Alice Morrison is a 7-year-old Caucasian female born with an irreparable
Question Answered step-by-step Alice Morrison is a 7-year-old Caucasian female born with an irreparableesophageal atresia that has required her to have G-tube feedings since birth. Alice has had multiple hospital admissions for recurrent bronchitis and was admitted through the emergency department Saturday at 0600 with a fever of 103.4 F (39.7 C).Patient InformationChief Informant: Linda MorrisonChief Complaint: Fever and coughHistory of Current Problem: Fever started last night; persistent cough kept Alice awake all night.Primary DiagnosisAcute bronchitisSecondary DiagnosisEsophageal atresia with G-tubePrevious IllnessesReflux, esophageal atresia, multiple hospitalizations for bronchitisAllergiesNKADietary HistoryComplete peptide-based elemental nutrition for children, 115 mL/hr for 12 hr/day in addition to regular diet during the dayCurrent MedicationsMetoclopramide 152 mg 4 times a day and acetaminophen 200 mgOrdered medicationsGentamicin injection via IV Piggyback 48 mg every 8 hoursAmpicillin injection IV Piggback 630 mg every 6 hoursRanitidine oral sol 47 mg every 12 hoursAcetaminophen 285 mg PRN every 4 hoursIbuprofen 190 mg PRN every 6 hoursVital signsTemp 100.5, Resp 26, Pulse 112, BP 112/76, SAT 92%Review of SystemsMom reports all normalPhysical ExamRespiratory: Right upper lobe crackles; bases are decreased; mild suprasternal retractions noted.Lymphatic: Unable to palpate cervical lymph nodesAll other areas normalImpressionsRecurrent bronchitis with increased refluxPlanDaily chest x-rays to monitor right upper lobe infiltrates; increased dosages of reflux medications; continued IV antibiotics pending culture results.Provider orders1). Code status: Full code2). Admitted to pediatric unit for bronchitis3). Routine vital signs every 8 hours4). Continuous pulse oximetry5). Head of bed at 30 degrees6). Intravenous access: Saline lock, maintain access.7). Gentamicin 48 mg IV every 8 hours8). Ampicillin 630 mg IV every 6 hours9). Acetaminophen elixir 285 mg via gastrostomy tube every 4 hours PRN for mild pain or fever greater than 100.5 F (38 C)10). Ibuprofen elixir 190 mg via gastrostomy tube every 6 hours PRN for mild pain or fever greater than 100.5 F (38 C)11). Ranitidine suspension 47 mg via gastrostomy tube every 12 hours, first dose now12). Lansoprazole suspension 15 mg via gastrostomy tube once per day, first dose now13). Activity: Out of bed as tolerated three times per day14). Complete peptide based elemental nutrition for children at 84 mL/hr for 16 hours, off at 1300 and back on at 2000; begin feeedings now 15). Oral fluids as tolerated16). Barium swallow for increased gastroesophageal reflux17). Endoscopy for possible esophagitis18). Daily chest x-rays19). Nutrition consult20). Pulmonary consult21). Call provider for:Temperature greater than 101 F (38.3 C)Heart rate greater than 140 or less than 60 beats/minSystolic blood pressure greater than 155 or less than 70 mm HgRespiratory rate greater than 30 or less than 18 breaths/minNursing Interventions/Basic Nursing CareSafety Fall PrecautionsSide rails up x2Side rails encouragedBed in low positionCall light within reachActivityActivity Notes:AwakeHygiene/Dressings/ComfortNo assessment or care required at this timeNutrition and HydrationGastrostomy tube (G-tube) in placeElimination Functional AbilityTo bathroom with mother’s assist.Needs assistance with toiletingSkin CareNo assessment or care required at this time 1. What concepts do you think are important in this scenario and why?2. What abnormal signs and symptoms did you recognize and how did you prioritize your care of this patient?3. How would you change your actions or interventions if you had a second chance to care for this patient?4. How would you apply what you have learned from this scenario to future patients? Health Science Science Nursing NURSING BSN 225 Share QuestionEmailCopy link Comments (0)
