Appendicitis

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?
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?

Before administering the Tylenol, what should the nurse check?
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

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?