Isabella Burgel is an 18-month-old Hispanic female with Down…

Question Answered step-by-step Isabella Burgel is an 18-month-old Hispanic female with Down… Isabella Burgel is an 18-month-old Hispanic female with Down syndrome. She was admitted on Monday to the general pediatric unit after being seen in the pediatrician’s office. She had a fever, cough, and runny nose for four days prior to admission. Since Isabella Burgel was admitted, the fever has continued, and she has had intermittent emesis of her gastrostomy tube feedings. Her respiratory status has also declined, and she has become increasingly lethargic. You enter Isabella Burgel’s room while cleaning your hands with antibacterial foam, and say good morning to the patient’s mother, Amanda Burgel. Isabella Burgel is laying in her crib with the head of the bed flat, and is in obvious respiratory distress. You note that she is tachypnic with subcostal and substernal retractions. You can hear an audible grunting from Miss Burgel on expiration. The patient begins with a strong cough, and promptly vomits her partially digested morning feeding. You roll her over so that she does not aspirate her feeding. You reach for the suction and clear her airway. She feels hot to the touch.Once she has stopped vomiting and is in no immediate danger, you elevate the head of her bed, and prop her up on a pillow. You gather supplies to bathe her, a set of EKG leads to attach her to the cardio-respiratory monitor, and a probe for the pulse oximeter in her room.You attach Isabella Burgel to the monitors and take her vital signs.Vital signs:Temperature : 101 degrees Fahrenheit, axillary…Heart Rate: 132 beats/minute, apical…Respiratory Rate: 56 breaths/minute…Blood Pressure: 120/84 mmHg, right upper extremity, lying supine…Oxygen Saturation: 89% on room air, digital finger probe…You step out of the room and gather a humidifier for the patient’s comfort and a nasal cannula. You change the alarm limits on the monitor to the following: high heart rate 160, low rate 80, and respiratory rate 70. Isabella Burgel’s perfusion to her lower extremities is 2 to 3 seconds.You insert the nasal cannula into Isabella Burgel’s nostrils and titrate the oxygen flow to 2 liters. The patient’s mother helps you bathe her and you leave her gown off to help cool her.You ask the patient’s mother,”I noticed when we bathed Isabella that her diaper was dry. Do you know when her last wet diaper was?””I changed her last night around 2230. She vomited again at midnight, but her diaper was dry then. Do you think the night nurse changed her diaper when I was asleep?” Amanda Burgel responds.”The last diaper charted was at 2300, so I don’t think so. And we know that she just vomited her 8am feeding, ” you state.”She just had some Tylenol at 0600, so I can’t give her another dose yet for her fever. I am going to notify Dr. Allen of her repeated emesis. I think she may be dehydrated, and I am concerned that she has not absorbed her cardiac medications.”Dr. Allen orders:1. CR monitor and pulse oximetry2. O2 to keep oxygen saturation greater than 93%.3. Notify provider if patient requires more than 4 liters per nasal cannula.4. NPO except for medications.5. Start peripheral IV: D5 1/2NS with 20 mEq/L KCl 88 mL/hr x 8 hours, then decrease to 66 mL/hr for 16 hours.6. Respiratory therapy consult. You gather supplies to start an intravenous line including: cold spray, a 22-gauge angiocath, a tegaderm, a statlock, and a 1000 mL bag of D5 1/2NS with 20 mEq/L of KCl.You enter the patient’s room while cleaning your hands with antimicrobial foam. “I just spoke with Dr. Allen. I told him about Isabella’s emesis and decreased urine output. He wants us to start an IV and start her on some fluids. We’ll hold her feedings for now, but we’ll still give her medications through the g-tube. Also, I told him I put her on a nasal cannula, and he wants the respiratory therapist to come in for an evaluation. They will work with her on deep breathing and coughing and will suction her.”Isabella’s mom states that she understands. You raise the head of bed for Isabella’s bronchiolitis.Another nurse enters the room, cleaning her hands with anti-microbial foam. She introduces herself, and you tell Isabella Burgel’s mother that the nurse is going to help you put the IV in.You place the IV on a first attempt in Isabella Burgel’s left dorsal venous arch. The patient cries but is easily comforted. The fluids are administered via an infusion pump at 88 mL/hr for 8 hours, then decreased to 66 mL/hr for 16 hours.You return to assess Isabella Burgel and note her vital signs.Vital signs:Temperature: 100.8 Fahrenheit, axillary…Heart Rate: 164 beats/minute, apical…Respiratory Rate: 70 breaths/minute…Blood pressure: 86/42, MAP 56, right upper extremity, lying supine…Oxygen Saturation: 94% on 2L/minute, nasal cannula, digital probe, finger…You note Isabella Burgel’s perfusion in her lower extremities is now 5 seconds.You step out of the room and update the patient’s provider on the changes in Isabella Burgel’s condition. He orders a cardiology consult, a chest x-ray, and an echocardiogram all to be completed STAT. He states that he is minutes from the hospital and will come straight to Isabella’s room. He asks you to write up the orders, which he will review and sign when he gets in.You re-enter the room while using anti-microbial foam, to update Isabella Burgel’s mother and she states that she is very worried about her daughter. The patient is ashen grey in color and has increased work of breathing with head bobbing. Because of your concern, you activate the Rapid Response Team and notify your charge nurse.The charge nurse enters the room within 1 minute, and the Rapid Response Team follows behind her to assess Isabella Burgel and offer assistance until Dr. Allen arrives.Come up with a SMART goal for this patient   Health Science Science Nursing BSN 246 Share QuestionEmailCopy link Comments (0)