Question

Shelly is a 4-year-old preschooler who lives with her parents and younger brother. She and her brother attend a local daycare center during the week while their parents are at work. In the evenings she and her brother take a bath and then their parents read to them before bedtime at 8:00 P.M. Shelly's daycare class includes many children her age and she enjoys playing outside with them, Although snack times are planned, Shelly would rather play and does not always finish her beverages,

Shelly's mother calls the pediatric clinic in town and tells the nurse that Shelly has been "running a fever of 101 0 F for the past 2 days' and although her temperature decreases to 37.20 C (990 F) with acetaminophen, it returns to 38.4 C, (1010 F) within 4 hours of each dose. Further, her mother says that Shelly complains that hurts when “I pee-pee." Shelly's mother also has noticed that her daughter seems to be in the bathroom every hour" She makes an appointment to see the pediatrician this afternoon

6.     Shelly's urine culture returns positive for Escherichia coli. 'What is the significance of this finding?

7.     What are the priorities for Shelly's care?

8.     Shelly is prescribed trimethoprim-sulfumethoxazole 60 mg every 12 hours for 10 days. What is this drug and is her prescribed dose safe? Shelly weighs 33 lb.

9.     What are the teaching priorities for Shelly and her mother prior to her discharge from the clinic?

10. Shelly is scheduled for a return visit to the clinic in 2 weeks. What is the purpose of this appointment?

Answer 1

6.The significance of this finding is to rule out urinary tract infection. If the culture report of urine shows E.coli positive then it means the patient has urinary tract infection

7.The priorities of Shelly's care are

• To treat the infection first by administration of antibiotics as per order. If infection is treated the patient will have reduced fever and then to normal temperature
• To manage the pain experienced during pee.This cannbe probably because of infection and concentrated nature of urine in this type of infection.

8.Given

Order: Trimethoprim sulphumethoxazole

Dose: 60mg

Frequency:Twice a day for 10 days

Weight: 33lb (0.454×33=14.9kg)

As the standard dose is 40mg/kg=sulphumethoxazole and 8mg/kg= Trimethoprim

Here the dose is 60mg twice a day:120mg

To calculate the standard dose

When 1kg=40mg sulphumethoxazole

Then 14.9kg=??mg

Cross multiply and divide

=14.9×40/1

=14.9×40

=596mg/day

As it is 120mg/day in two dose it is in safe dose range.

This drug us a broad spectrum antibiotic

9.The teaching which had to be provided are

• Encourage the mother to complete the antibiotic course completely not to stop when symptoms are better because this can aggregate the condition later
• Encourage to drink plenty of liquids
• To maintain perineal hygiene
• Report any adverse reactions immediately
• No OTC drugs

10.The puropse of the appointment is to ensure the patient is completely recovered from the infection. This is because the infection can reoccur after the treatment is completed in certain cases .