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Pediatric Case Study

Yohana Nuguse (430578) and A B M Reazuddin Mosharaf (386244)

School of Health and Wellness, Bow Valley College

NURS2502: Pediatric Nursing

Course Instructor: Leslie Hirsch

Nov 20, 2023

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1. Identify three appropriate therapeutic communication techniques and how they

would be used to help the nurse build a therapeutic relationship with the child and

her aunt.

There are different therapeutic communication techniques in nursing, some of them active

listening, sharing empathy, and using touch (Sonya et al.,2019). Active listening means being

focused on what the patient is saying both in words and non-in words (Sonya et al. 2019) Sharing

empathy is also the expertise to understand another person’s situation emotionally and

intelligently to truly perceive unspoken feelings. Using touch is one of the appropriate

therapeutic communications for many patients understand feelings of isolation related to their

personal and social context (Sonya et al.,2019). The nurse should try to emphasize and reduce

the aunt ‘s anxiety that Yasmin is in a common situation according to vital signs information can

be improved easily. Also, the nurse should try to touch Yasmin so that, she will not feel she is

alone because only her aunt is with her that is why needs more active listening and touching

giving her more attention with playing to build trust and for more comfort of Yasmin (Sonya et

al.,2019).

2. Discuss three safety concerns related to Yasmin’s hospital admission and

developmental stage.

The first safety concern is the aunt must watch Yasmin from the risk of falling as she is 20

months old, and she needs more attention. Yasmin is already dehydrated according to the case

study information so probably she is going to have an IV line Therefore, there is a second safety

concern because IV tubing commonly gets twisted as it rolls about. The third concern is
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infection. As Yasmin is 20 months old, she can grab some unclean equipment from the room or

eat something so infection is the main concern (Leifer & Keenan ,2020).

3. Describe and provide a rationale explaining what findings in Yasmin’s assessment

are of concern.

Temperature is a concern according to Lisa Keenan Lindsay’s textbook standards. Her

temperature is 39.0 so this one concern is high, and she has a fever. Because Yasmin is 20

months old at her age this is a concern (Leifer & Keenan ,2020).Yasmin’s aunt anxiously reports

that the child has been having diarrhea for the past two days and “is not her usual self”. This is

also a concern because diarrhea is a serious issue in children it causes severe dehydration.

Yasmin is also not drinking well and is not getting enough electrolytes which is a big concern

(Leifer & Keenan ,2020).

4. Identify two early and two late signs and symptoms of dehydration in pediatric

patients.

Dehydration in children is relatively uncommon, but it can quickly escalate into a significant

medical risk if not treated promptly. Fortunately, it is generally cured by simply feeding your

infant more frequently (Younis et al.,2015). However, they must consult with their pediatrician

to ensure that their hydration levels soon return to normal. Signs and symptoms of dehydration in

pediatric patients, the early signs and symptoms are Dry mouth, lips, and dry skin Less wet

diapers, and faster breathing No tears were shed (Younis et al.,2015).

Constipation, hard or fewer bowel motions (if dehydration is caused by a lack of liquids).

The late signs and symptoms of dehydration in pediatric patients also dry mucous membranes,

excessive sleepiness, and irritability (Younis et al.,2015).

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5. Describe the differences between mild, moderate, and severe dehydration in

pediatric patients.

Dehydration is defined as a lack of fluid in the body that prevents it from performing its

regular tasks. Babies and little children are more likely to get dehydrated because their bodies

contain a larger proportion of fluid. Because children have a high metabolic rate, their bodies

require more water. The kidneys of a youngster do not save water as efficiently as the kidneys of

an adult (Younis et al.,2015).

However, dehydration is classified as mild moderate, and severe. Mild dehydration is

characterized by a dry mouth and lips as well as increased thirst, and children may pee less

regularly. Moderate dehydration causes children to be less engaging or lively, to have a dry

mouth, and to pee less regularly. Moderate to severe dehydration might produce a racing heart

and lightheadedness (Younis et al.,2015). Severe dehydration causes children to become tired or

sluggish, indicating that they should be assessed by a doctor or transported to a hospital or urgent

care clinic as soon as possible (Younis et al.,2015). They do not cry. They may acquire a bluish

hue on their skin (cyanosis) and have fast breathing. Dehydration can cause the concentration of

salt in the blood to fluctuate irregularly. Changes in salt concentration can exacerbate

dehydration symptoms and aggravate lethargy. In extreme circumstances, the youngster may

experience convulsions, unconsciousness, or brain damage. Severe dehydration is potentially

dangerous (Younis et al.,2015).

6. Outline four priority nursing actions based upon your assessment of Yasmin

As Yasmin has been diagnosed with severe Diarrhea, nursing interventions should be

focused on managing her electrolytes balance, keep comfort and monitor her fluid intake and

output balance. Four priority of nursing actions could be:

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1. Encourage to take clear liquid every two hours while awake. As diarrhea requires

bowel rest, clear or full liquid diet is important to give rest for the intestine (Leifer,

2021). A bland diet with low fiber is needed to bulk the stools. This includes soft

foods without added sugar or spices such as white rice, white toast, crackers, and

eggs. Potassium riches foods such as potatoes, bananas and fruit juices and yogurt

with active bacterial cultures are required (Ward & Hisley, 2009).

2. Yasmin may need oral rehydration solutions due to her severe dehydration. Drinking

more water may not be enough for a patient with severe diarrhea. Aside from fluids,

the patient is also losing important minerals and electrolytes that water can’t supply.

We need to keep giving oral rehydration solution until diarrhea is less frequent. If this

20-month-old refuses ORS by the cup or bottle, we need to give this solution using a

medicine dropper, small teaspoon or frozen pops (Ward & Hisley, 2009). These can

also be served through a mixture of water, sugar, and salt to replace lost fluids. When

vomiting decreases, it’s important to have the child drink the usual formula or whole

milk and regular food in small frequent feedings. Supplementation of electrolyte

solutions may be required (Leifer, 2021).

3. Monitoring vital signs is an important aspect for this patient, considering her

tachycardia and respiratory situation. Her temperature and respiration rate must be

monitored on regular frequency which indicates possible aspiration of emesis. We

need to monitor intake and output by assessing the number of wet diapers. Frequent

diarrhea can cause skin breakdown to the perianal area. Frequent diaper change and

try to keep the perineum dry should give her a little comfort. We should also monitor
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dehydration situation by monitoring skin turgor as hypovolemic status can be serious

and cause death (James et al., 2013, p. 347).

4. We should send stool for culture to identify possible symptoms to determine whether

diarrhea is due to a parasitic or bacterial infection (Ward & Hisley, 2009). The

identification would help to provide right treatment for the cause.

7. Explains the pathophysiological relationship between diarrhea, fluid and

electrolyte imbalance and dehydration

Diarrhea occurs when organisms attacking and terminating intestinal mucosal cells,

decreasing intestinal superficial area and impairing the intestines capacity to absorb fluids and

electrolytes (James et al., 2013, p. 347). Its results vomiting or extreme emission of stool, which

effects emptying intestines and stomach. This high motility and sudden emptying causes in

impaired absorption of nutrients and ultimately leads towards electrolyte imbalance. Dehydration

in intestine causes stool to pull water, sodium, potassium and bicarbonate from extracellular

space. It consequences electrolyte depletion and metabolic acidosis. The increased motility and

rapid emptying of the intestines result in impaired absorption of nutrients and water and an

electrolyte imbalance (James et al., 2013, p. 347).

8. Describe 3 common methods of treatment for dehydration in young children

Oral Rehydration Therapy (ORT): This oral method of drinking electrolyte containing

solution works as a rehydrating agent. These are commercially available over the counter

solution or drinks and have shown to be more effective for fluid and electrolyte replacements.

This solution is low in osmolality and helps quick regaining of imbalance of electrolyte from

excessive voiding or vomiting.

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Parenteral Fluid and Electrolyte Therapy: This is intravenous infusion therapy and

may be given continues or in boluses as required. It’s an emergency intervention and consists of

either lactated ringer’s solution or 0.9% sodium chloride solution. This helps quick return of

urination or hydration to an acceptable level.

Medications: Diarrhea can be caused from bacteria, parasite or fungal invasion. Based on

stool culture, medication can be provided to prevent it. If diarrhea is caused by a pathogen, then

no medication may be prescribed considering body’s own effort to fight back the intruder.

However, doctor may order antibiotics if the cause of the diarrhea is suspected to be bacterial,

parasitic or fungi. It is to be note that antidiarrheal medications are not recommended for

children due to their less effectiveness of shortening the course of diarrhea.

9. Describe the proper administration technique that should be taught to the aunt to

help her to administer an oral antipyretic to Yasmin on discharge to prevent her from

spitting it out

If Yasmin hates the taste of the antipyretic and keeps on spitting out, then medication can

be sneak into a small bowl of applesauce or can be mixed with a little bit of water or juice. It

should be noted that Yasmin drinks the entire amount and does not leave a portion of it. It would

be wise to mix with a small amount of juice or sauces so that the child can finish the medication

and doesn’t fill up before. For liquid or suspension, medicine dropper can also be used. If

medication can be aimed towards the cheek as close to her throat as possible, then it is less likely

that she will spit. Gently holding the child’s cheek together once medication is in her mouth, can

ensure that she has swallowed it. Yasmin’s aunt must ensure that medication has been given
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while Yasmin is sitting in upright position and never to give extra medication if she spit a little

out.

10. Identify 3 assessment findings that indicate improvement in the dehydrated

child

Yasmin should gradually response more with normal respiratory rate. She should have

more urine output measured by wet diapers numbers. The skin should look more elastic and

softer. Pathological reports should show serum pH and electrolyte levels are within limit.

References

Leifer, G., & Keenan-Lindsay, L. (2020). Leifer's Introduction to Maternity & Pediatric Nursing

in Canada E-Book. Elsevier Health Sciences.

Sonya, L.Jakubec,Barbara J.&Astel.(2019).Communication and Relational Practice In B.J.Astel

&W.Duggleby (Eds.)Canadian Fundamental of nursing (6th ed.,pp.282-283).Elsevier

Younis, J. R., Mabrouk, S. M., & Kamal, F. F. (2015). Effect of the planned therapeutic

communication program on therapeutic communication skills of pediatric nurses. Journal

of Nursing Education and Practice, 5(8), 109-120.

James, S. R., Nelson, K. A., & Ashwill, J. W. (2013). The child with fluid and electrolyte

alteration. In Nursing care of children: Principles & practice (4th ed., pp. 336-352). St.

Louis, MO: Elsevier-Saunders.

Leifer, G. (2021). Introduction to maternity & Pediatric Nursing. Missouri: Elsevier Saunders.

Ward, S. L., & Hisley, S. M. (2009). Maternal-child nursing care: optimizing outcomes for

mothers, children, and families. Philadelphia: F. A. Davis Company.

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