Pediatric Case 6: Eva Madison (Complex) Documentation Assignments ✓ Solved

1. Document your initial focused assessment of Eva Madison.

2. Identify and document key nursing diagnoses for Eva Madison.

3. Referring to your feedback log, document the nursing care you provided and Eva Madison’s response.

4. Document the patient teaching that you would provide for Eva Madison and her parents before discharge, including teaching related to contact isolation precautions and diet progression.

Paper For Above Instructions

Initial Focused Assessment of Eva Madison

Upon evaluation, Eva Madison is a 5-year-old female presenting with a 3-day history of vomiting and diarrhea. She arrived at the pediatric unit following treatment in the emergency department, indicating significant concerns regarding her hydration status. Notably, her weight has declined from 21.2 kg at her last check-up to 20.5 kg upon admission, signifying a potential fluid deficit. Her vital signs reveal a slight tachycardia with a heart rate of 130 beats per minute and a temperature of 98.6°F. Physical examination reveals signs of dehydration, characterized by dryness of her mucous membranes and diminished skin turgor. She appears pale, lethargic, and listless, necessitating close monitoring.

Nursing Diagnoses for Eva Madison

The following nursing diagnoses can be identified based on Eva Madison's assessment:

  • Risk for Deficient Fluid Volume related to excessive vomiting and diarrhea as evidenced by weight loss and dry mucous membranes.

  • Imbalanced Nutrition: Less Than Body Requirements related to inability to retain fluids and reduced caloric intake.

  • Fatigue related to dehydration and nutrient depletion as evidenced by lethargy and weakness.

  • Anxiety related to hospitalization and condition affecting the patient and her family.

Nursing Care Provided and Response

In response to the identified nursing diagnoses, the following nursing care was provided to Eva Madison:

  1. An intravenous bolus of 400 mL of normal saline was administered to address dehydration.

  2. Maintenance fluids were initiated post-bolus to stabilize her hydration status.

  3. Close monitoring of vital signs and input/output patterns was instituted, with documentation of urine output to assess hydration levels.

  4. Education was provided to Eva's parents concerning signs of dehydration and the importance of maintaining fluid intake.

Eva showed a positive response to the treatment, exhibiting improved hydration indicators such as moist mucous membranes and increased energy levels. Her anxiety appeared to diminish as her physical condition improved, and her parents expressed relief regarding her care plan.

Patient Teaching Prior to Discharge

Before discharge, comprehensive teaching for Eva Madison and her parents included:

  • Information regarding maintaining hydration at home, emphasizing frequent, small sips of a rehydration solution (such as Pedialyte).

  • Diet progression advice, suggesting a gradual reintroduction of bland foods (e.g., bananas, rice, applesauce, toast) as tolerated.

  • Contact isolation precautions due to the potential for infectious diarrhea, stressing the importance of hand hygiene and sanitation.

  • Details regarding the signs and symptoms that necessitate immediate return to medical care, such as increased vomiting, decreased urine output, or lethargy.

This teaching aims to empower the family in managing Eva's condition at home while ensuring they are aware of important precautions to maintain her health.

Reflection and Future Implications

Reflecting on Eva Madison’s case, the simulation experience highlighted pivotal actions in pediatric care. The necessity for timely hydration intervention is underscored, and the significance of family education is central to ensuring patient safety and effective care at home. Future practice will integrate the lessons learned regarding emotional support for families, emphasizing a patient-centered approach that considers both physical and psychological needs.

References

  • Kyle, T., & Carman, S. (2021). Essentials of Pediatric Nursing (4th ed.). Wolters Kluwer Health.

  • American Academy of Pediatrics. (2018). Red Book: 2018 Report of the Committee on Infectious Diseases. Elk Grove Village, IL: AAP.

  • American Nurses Association. (2015). Nursing: Scope and Standards of Practice (3rd ed.). ANA.

  • Barnett, R. R., & Manna, T. (2020). Pediatric Fluid and Electrolyte Management. Pediatric Emergency Care, 36(12), 623-629.

  • Centers for Disease Control and Prevention. (2022). Food Safety and Your Child. CDC.

  • Hoffman, J. (2023). Pediatric Assessment and Management. Journal of Pediatric Health Care, 37(5), 475-483.

  • National Institute of Health. (2019). Pediatric Dehydration and Fluid Replacement Strategies. NIH Clinical Guidelines.

  • Ron, R., & Cohn, R. (2021). Managing Infectious Diarrhea in Children: A Review. Pediatrics, 147(5).

  • Thompson, D., & Bevan, W. (2020). Family-Centered Care and Anxiety Reduction. Journal of Family Nursing, 26(1), 88-97.

  • World Health Organization. (2021). Guidelines for the Treatment of Diarrhea and the Prevention of Dehydration in Children. Geneva: WHO.