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Outline
A 4-year-old girl comes into the emergency room for nausea, vomiting, fever and abdominal pain. The mother reports that the child has been saying their tummy hurts for the past 3 days and not wanting to eat very much but that today she started to throw up.
What nursing assessment data and history questions would you obtain at this time?
- How many times the child has vomited, what the vomit looks like?
- Does she have any known medical conditions or allergies?
- Full set of vitals
- Full abdominal assessment
- Assess the child’s countenance and behavior for signs of guarding or discomfort
The emesis is yellow and the child has thrown up 4 times. Upon assessment of the child, the girl cries anytime she sees a nurse or doctor and hugs her blanket and mother. The nurse notes tears, pink dry skin and a patent airway. The nurse stays in the room and plays with the child until the nurse is finally able to get a set of vitals:
HR 122
RR 28
BP 91/52
Temp 101°F axillary
The child still will not let anyone auscultate or palpate her abdomen. The doctor orders blood work, Tylenol and an X-Ray of the abdomen. The nurse draws the blood work and sends the child to X-Ray with her mother.
Which labs do you expect will be abnormal for the child?
- Elevated WBC count due to infection
- Possibly elevated inflammatory markers (ESR, CRP)
Before administering the Tylenol, what should the nurse check?
- Tylenol is weight-based medication so the nurse should make sure the child was properly weighed and that the medication was properly dosed.
- The nurse should also check that the child doesn’t have any allergies to Acetaminophen.
The child has returned from X-Ray and is cuddled up with her mother and blanket. The child still will not let the nurse listen with her stethoscope but isn’t crying anymore. The X-Ray has resulted and shows the child has appendicitis. The nurse knows she needs to prepare the parents and the child for being admitted to the hospital and surgery. A re-check in vital signs shows the following:
HR 110
BP 95/53
RR 22
Temp 101.2°F axillary
The OR schedules the child’s surgery for tomorrow at 6 AM and the hospital room is ready for the child to be admitted to overnight. Which non-pharmacological interventions should the nurse implement at this time to address the child's fever
What would be the most concerning behavior that the nurse should be watching out for in the child?
What is the most important thing for the nurse to educate the mother on before sending them to the room?
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