Case Study 1 Introduction: Sam is a
Case Study 1 Introduction: Sam is a three-year-old boy admitted to the Children’s Hospital emergency department (ED). Situation: Sam was brought to the ED by his mother because he has been vomiting and had diarrhoea for 2 days and he has become increasingly irritable today. Background: Sam is usually a well and active three-year-old who attends day care where there has been an outbreak of norovirus. Sam started vomiting two days ago and has had diarrhea. Assessment: Weight: 15kg Medical History: Nil significant; Nil allergies; up to date with all current vaccinations Current medications: 225mg Paracetamol oral given on admission (1 hour ago) Nutrition & Elimination: Nil orally since arriving at ED and decreased intake for past two days. Complains of feeling thirsty but take small sips of water only – estimate 150mls in 24 hours. Mother reports Sam last vomited 8 hours ago and had a large BO Type 7 while in the ED and soiled himself. Usually is toilet trained and does not have any special nutrition or hydration considerations. Vital signs: Temperature 37.9 degree Celsius; Blood pressure 95/54; Pulse rate 124, Respiratory rate 32, SPO2 100% on room air. Oral mucous membranes are dry, skin turgor less than 2 seconds, last voided 6 hours ago and no palpable bladder. Extremities are cool to touch. Neurological: V; cries and is irritable when woken, sitting on mother’s lap or in cot. Pain: 5/10 (FLACC scale), occasional grimace and cries when awake and difficult to console; states ‘my tummy hurts’. Recommendations: Sam will be observed for the next 8-hours in hospital where you need to conduct the appropriate assessments and provide care. His doctors have stated that intravenous fluid therapy (IVT) is not necessary at present. 4 Case study 2 Introduction: Sandra is an 83-year-old woman admitted to the Emergency Department (ED) Situation: Sandra was brought to the ED by her daughter because she has been vomiting and has had diarrhea for two days and she has become increasingly drowsy and disorientated today. Background: Sandra lives alone and is usually able to manage independently with occasional assistance from her daughter who lives in the next suburb. Her daughter’s children had norovirus 4 days ago and Sandra started vomiting and having diarrhea 2 days ago. Assessment: Weight: 70kg Medical History: Nil significant, Nil allergies; up to date with all current vaccinations Current medications: 1G Paracetamol oral given on admission (1 hour ago) Nutrition & Elimination: Nil orally since arriving at ED and reduced intake for 2 days. Taking sips of water only – estimate 300mls in 24 hours. Last vomited 6 hours ago and had a large BO Type 7 while in the ED and was incontinent. Is usually continent for urine and faeces and does not have any special nutrition or hydration considerations. Vital signs: Temperature 37.3 degree Celsius; Blood pressure 105/80 (lying); 95/54 (standing); Pulse rate 98, Respiratory rate 18, SPO2 99% on room air. Oral mucous membranes are dry, skin turgor greater than 2 seconds, last voided 6 hours ago and no palpable bladder. Extremities are cool to touch. Neurological: V; GCS – 14; 4AT – 8 – drowsy and disorientated to time. Pain: 7/10 (Abbey pain scale); states she has abdominal cramps. Recommendations: Sandra will be observed for the next 8-hours in hospital where you need to conduct the appropriate assessments and provide care. Her doctors have stated that intravenous fluid therapy (IVT) is not necessary at present.
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