Matthew W. Daniels 4 years old - Male - 6/10/xx - Ht: 105.9cm 70th percentile - Wt: 15.3kg 25th percentile - BMI 13.6 - KNDA

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Nursing

Priority Nursing Diagnosis #2 At risk for hypovolemic shock r/t salmonella poisoning aeb excessive fluid loss and electrolyte imbalance

Evaluation: Patient has met goal but will continue to monitor intake and output at home until diarrhea has resolved.

Interventions 1. administer IV fluids 2. Monitor I&O flowsheet 3. measure weight daily 4. encourage oral fluid intake 5. minimize vomiting

Goal - By discharge Matthew will exhibit reduced risk of hypovolemic shock by increasing fluid intake over out put aeb I&O flowsheet and weight gain

Priority Nursing Diagnosis #1 Fluid Volume Deficit r/t salmonella poisonings aeb vomiting and diarrhea

Evaluation; Monitor I& O and once they are WDL for the patient our goal will be met.

Interventions: 1. Measure I&O & weight 2. Lab work to verify electrolyte levels 3. encourage eating and drinking 4. IV solution administration 5. Promethazine to minimize fluid loss from vomiting

Goal - By discharge Matthew will exhibit fluid volume WDL by increasing fluid and nutrition aeb I&O flow sheet.

Matthew W. Daniels 4 years old - Male - 6/10/xx - Ht: 105.9cm 70th percentile - Wt: 15.3kg 25th percentile - BMI 13.6 - KNDA

Medication

Hospital Medications

Name: Potassium Chloride in Sodium Chloride (Klor-Con) Strength: 5mEq in 0.9% Directions: Administer 5mEq in 100ml via intermittent IV bolus over 1 hour Class: Electrolyte Supplement Reason for use: critically low potassium serum Dosage Calculation:1 to 2 mEq/kg/day in divided doses Matthew's dose - 15.3 - 30.6 mEq/kg/day Is it safe for Matthew? yes

Name: Dextrose in Sodium Chloride IV Strength: 5% in 0.45% Directions: Administer 1000ml via IV at 50ml/hr continuously Class: IV nutritional therapy Reason for use: continuous rehydration, IV nutritional therapy Dosage Calculation: Is it safe for Matthew?

Name: sodium chloride Strength: 9% Directions: 200ml IV bolus to be administered over 90 mins Class: electrolyte supplement Reason for use: Immediate rehydration Dosage Calculation: Is it safe for Matthew? yes

Name: Promethazine HCL (Phenergan) Strength: 7mg Directions: Inject 7mg IM Q6H PRN N/V Class: antiemetic Reason for use: Nausea & Vomiting Dosage Calculation: 0.25 to 0.5 mg/kg/dose q4-6h Matthew's dose - 3.825mg/dose - 7.65mg/dose Is it safe for Matthew? yes

Name: Clotrimazole cream (Lotrimin) Strength: 1% Directions: Apply to diaper area BID Class: antifungal cream Reason for use: diaper rash r/t diarrhea Dosage Calculation: Thin layer Is it safe for Matthew? yes

Name: Acetaminophen (Tylenol) Strength: 160mg Directions: 160mg PO q4h PRN for fever over 101.5F Class: analgesic, nonopioid, antipyretic Reason for use: antipyretic in the event of temp over 101.5F Dosage Calculation: 10-15mg/kg/dose q4-6h max 5 doses per day, no more than 4,000mg per day Is it safe for Damien: 153-229.5mg/dose is safe range for Matthew Yes this is a safe dose for Matthew

Home Medications No home medications listed

Lab/Diagnostics

Heart Monitor due to low potassium - d/c when potassium is within normal range

Labs

1430 Stool Culture with Gram Stain positive salmonella gram negative rods

0900 CBC RBC - 22ml/kg Hgb - 14g/dL Hct - 40% WBC - 14.3/mm Iron - 100mcg/dL BMP Na - 136 mEq/L K - 2.9 mEq/L (low) chloride - 98 mEq/L BUN - 11.2 mg/dL Creat. - 0.32 mg/dL CO2 - 21 mEq/L UA appearance - cloudy Color - Amber Odor - Strong Specific Gravity - 1.030

Patho

Diarrhea

Possible Complications of Me? dehydration, electrolyte imbalance, kidney failure, and organ damage

Signs & Symptoms abdominal cramps/pain, bloating, nausea, vomiting, fever, blood in the stool, mucus in the stool, urgent need to have a bowel movements

What Causes Me? infections, travelers' diarrhea and side effects of medications

What am I? Loose and watery stool during a bowel movement multiple times with in a time frame

Dehydration

Possible Complications of Me? Urinary/Kidney problems, seizures, hypovolemic shock

Signs & Symptoms Dry mouth, no tears when crying, sunken in eyes/cheeks, little to no urine production, irritability

What Causes Me? losing more water/electrolytes than you take in, fluid loss can be from sweat, tears, vomiting, diarrhea, and/or urine

What am I? A harmful reduction of water from the body.

Chief Complaint

Current Hospitalization

Admitted 8/12/xx - 0850 Contact Isolation Diarhea x2 days, not eating, only a few sips of apple juice over 1 day, FACES pain 3, current immuzaion, 38C 120pul, RR 30 , no murmurs, clear lung, hyperactive bowel, diaper briefs due to diarrhea but potty trained and goes to day care full time, crying I/O Diaper Rash

I PO - 120ml - 1200 IV - 200ml - 1030, 1000ml - 1200, 100ml - 1250, O Urine - 70ml - clear yellow Stool - 52, 26, 33, loose watery, green 10,11,12 Emesis - 25 0930