1.

A 13-year-old boy presents to his primary care provider with a 5-day history of abdominal
pain and a 2-day history of diarrhea and vomiting. He describes the quality of the abdominal
pain as sharp, originating in the epigastric region and radiating to his back, and exacerbated
by movement. Additionally, he has had several episodes of non bloody, non bilious vomiting
and watery diarrhea. His mother discloses that several family members at the time also have
episodes of vomiting and diarrhea. He admits to decreased oral intake throughout the
duration of his symptoms. He denies any episodes of fever, weight loss, fatigue, night sweats,
or chills. He also denies any hematochezia or hematemesis. His medical history is significant
for a ventricular septal defect that was repaired at a young age, but otherwise no other
remarkable history. During the physical examination, the adolescent is afebrile and assessed
to be well hydrated. Examination of the abdomen reveals tenderness in the epigastric region
and the right lower quadrant on light to deep palpation, with radiation to his back on
palpation. There are no visible marks or lesions on his abdomen. Physical examination is
negative for rebound tenderness, rovsing sign (pain in the right lower quadrant with palpation
of the left lower quadrant.), or psoas sign (RLQ pain with extension of the right hip or with
flexion of the right hip against resistance). The remainder of the examination findings are
negative. Complete blood cell count, liver enzyme levels, pancreatic enzyme levels, and
urinalysis results are all within normal limits. Our patient was asked to observe his hydration
status and pain at home and to report any changes. However, he arrived at the emergency
department the next day due to increased severity of abdominal pain. The pain had localized
into the right lower quadrant. Further imaging revealed the diagnosis.
Subjective Data: “Limang araw na po masakit ang aking tiyan at dalwang araw pong lusaw ang
dumi ko at nagsusuka rin po.” as verbalized by the patient.
Objective Data:
 Afebrile
 Tenderness in the epigastric region
 rovsing sign
 psoas sign
 pain into the right lower quadrant
Nursing Diagnosis:
 Diarrhea related to bacterial infections/inflammatory bowel changes as evidenced by
abdominal pain.
 Risk for deficient fluid volume as evidenced by diarrhea
2. A 4.5-month-old female presented to hospital with a 2-day history of watery diarrhea and
fever developed in the 12 hours before admission. The infant was reported to have had 10
watery stools over the previous 24 hours, during which she became quite unsettled, crying a
lot, whilst drinking half her usual amount of liquids. There was no history of vomiting. On
the day of presentation, physical examination revealed an alert but irritable and ill-appearing
infant with a temperature of 39.9°C, heart rate between 170 and 190 beats/min, respiratory
rate between 40 and 80 breaths/min, The child’s weight at admission into hospital was 3990 
g, meaning she lost 10% of the previous reported weight. The skin was pale grey, tenting
skin turgor, dry lips and dry buccal mucosa, normal looking eyes but reduced tears, soft
fontanelle, and capillary refill time of 3 seconds. The urine output was also decreased. Heart
and lung examination were normal except for tachycardia; the abdomen was swollen and
slightly painful on palpation, no hepatosplenomegaly. Abdominal and thorax radiographs
were normal. There were no signs of meningeal irritation. Laboratory tests showed
hemoglobin 12.6 g/dL, white blood cells 11 970/mm3 (PMN = 7590), platelets 1 085 
000/mm3, and C-reactive protein was less than 0.05 mg/dL (Table 1). Routine stool specimen
tested positive for rotavirus antigen (Vikia Rota-Adeno, Biomerieux), whilst results for blood
and urine culture were negative. Serum electrolytes were significant for a sodium
concentration of 146 mEq/L and a bicarbonate level of 8 mEq/L. Blood urea nitrogen was 61 
mg/dL.
Subjective Data: “Lusaw ang dumi ng anak ko at naka sampong dumi na siya simula kahapon”
as verbalized by the mother.
Objective Data:
 Irritable
 Pale skin
 Skin turgor
 Dry lips and dry buccal mucosa
 normal looking eyes but reduced tears
 soft fontanelle
 capillary refill time of 3 seconds
 tachycardia
 abdomen was swollen
 hemoglobin 12.6 g/dL
 white blood cells 11 970/mm3 (PMN = 7590)
 platelets 1 085 000/mm3
 C-reactive protein was less than 0.05 mg/dL
 Blood urea nitrogen was 61 mg/dL
 Weight: 3990 g
V/S are taken as follows:
T: 39.9°C
CR: 170 and 190 bpm
RR: 40 and 80 bpm
Nursing Diagnosis: Fluid volume deficit related to active fluid loss as evidenced by watery
stool/frequency of stools