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 months old; irritable when stimulated. Mother is at the 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

Jana 14 month old baby admitted to hospital with profuse watery diarrhea and vomiting. She was diagnosed as moderate degree dehydration secondary to gastroenteritis. On assessment she is lethargic, sleepy and irritable.

Prior to illness she was 10 kgs in weight and after the illness she reduced to 8 kgs that is around 19 lbs. On systemic examination she has fever of 101F , heart rate is slightly higher because of illness and fever. Blood pressure is in lower side due to fluid loss.

Skin is dry, hot and poor in turgor with tenting that is because of fluid loss.

14 months old baby normal vitals should be heart rate 80-130, here heart rate is high around 168, blood pressure should be 90/50 and here its low 76/38. baby has fever high temperature.

As per my knowledge baby's lab values looks fine other than glucose levels, it should be within 70-90, its in lower range. Because baby lost fluid and electrolytes they are infusing IV potassium through saline so that dehydration can be treated.

As baby had profuse watery loose stools and vomiting doctor kept baby NPO nil per oral and giving medications through IV. As baby lost electrolytes they infusing IV electrolytes so that they can treat dehydration.

As baby had high fever nurse checked axillary temperature because baby was sleeping and irritable.