After reading the following case study, answer the questions with

After reading the following case study, answer the questions with the concept of infection in mind: R.O. is a 12-year-old girl who lives with her family on a farm in a rural community. R.O. has 4 siblings who have recently been ill with stomach pains, vomiting, diarrhea, and fever. They were seen by their primary care provider (PCP) and diagnosed with viral gastroenteritis. A week later, R.O. woke up at 0200 crying and telling her mother that her stomach “hurt really bad!” She had a temperature of 37.9°C (100.2°F). R.O. began to vomit over the next few hours, so her parents took her to the local emergency department (ED). R.O.’s vital signs, complete blood count, and complete metabolic panel were normal, so she was hydrated with IV fluids and discharged to home with instructions for her parents to call their PCP or to return to the ED if her condition did not improve or if it worsened. Over the next 2 days, R.O.’s abdominal pain localized to the right lower quadrant. She refused to eat and had slight diarrhea. On the third day, she began to have more severe abdominal pain, increased vomiting, and fever that did not respond to acetaminophen. R.O. has returned to the ED. Her vital signs (VS) are BP: 128/78, Pulse: 130, RR: 28, Temp: 39.5°C (103.1°F). R.O. is guarding her lower abdomen, prefers to lie on her side with her legs flexed, and is crying. IV access is established, and morphine sulfate 2 mg IV is administered for pain. R.O.’s white blood count is 12,000 mm3 (12 × 109/L). Assessment (Recognizing Cues) Which patient information is relevant? What patient data is most important? Which patient information is of immediate concern? Consider signs and symptoms, lab work, patient statements, H & P, and others. Consider subjective and objective data. Analysis (Analyzing Cues) Which patient conditions are consistent with the cues? Do the cues support a particular patient condition? What cues are a cause for concern? What other information would help to establish the significance of a cue? Analysis (Prioritizing Hypotheses) What explanations are most likely? What is the priority order for safe and effective care? Planning (Generate Solutions) What are the desirable outcomes? What should be avoided? (SMART Planning- specific, measurable, attainable, realistic/relevant, time-restricted- Goal setting) Implementation (Take actions) How should the intervention or combination of interventions be performed, requested, communicated, taught, etc.? What are the priority interventions? (Mark with asterisk) Evaluation (Evaluating Outcomes) What signs point to improving/declining/unchanged status? What interventions were effective? Are there other interventions that could be more effective? Did the patient’s care outlook or status improve?

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