Section 1: Presentation: What aspects of this case will you wish to focus upon?

The most important presenting aspects I will focus on regarding Lucas will be the ‘runny

poos’ which depict diarrhea, the somewhat loss of personality and irritability as well as the

loss of skin elasticity. The presenting temperature and high HR of Lucas are also areas that

need to be addressed quickly and effectively. From the description given, Lucas has had

major decreases in his oral intake when feeding which is also a factor which will be taken

into account when making assessments.

Section 2. Pathophysiology

Based on the presenting factors, Lucas seems to be dehydrated. The presenting signs and

symptoms correlate with this assessment. When dehydrated, especially with diarrhea as

Lucas has, there is a loss of bicarbonate as well as possible hypotranemia or hypertranemia.

However, the presenting signs show that there may be something more than just

dehydration such as Rotavirus. The dry mouth, unusual sleepiness and lack of tears all depict

dehydration however the high temperature and irritability with diarrhea depict something

more. The Pathophysiology of rotavirus is multi factorial. There is a viral enterotoxin NSP4

produced by rotavirus which are known to cause secretory diarrhea. Rotavirus will also

cause an electrolyte imbalance which would correlate with his symptoms of dehydration.

Section 3: Tests and Interventions

1. Due to the presenting symptoms being that of dehydration, a stool sample may be

necessary to confirm a diagnosis of something more such as Rotavirus.

 2. Immediate actions will include encouraging an intake of fluids and continued

assessment of vital signs. It is important to begin replacing the lost fluid and

electrolytes. This may begin with promoting hydration with a bottle or

breastfeeding. As the child is 5 months old, an electrolyte solution between breast-

feedings may be beneficial.

3. Due to the patient being a 5 month old baby, it will be important to educate the

caregiver about possibilities of viral gastroenteritis and provide education about

hygiene measures and hand washing.

4. Also, an assessment of the intake and output will be vital for assessing if the patient

is improving at all.

5. Further assessments for abdominal pain and nausea may also assist in making a

more specific diagnosis.

Section 4: Nursing/nurse practitioner responsibilities and tasks

1. Monitor and document vital signs, focussing on BP and HR. As well as thus, capillary

refill time and changes in skin turger. This will assist in tracking changes and

developments of signs and symptoms the child is presenting with. It will allow for an

effective tracking of improvement and evaluation of the effectiveness of

implemented interventions.

2. Administer IV fluids if the diarrhea continues to increase or if there is any severe

vomiting that begins.

3. Monitor weight and assess intake and output frequently. Assessing these aspects will

assist in meeting the goal of the child returning to normal hydration status and will

not develop hypovolemic shock.

4. Cooling measures including removing excessive clothing or blankets as well as

adjusting the room temperature. This will assist in regulating the temperature of the

environment and also makes it more comfortable for the patient.

5. Promote skin integrity. Due to the diarrhea it is important for the baby to reduce any

opportunity for skin breakdown to the perinatal area. Educating the guardians as

well on proper wiping from print to back and the use of non-irritating cleansers will

be necessary. It will be important to provide frequent diaper changed to keep the

perineum dry and also applying skin barrier ointments.