Nursing
Priority Nursing Diagnosis #2
At risk for hypovolemic shock r/t salmonella poisoning aeb excessive fluid loss and electrolyte imbalance
Evaluation:
Patient has met goal but will continue to monitor intake and output at home until diarrhea has resolved.
Interventions
1. administer IV fluids
2. Monitor I&O flowsheet
3. measure weight daily
4. encourage oral fluid intake
5. minimize vomiting
Goal -
By discharge Matthew will exhibit reduced risk of hypovolemic shock by increasing fluid intake over out put aeb I&O flowsheet and weight gain
Priority Nursing Diagnosis #1
Fluid Volume Deficit r/t salmonella poisonings aeb vomiting and diarrhea
Evaluation; Monitor I& O and once they are WDL for the patient our goal will be met.
Interventions:
1. Measure I&O & weight
2. Lab work to verify electrolyte levels
3. encourage eating and drinking
4. IV solution administration
5. Promethazine to minimize fluid loss from vomiting
Goal -
By discharge Matthew will exhibit fluid volume WDL by increasing fluid and nutrition aeb I&O flow sheet.
Matthew W. Daniels
4 years old - Male - 6/10/xx - Ht: 105.9cm 70th percentile - Wt: 15.3kg 25th percentile - BMI 13.6 - KNDA
Medication
Hospital Medications
Name: Potassium Chloride in Sodium Chloride (Klor-Con)
Strength: 5mEq in 0.9%
Directions: Administer 5mEq in 100ml via intermittent IV bolus over 1 hour
Class: Electrolyte Supplement
Reason for use: critically low potassium serum
Dosage Calculation:1 to 2 mEq/kg/day in divided doses
Matthew's dose - 15.3 - 30.6 mEq/kg/day
Is it safe for Matthew? yes
Name: Dextrose in Sodium Chloride IV
Strength: 5% in 0.45%
Directions: Administer 1000ml via IV at 50ml/hr continuously
Class: IV nutritional therapy
Reason for use: continuous rehydration, IV nutritional therapy
Dosage Calculation:
Is it safe for Matthew?
Name: sodium chloride
Strength: 9%
Directions: 200ml IV bolus to be administered over 90 mins
Class: electrolyte supplement
Reason for use: Immediate rehydration
Dosage Calculation:
Is it safe for Matthew? yes
Name: Promethazine HCL (Phenergan)
Strength: 7mg
Directions: Inject 7mg IM Q6H PRN N/V
Class: antiemetic
Reason for use: Nausea & Vomiting
Dosage Calculation: 0.25 to 0.5 mg/kg/dose q4-6h
Matthew's dose - 3.825mg/dose - 7.65mg/dose
Is it safe for Matthew? yes
Name: Clotrimazole cream (Lotrimin)
Strength: 1%
Directions: Apply to diaper area BID
Class: antifungal cream
Reason for use: diaper rash r/t diarrhea
Dosage Calculation: Thin layer
Is it safe for Matthew? yes
Name: Acetaminophen (Tylenol)
Strength: 160mg
Directions: 160mg PO q4h PRN for fever over 101.5F
Class: analgesic, nonopioid, antipyretic
Reason for use: antipyretic in the event of temp over 101.5F
Dosage Calculation: 10-15mg/kg/dose q4-6h max 5 doses per day, no more than 4,000mg per day
Is it safe for Damien:
153-229.5mg/dose is safe range for Matthew
Yes this is a safe dose for Matthew
Home Medications
No home medications listed
Lab/Diagnostics
Heart Monitor
due to low potassium - d/c when potassium is within normal range
Labs
1430
Stool Culture with Gram Stain
positive salmonella gram negative rods
0900
CBC
RBC - 22ml/kg
Hgb - 14g/dL
Hct - 40%
WBC - 14.3/mm
Iron - 100mcg/dL
BMP
Na - 136 mEq/L
K - 2.9 mEq/L (low)
chloride - 98 mEq/L
BUN - 11.2 mg/dL
Creat. - 0.32 mg/dL
CO2 - 21 mEq/L
UA
appearance - cloudy
Color - Amber
Odor - Strong
Specific Gravity - 1.030
Patho
Diarrhea
Possible Complications of Me?
dehydration, electrolyte imbalance, kidney failure, and organ damage
Signs & Symptoms
abdominal cramps/pain, bloating, nausea, vomiting, fever, blood in the stool, mucus in the stool, urgent need to have a bowel movements
What Causes Me?
infections, travelers' diarrhea and side effects of medications
What am I?
Loose and watery stool during a bowel movement multiple times with in a time frame
Dehydration
Possible Complications of Me?
Urinary/Kidney problems, seizures, hypovolemic shock
Signs & Symptoms
Dry mouth, no tears when crying, sunken in eyes/cheeks, little to no urine production, irritability
What Causes Me?
losing more water/electrolytes than you take in, fluid loss can be from sweat, tears, vomiting, diarrhea, and/or urine
What am I?
A harmful reduction of water from the body.
Chief Complaint
Current Hospitalization
Admitted 8/12/xx - 0850
Contact Isolation
Diarhea x2 days, not eating, only a few sips of apple juice over 1 day, FACES pain 3, current immuzaion, 38C 120pul, RR 30 , no murmurs, clear lung, hyperactive bowel, diaper briefs due to diarrhea but potty trained and goes to day care full time, crying
I/O
Diaper Rash
I
PO - 120ml - 1200
IV - 200ml - 1030, 1000ml - 1200, 100ml - 1250,
O
Urine - 70ml - clear yellow
Stool - 52, 26, 33, loose watery, green 10,11,12
Emesis - 25 0930
