You are the RN getting report on a 3 month old named Tommy who was admitted at 2 a.m. last night with bronchiolitis and otitis media. Assessment findings: Fatigues easily and diaphoretic while eating, retractions,

NUR 2310C – Pediatrics

Critical Thinking Activity

Scenario:

You are the RN getting report on a 3 month old named Tommy who was admitted at 2 a.m.

last night with bronchiolitis and otitis media.

Assessment findings: Fatigues easily and diaphoretic while eating, retractions, tachypneic, tachycardic, poor skin turgor, anterior fontanel depressed with mottled extremities.

VS: T 101.6 o F., HR:148, RR: 66 with wheezing and rhonchi, B/P: 86/58

Weight: 5.1 kg

Pulse Oximeter: 90%

Physician Orders:

CXR for respiratory distress

IV: D5 .25NS @ 21 ml/hr

Augmentin 115mg po Q 12 hrs (oral suspension)

Tylenol 160 mg P.O. q 4-6 hr prn T > 101o F

Albuterol (ProventilR) nebulizer 0.63mg/3mlNS q 4 hr

(Recommended dose:

1-5yr: 1.25- 2.5 mg/dose q 4-6 hr

Methylprednisolone (solumedrol) 5 mg IV BID

(Recommended dose: 0.5-1.7mg/kg per day divided q6- 12 hr)

Famotidine 2.5 mg po Q 12 hrs

Diet for Age, if RR<>

Strict I/O

Contact isolation

Place NC 1 LPM to keep Sats >92%

Place pulse oximeter

1. Tommy weighed 12 lbs at the pediatrician’s office for his 3 month old visit 2 weeks ago. What is the percentage of dehydration?_____________________

How would you expect the dehydration to be treated?

(3pts)

2. Explain to mom and dad the pathophysiology of Tommy’s conditions. Include why

Tommy is wheezing and restless and what is the probable cause of the respiratory distress and OM. (Worth 14 points)

Upon assessment you ascultate expiratory wheezing in lower lung fields and an audible 3+murmur. The CXR shows cardiomegaly. The physician orders an Echocardiogram. The echo shows a VSD and pulmonary hypertension. Now answer the following questions:

3. Explain to mom and dad the pathophysiology of what is wrong with

Tommy’s heart. Include why he is having the signs and symptoms he has been

experiencing at home and on assessment. (10 points)

4. What has caused the Pulmonary Hypertension?(4 points)

5. The parents ask if their son will require surgery for the VSD. What will you tell the parents regarding treatment for a VSD. (8 points)

6. What complications could Tommy be at risk for due to the VSD? (4 points)

7. Discuss the medications ordered for Tommy listed below. Include the reason for

being ordered and whether they are safe and therapeutic to administer. Also include one

possible side effect for each drug . You must provide the math for each medication

(Worth 18 points)

Reason for Being Ordered Safe or Unsafe & Why Side Effect

Reason for being ordered

safe or unsafe/ why

Side effects

IV: D5 ¼ NS @ 21cc/Hr

Augmentin 115 mg po Q 12 hrs

Tylenol 160 mg P.O. q 4-6 hr prn temp > 101 degrees

Albuterol neb 0.63mg/3mlNS Q 4 hrs

Solumedrol 5mg IV BID

Famotidine 2.5 mg po Q 12 hrs

8. Name 4 different things you could teach Tommy’s parents in regard to his care

when they go home. (Worth 12 points)

A.

B.

C.

D.

9. Providing appropriate care (Worth 6 points)

A. According to Erickson’s theory, what stage of development should Tommy be

attempting to accomplish?

B. According to Freud’s psychosexual development theory, what developmental stage is Tommy in?

C. What physical developmental milestones should Tommy be demonstrating?

D. What toys would be appropriate for him during this hospitalization?

10. Nursing Plan of Care. Include 2 pertinent physical and 1 pertinent psychosocial nursing diagnosis. Include 3 nursing interventions and the rationale for each. (Worth 21 points)

Nursing Diagnosis

Nursing Intervention

Rationale for intervention

Nursing Diagnosis

1.

2.

3.

1.

2.

3.

Nursing Diagnosis

1.

2.

3.

1.

2.

3.

Nursing Diagnosis

1.

2.

3.

1.