NR 602 Week 6 SOAP_Lataille_2020 – Chamberlain College of Nursing | NR602 Week 6 SOAP_Lataille_2020

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NR 602 Week 6 SOAP_Lataille_2020 – Chamberlain College of Nursing NR 602 Week 6 SOAP_Lataille_2020 L. F. 16 yo, Female, Latino S. CC- Vomiting over the last 2 days and have developed diarrhea ... in the last 24 hours HPI- Both the oldest and youngest children in the house have had several episodes of vomiting over the last 2 days and have developed diarrhea in the last 24 hours. Lilly has not vomited today. They have both had low-grade fevers of around 100 to 101 degrees in the afternoons. Mother reports that both have not eaten solid food since 36 hours prior to this visit, when they went to a pizza buffet in a town nearby. They have been keeping down some sprite, apple juice, and popsicles. Both urinated this morning. Mother has given both children Pepto-Bismol over the counter (OTC) to prevent an upset stomach and acetaminophen two to three times a day for fever. Lily is complaining of some lower abdominal pain starting this morning, but also reports she has started menses today.  Lilly complains also of headache, myalgia. Her pain is a 5 on a 1-10 scale and has progressed in the last hour. No other household members are ill. - - - - - - - - - - - - - - - - - - - - - - - - - Conservative Measures- Signs of dehydration include excessive thirst, infrequent urination, dark-colored urine, lethargy, dizziness, or faintness. Drinking plenty of fluids is very important to prevent dehydration. Fluids should be replaced with fruit juices (not high in sugar), sports drinks, caffeine-free soft drinks such as Sprite or Ginger ale, and broths (chicken, beef, vegetable). Avoid fatty foods, sugary foods and juices, dairy products, caffeine (this dehydrates you) until recovery is complete (NIDDK, 2014). Over-the-counter medications such as Imodium and Pepto-Bismol (children’s formulation) can be used to help reduce diarrhea but should be avoided if there are signs of a bacterial or parasitic infection, in which the medications could prolong the problem (NIDDK, 2014). Referrals- Possible referral to general surgery after getting ultrasound results for cholecystitis or appendicitis. If a STAT ultrasound of Lily’s abdomen cannot be performed she should go to the ER for further evaluation of guarding to the lower abdomen and rebound tenderness to the right lower quadrant. (Fenstermacher & Hudson, 2016) Follow up- Ultrasound results should be read that day to rule out an acute process. If no acute process is noted, follow up in 24 hours to go over lab results and discuss plan of care. (Fenstermacher & Hudson, 2016) References Fenstermacher, K. & Hundson, B. T. (2016). Practice Guidelines for Family Nurse Practitioners (4th ed.). St. Louis, MO: Elsevier. Hay, W., Levin, M., Deterding, R., & Abzug, M. (2014). Current diagnosis and treatment: Pediatrics (22nd ed.). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2012, April). Retrieved from Viral Gastroenteritis: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/viral-gastroenteritis/Pages/facts.aspx National Institute of Diabetes and Digestive and Kidney Diseases. (2014, June). Retrieved from Foodborn ilnesses: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/foodborne-illnesses/Pages/facts.aspx Reust, C. E. & Williams, A. (2016, May 15). Acute abdominal pain in children. American Family Physician, 93(10), 830-837. R. F. 24mo, M, Latino S. CC- vomiting over the last 2 days and have developed diarrhea in the last 24 hours HPI- Both the oldest and youngest children in the house have had several episodes of vomiting over the last 2 days and have developed diarrhea in the last 24 hours. Riley vomited twice this morning in small amounts since awakening. They have both had low-grade fevers of around 100 to 101 degrees in the afternoons. Mother reports that both have not eaten solid food since 36 hours prior to this visit, when they went to a pizza buffet in a town nearby. They have been keeping down some sprite, apple juice, and popsicles. Both urinated this morning. Mother has given both children Pepto-Bismol over the counter (OTC) to prevent an upset stomach and acetaminophen two to three times a day for fever, but she reports that Riley vomited soon after his dose this morning. No other household members are ill. Current medications- Children’s chewable multivitamin daily Immunizations- Birth – Hep B, 2 months – Hep B, DTaP, HIB (COMVAX), PCV13, IPV, 4 months - DTaP, HIB (COMVAX), PCV13, IPV, 6 months DTaP, IPV, 6 months – DtaP, PCV 13, IPV, Hep B Allergies- Seasonal allergies. PMH- Born at 34 weeks gestation via cesarean section, weight. 5lb 1 oz. The mother developed preeclampsia and gestational diabetes. The mother quit smoking when she found out she was pregnant.  Social history- The children currently live with their mother and maternal grandparents for the last 8 weeks. Their father is involved but lives 2 hours away in the state capital where he works.  Family history- They are maternal and paternal smokers. The mother has been one since age 22 at one pack-per-day until 18 months ago. The father continues to smoke. There were no diseases reported in either parent. Mother has a history with gestational diabetes and preeclampsia.  MGM has a history of hyperlipidemia, Type 2 DM, and Hypertension. They are Latin American in descent, emigrated from Cuba in the 1970s. MGF has a history of hypertension, hyperlipidemia, and an MI with stenting 2 years ago.  The mother has two siblings; one who died in an MVA 5 years ago at the age of 18 a younger brother, and an older sister who is 42 and lives in a large urban city in the Midwest with her family, and she is in good health. Other family members died of old age. She is unaware of paternal familial health history. ROS: Constitutional- Reports low grade fevers, 100 to 101 degrees F. - - - - - - - - - - -- - - - - - - - - - - - - - - - - - Infants and children become dehydrated quickly from diarrhea and vomiting because of their small body size. Oral hydration should be maintained with Pedialyte, Naturalyte, Infalyte, and Ceralyte. Start giving food as soon as the child is hungry. Signs of dehydration include dry mouth and tongue, lack of tears when crying, no wet diapers for 3 hours or more, drowsy behavior, sunken eyes and/or cheeks (NIDDK, 2014). The research supports use of oral rehydration for the moderately dehydrated child. Similar outcomes have been achieved in randomized studies comparing (oral rehydration solution) ORS with intravenous fluid therapy with fewer complications and higher parent satisfaction in the ORS groups. Moreover, ORS can typically be initiated sooner than IV fluid therapy. However, children must be cooperative and have caregivers available to instruct and administer the oral fluids. (Spandorfer et al., 2015)

With ORS, patients should receive approximately 50-100 mL/kg body weight over 2-4 hours, again starting with 5 mL every 5 minutes. If the child can tolerate this amount and asks for more fluids, the amount given can gradually be increased. Once the fluid deficit has been corrected, parents should be instructed on how to replace volume losses at home if the child continues to have vomiting or diarrhea. (Spandorfer et al., 2015)

Children in whom ORS fails should be given a bolus (20 mL/kg) of isotonic fluid intravenously. This may be followed by 1.5-2 times maintenance therapy. Over the next few hours, the patient may be transitioned to oral rehydration as tolerated, at which point the intravenous therapy may be discontinued. (Spandorfer et al., 2015)

Children with moderate volume depletion may require inpatient treatment if they are unable to tolerate oral fluids despite rehydration. Hospitalization may also be required for treatment of the underlying cause of the fluid deficit. (Spandorfer et al., 2015) Over-the-counter medications such as Imodium and Pepto-Bismol (children’s formulation) can be used to help reduce diarrhea but should be avoided if there are signs of a bacterial or parasitic infection, in which the medications could prolong the problem (NIDDK, 2014). Referrals- Depending how Riley tolerates the oral fluids after the Zofran in the office he may need to be sent to the ER for IV hydration. (NIDDK, 2014). Follow up- In 24 hours to see how his hydration status is and to reevaluate how he looks and is acting. (NIDDK, 2014). References Fenstermacher, K. & Hundson, B. T. (2016). Practice Guidelines for Family Nurse Practitioners (4th ed.). St. Louis, MO: Elsevier. Hay, W., Levin, M., Deterding, R., & Abzug, M. (2014). Current diagnosis and treatment: Pediatrics (22nd ed.). National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2012, April). Retrieved from Viral Gastroenteritis: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/viral-gastroenteritis/Pages/facts.aspx National Institute of Diabetes and Digestive and Kidney Diseases. (2014, June). Retrieved from Foodborn ilnesses: http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/foodborne-illnesses/Pages/facts.aspx Spandorfer, P., Alessandrini, E., Joffe, M., Localio, R., & Shaw, K. (2015). Oral versus intravenous rehydration of moderately dehydrated children: A randomized, controlled trial. Pediatrics, 115(2), 295-301. [Show More]

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