Question

Please help

1. An 13 month old child boy is admitted to your fluid with acute diarrhea secondary to shigella infection. He has had several days of watery, runny stools. There was a delay in placing his IV and he has not yet received any medications or fluids.

Diarrhea 1. What would you check to determine this patients level of dehydration? (ie: what are the signs of dehydration, what would you look for?)** bullet points ok

Diarrhea 2. What labs and medications would you anticipate having ordered for this patient? (**bullet points ok)

2. A 6 year old girl had a recent diagnosis of streptococcus pharyngitis. This was treated after 5 days of pain. She has finished her antibiotics ten days ago and is now having increased fatigue, pink colored urine and some swelling to her face. Dad brings her to the clinic and you suspect acute glomerulonephritis.

Strep 1. What is the pathophysiology causing symptoms in APSGN (not how does strep cause it, but what is happening in the kidneys)?

Strep 2. What labs and medications would you anticipate being ordered for this girl? (labs, medications, fluids, diet, general orders) **bullet points ok

3. A 12 year old boy is being discharge with a temporary colostomy- what would you describe in your discharge teaching to him and the family about care of this colostomy?

Answer 1

1)1.The following has to be done to determine the level of dehydration

• Skin :dry,poor skin tugor
• Cry:no tears, dry eyes,sunken eyes
• Urine:decreased,dark urine or in severe cases no urine output or no voiding
• fatigue
• Inadequate intake
• Vitals:low blood pressure

2.The following lab tests can be anticipated

• Stool test to rule out the cause of diarrhea
• Sr.Electrolytes: when there is a fluid loss the alteration happens in the electrolytes making acid base imbalance
• CNC :to rule out infection and it is the basic panel

2)1.In these types of infection ,the filtering capacity of the nephron are lost mostly in the glomerulus.This detoriates the function of renal system leading to hematuria or pink or dark colored urine, swelling ,and subsequent fatigue.

2.Labs

• Blood culture to rule out growth of any bacteria
• Immunoglobulin A (deficiency can cause glomerular problems)
• Renal profile to assess kidney function
• CBC to rule rule infection

Treatment

• Antibiotics treatment with penicillin groups
• Diuretics to decrease fluid retention
• Correction of electrolyte imbalances
• Low sodium and low potassium diet is recommended