Question

Gastroenteritis with Dehydration Case Study

Jana, 14 months old, presents in the emergency room with a 48 hour history of profuse watery diarrhea and vomiting. Prior to this illness, her most recent weight was 10kg. She is diagnosed with isotonic dehydration secondary to gastroenteritis and is admitted into the hospital.

Admission assessment:

Lethargic, sleepy 14 month old; irritable when stimulated. Mother is at bedside.

Weight: 19 lbs. 8 oz.

Vital signs: T 101.4F (axillary)

P: 168 per minute (apical)

R: 36 per minute

B/P: 76/38

Skin: Dry, hot, poor turgor with tenting. Color is pale and grayish

Mucous membranes: Pink, dry, little saliva

Eyes: Sunken, tears not present

Anterior fontanel: Sunken

Capillary refill: 3 seconds

Extremities: Cool to touch, pale, weak peripheral pulses in all four extremities

Urine: Dark yellow, scant

Stools: Large, green, with mucous streaks and large water ring, hematest negative

Lab values:

Hemoglobin: 16.7

Hematocrit: 55

Glucose: 64

BUN 25

Na 140 mEq/L

K 4.3 mEq/L

Urine specific gravity 1.035

MD orders:

IV D5% in 0.2NaCl at 60cc/hr

Add 10 mEq KCL to each 500cc bag

Strict I & O’s

NPO

Contact Precautions

1. What degree of dehydration is Jana experiencing? Explain your answer.

2. List which vital signs are abnormal. What should the vital signs be for this child?

3. Explain the significance of each lab value and list the normal values for a child Jana’s age. Why are these labs abnormal?

4. Why is Jana NPO? Why did the physician order an IV? Why did the physician order the specific IV fluids that he did? Why is Jana receiving both sodium and potassium in her IV?

5. Why did the nurse take an axillary temperature?

6. List 5 assessment findings that would indicate that Jana is improving?

Answer 1

1.The child is in severe dehydration

• Weight loss is more than 15% (lost 2 kg out of 10kg)
• Lethargic, irritable and sleepy
• Dry skin,hot with poor tugor
• Mucous membrane is dry pink and little saliva
• Sunken eyes with no tears
• Sunken fontanelles
• Dark and scanty urine
• Increased capillary refill time

2.The abnormal vital signs and it's normal values are

T:101.4°F (increased) normal temperature should be 95.9 to 99.5°F

P: 168(elevated)normal range should be 98 to 140bpm

BP: 76/38(decreased) normal range should be ranging 86_106/42_63

3.Hemoglobin:16.7 (increased) 10.5 to 13.5g/dL

Hematocrit:51(increased) 29% to 41%

Glucose:64 (decreased) the random should range about 180mg/dL

BUN :25 (increased)4_14mg/dL

In dehydration there is loss of fluids which increases the concentration of the blood leading to increased hematocrit, as a result of this the there is decreased supply of oxygen making more hemoglobin to carry the needed oxygen to make hemodynamic stability. Due to continuous loss of fluid there is electrolyte imbalance resulting in elevated blood urea nitrogen, the glycolysis cycle is affected leading to decreased glucose level in the child causing hypoglycemia and associated symptoms

4.The baby is kept on NPO to prevent aspiration if feed orally due to lethargy and sleepiness The child has a normal sodium and potassium level so an isotonic solution is necessary to balance preventing any further loss and preventing hyponatremia .When sodium alone is given it will increase the sodium level and decrease the potassium level ,in order to counterbalance the potassium is also administered