Question

Rachel Singer is a 5-year-old girl who is brought to the emergency department by her parents, Lucas and Veronica. They report that Rachel has been experiencing vomiting and diarrhea for the past 36 hours. “She hasn’t been able to keep anything down. We tried sips of liquids and even that didn’t help.” She is lethargic and her mucous membranes are dry and pale. Rachel is to be admitted. Her orders include intravenous fluid therapy and nothing by mouth (NPO).

1. Normally, rehydration would begin with oral rehydration. Why did the physician go right to IV rehydration for Rachel?

2. Why did the physician make Rachel NPO?

3. Discuss dehydration in children.--Include how it is different in children vs. adults and why we need to act quickly to rehydrate children.

4. What is a PRIORITY NURSING diagnosis for Rachel?

5. Provide 3 PRIORITY nursing interventions. Include rationales.

Answer 1

Rachel has history of vomiting and diarrhoea past 36 hours. She has lost alot of fluids in her body and needs urgent fluid replacement to prevent complications and she is also not able to tolerate fluids orally and hence the physician went directly for IV replacement than oral replacement.

Rachel was put on NPO because she is not able to tolerate oral fluids and she is vomiting as soon as she is taking fluids.

Dehydration in children is severe compared adults because of their low body mass index and the risk of developing renal complications is higher . Skin turgor is an indicator of dehydration. We pinch the back of the palm and forehead , if the recoiling of skin is delayed and lack of elasticity , sunken eyeballs, lethargic and pale look indicates dehydration in children.

Nursing diagnosis :

1. Fluid volume deficit related to continuous vomiting and diarrhoea.

2. Fatigue related to fluid loss secondary to diarrhoea and vomiting.

3. Risk for complications related to dehydration.

Nursing Interventions :

• Start with IV line and replenish fluids .
• Assess for vitals frequently.
• Check for skin turgor.
• Administer antiemetics as prescribed.
• Administer proton pump inhibitors and antibiotics if prescribed.
• Keep the patient on NPO till orders.
• If patient feels thirsty, can put few drops on the lips just to satiate thirst.