SEMINAR SCENARIO
NUR 4307 (formerly NUR 4270)
PEDIATRICS- GI, GU, FLUID & ELECTROLYTE ALTERATIONS
You are an RN working the 7a-7p shift on a Renal/GI Pediatric Unit in a community hospital.
The Renal/GI Pediatric Unit has 22 beds. The day staff consists of a Nurse Manager, 6 RNs, 4
PCTs (Patient Care Technicians), a Child Life Specialist, and a Unit Clerk. Patient rounds with
the pediatricians, nurse practitioners, physician specialists, and charge nurse occur daily at 0800.
After rounds, the charge nurse and nurse practitioner meet with the Nutritionist, PT and OT,
Child Life, Certified Teacher, Nurse Case Manager and Social Work to discuss each patient's
daily plan of care. A satellite Pharmacist is assigned to the pediatric unit.
You arrive and receive report from the RN on night shift:
100
David York Age: 5 months
Weight: 12 lbs
Admitting Dx: Diarrhea/Dehydration
PMH: Asthma, Failure to thrive
Third admission for dehydration and failure to thrive
EGD and colonoscopy scheduled today at 1100
02 Sats 97% on 2L humidified FiO2 via NC, lungs clear
AM lab results: Hgb 10, Hct 32.0, NA 134, K 5
NPO since 12MN except breast milk, full NPO at 0600
No wet diapers since 2200, No BM
D5 ½ NS @ 15cc/hr stopped due to IV infiltrate @ 0200 (attempts to replace IV
unsuccessful)
Consent signed
Pre-procedure checklist on chart
Pre-procedure medications ordered
Mother at the bedside. Father at home with 2 yr old sister
102
Charity Williams
Age: 9 yo
Weight: 110 lbs
Admitting Dx: Gastroesophageal Reflux Disease (GERD), R/O aspiration
PMH: pneumonia 2x within last year, Cerebral Palsy, developmental delay
CXR: hazy infiltrate RML
Current medications: Nexium 10mg PO once a day
Diet: bland thickened liquid feedings in upright position
02 Sats 96% on 2 L 02 via NC
Hgb 11.4, Hct 36.4
No emesis last night
Abd soft BM x2 yesterday
IV Saline lock
OOB to wheelchair as tolerated
Mother primary caregiver and is overwhelmed with Charity’s care.
Consults: Surgery to evaluate for Nissen Fundoplication and GT insertion
Dietary to evaluate caloric needs and feeding frequency
103
Yolanda Martinez Age: 15 yo
Wt: 110 lbs
Admitting Dx: Hemolytic Uremic Syndrome (HUS)
No past medical history
Identifies as transgender
PHI: Seen by PMD (primary medical doctor) 5 days ago and diagnosed with viral
gastroenteritis. Symptoms did not improve and parents brought child to ED after
12 hrs
of no urine output
+ Ecoli from stool culture
lethargic, voided x1 last night 20ml dark urine
Hgb 8.7 Hct 28.2
Plt 67,000
BUN 104 Creatinine 3
Received 1 unit PRBC yesterday after dialysis
Labs drawn this AM @ 0600
IV saline lock
Diet: as tolerated protein restricted diet (restrict protein intake to 20% of caloric intake)
No family at bedside, father a single parent and is at work
106
Samuel Penn Age 16 months
Wt: 18.5 lbs
Admitting Dx: Acute Abd pain, R/O Intussusception
Just arrived from ED
PHI: parents brought child into ED early this AM after several episodes of child drawing
his knees to his chest and screaming, mom stated that child has had vomiting and diarrhea
for 2 days, mom noticed that two stools were mixed with blood and mucus (currant jelly
stool), no PO intake since yesterday evening
PMH: Cystic Fibrosis (CF)
Lethargic, irritable, diaphoretic
Palpable, tender abdominal mass
#24 G IV to R hand – D5 NS @ 53cc/hr
Received NS bolus (20ml/kg) in ED x1
Abd x-ray ordered for 0800
HR 180, RR 28, BP 88/41, Axillary T=101
Mom names daily medications for CF management but cannot remember dosages
N-acetylcysteine, Albuterol, Creon, Vitamins ADEK, and Motrin as needed for
pain.
Father lost job and will lose insurance benefits in a month.