O. is a 12-year-old girl who lives

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 “hurts really bad!” She had an elevated temperature of 37.9°C. 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 (VS), CBC, complete metabolic panel (CMP) were normal, so she was hydrated with IV fluids and discharged to home with instructions to call their PCP or to return to the ED if she did not improve or worsened. Over the next 2 days, R.O.’s abdominal pain localized to the right lower quadrant (RLQ), she refused to eat, and she 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. returns to the ED. Her VS are 128/78, 130, 28, 39.5°C. Weight is 42 kg, and height is 155 cm. 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 2.0 mg IV is administered for pain. An abdominal ultrasound (US) confirms a diagnosis of appendicitis. R.O.’s WBC is 25 thou/cmm. SCIENCE HEALTH SCIENCE NURSING NURS 317L

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