baby is lying on mom’s shoulder, does not cry when approached, appear weak and listless but is awake. The baby is not interested in toys or playing. Vital signs T. 38.2 A, HR. 160, RR 39, B/P 90/42. Capillary refill time less than 3 second, skin turgor tenting. Baby weighs 24lbs. Mom reports that at the infant last well child visit 3 weeks ago the baby weighed 27 lbs. Over the last month, the Baby is being weaned from the breast and drinks from a bottle and eats baby food. Mother does not recall a wet diaper in last 4 hours when baby had a large diarrhea stool and vomited twice.
Orders include:
IVF D51/3NS at 100 ml/hr
Strict I/ O
Age appropriate diet
Encourage oral fluids
Stool for ova and parasite
CMP, BMP, CBC, Blood for temp 39C
a. Develop a plan of care for this child and family.
b. List 4 priority nursing diagnosis
c. Calculate the child daily and hour fluid requirement. Use formula in Table 24-1 on pg. 947 of your Hockenberry Wilson (WONG’S) Nursing Care of Infants and Children textbook, 10th Edition.
d. Make a decision about the orders. Would you implement as written? If yes why? If no why not?
e. Create a concept map for the top prioritized diagnosis
f. Identify concepts to be included in a teaching plan
g. Incorporate developmental theories appropriate to the patient and family ages.
h. List 3 points you need clarify

2. A 30 month old is in the clinic for a well child visit. The child is typically developing. This is parents’ first child. They are planning to have 2 more children. The nurse reviews the child’s medical record and notes the child did not receive the MMR and Varicella vaccines at age one. All other vaccines were given on time. The nurse documents that the child is not are up to date for age appropriate immunizations.
a. Discuss how the nurse would approach this situation.
b. Obtain a copy of the recommended childhood immunization schedule from the CDC website www.cdc.gov/vaccines
c. Identify childhood vaccine preventable diseases; briefly describe each.
d. Discuss childhood immunization and the recommended childhood schedule.
e. Discuss risk vs benefits of immunizations
f. Discuss barriers to immunization.
g. Develop a teaching plan for this child and family.
h. List 3 points you need clarify

3. A nine year old child was burned by hot liquid why attempting me make tea. Her mother brings her to the ER and states “the child was removing a cup of hot water from the microwave when it spilled on her”. The child has burn areas without skin and blisters on her the front of her chest, front of left arm and front of both legs. Child is admitted with second and third burns. She weight 68lbs. The child was at home with her maternal grandmother who is visiting and speaks limited English. Go to YouTube and watch these videos and answer the questions below. https://www.youtube.com/watch?v=7fK6tQ01Ap0. https://www.youtube.com/watch?v=ba9zHMkqo1g

a. What additional information would the nurse need in order to plan care for this child?
b. Develop a plan of care for this child.
c. Identify 4 prioritized nursing diagnosis for this child and family
d. Calculate the child’s total body surface area burned and her daily fluid need.
e. Discuss developmentally
f. Use the Parkland formula to calculate the child’s fluid need. What is the 8 hour infusion rate? What is the 16 hour infusion rate?
g. What anticipatory guidance strategies and information would be essential to this child’s care?
h. List 3 points you need clarify