Nursing
Nursing
Title: respond to post
Assignment Instructions: Danielle is an 11-month old infant, presents to the office with her mother who reports the infant has had
for 2 days. She also reports having had some vomiting for 1 day and fever of 1020 (rectal) for last 2 days. She’s had up to 10 diapers a day due to her diarrhea, which has caused reddened and excoriated buttocks. Mother is not sure of urinary output because of the diarrhea. She reports another child at the child care center was sent home for diarrhea and vomiting. No one at home has any symptoms.
Please answer the following questions, use evidence-based guidelines and APA format for citations and references:
1. Have you seen this situation at your clinical site?
I have seen this situation several times during my clinical rotations. The majority of cases end up being viral gastroenteritis with no need for hospitalization.
2. What was the physical assessment priority?
Top priority for this patient is to evaluate hydration status. Using a tool such as the Clinical Dehydration Scale (which assess four different presenting symptoms) can be beneficial for determining the level of dehydration. Overall appearance of the patient will give some indication of hydration status. Are her eyes sunken in? Does she appear lethargic/ irritable, or drowsy/limp? Are her mucus membranes moist, sticky, or dry? Is she producing tears? Since the mother is unable to provide information regarding urine output, it is important for the provider to fully evaluate the patient’s hydration status. The other top priority for this patient is to determine if the patient presents with any red flag symptoms that would require more aggressive treatments resulting in the need for a higher level of care. Red flag symptoms for this patient include altered mental status, bilious or bloody emesis, cyanosis, inconsolability, poor perfusion, petichiae, rapid or labored breathing, fever >104 degrees F, and toxic appearance (Hartman et al., 2019).
3. What are the top three differential diagnoses and why?
Viral gastroenteritis – Symptoms for viral gastroenteritis include vomiting and diarrhea and may include fever, abdominal pain, and nausea. Most common cause of gastroenteritis in children ( Leung,, 2024).
Bacterial gastroenteritis – Similar symptoms to viral gastroenteritis with the exeption of higher fever, abdominal cramps, and possible blood and white blood cells in the stool (Elliott, 2007).
Food poisoning – Similar symptoms to viral and bacterial gastroenteritis, but symptoms tend to appear about 6 hours after consumption of contaminated food (LaRocque & Harris, 2023). Less likely since no one else has been sick at home and only one other child was sent home sick from daycare.
4. What is the primary diagnoses based on your assessment?
Acute viral gastroenteritis
5. What is your treatment plan, referral, and follow up care for this child?
Treatment for viral gastroenteritis will consist of oral rehydration therapy. WHO guidelines recommend a reduced osmolarity fluid of 75 mEq per L of sodium and 75 mmol per L of glucose dissolved in 1 L of water.600 to 800mL of fluid given in the first four hours (Hartman et al., 2019). If nausea interferes with rehydration therapy, ondansetron can be prescribed to reduced nausea symptoms. “The typical dose of ondansetron is 2 mg for children weighing 8 to 15 kg (17 lb, 10 oz to 33 lb), 4 mg for children weighing 15 to 30 kg (33 lb to 66 lb, 2 oz), and 8 mg for children weighing more than 30 kg” (Hartman et al., 2019).
6. Are there any demographic factors that should be considered?
Demographic factors that should be considered for this patient include the patient’s age which puts her at increased risk for acquiring infections; socioeconomic status which can hinder ability for proper hygeine and access to healthcare; and risk for infection d/t higher exporsure with other children (Brodie et al., 2021).
7. What if parents are in the midst of a financial hardship and are unable to pay for medication? What are your recommendations?
There are coupons available that could be provided for medication assistance; referral for government assistance programs such as WIC or medicaid should also be offered.
8. What is the evidence-based guideline for the care of Acute Viral Gastroenteritis?
Evidence-based guidelines for acute viral gastroenteritis for mild to moderate include oral rehydration therapy as stated above with ondansetron used as needed for nausea.
References
Brodie, K. D., Fakurnejad, S., Czechowicz, J. A., & Nadaraja, G. S. (2022). Associations between demographic factors and pediatric otolaryngology access disparities in the COVID-19 era. International journal of pediatric otorhinolaryngology, 152, 110971. https://doi.org/10.1016/j.ijporl.2021.110971
Elliott, E. J. (2007, January 6). Acute gastroenteritis in children. BMJ (Clinical research ed.). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764079/
Hartman, S., Brown, E., Loomis, E., & Russell, H. A. (2019, February 1). Gastroenteritis in children. American Family Physician. https://www.aafp.org/pubs/afp/issues/2019/0201/p159.html#afp20190201p159-t3
LaRocque, R., & Harris, J. (2023, August 16). Foodborne illness overview. UpToDate. https://www.uptodate.com/contents/foodborne-illness-food-poisoning-beyond-the-basics?topicRef=1223&source=see_link
Leung, A. K. C. (2024, February 22). Viral gastroenteritis in children. Viral gastroenteritis in children – Symptoms, diagnosis and treatment | BMJ Best Practice US. https://bestpractice.bmj.com/topics/en-us/794
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