12387 Subject or discipline: Nursing Title: Writer’s choice Paper instructions: Attached Chapter 27 Case Study: Maria Gonzales Scenario: The triage nurse at a local pediatric clinic receives a call from the mother of a 4-year-old girl named Maria. Maria has polycystic kidney disease. For the past 2 days Maria has been extremely thirsty and going to the bathroom constantly. For the past 2 nights Maria has wet the bed. The nurse asks Maria’s mother the following questions: ??Has Maria had a fever recently? Does Maria complain of painful urination (dysuria)? How often is Maria urinating? Is there an odor to her urine? What color is Maria’s urine? Has Maria had any diarrhea? Is Maria active and playful? Has Maria lost any weight recently? Maria’s mother reports that she has not had a fever, dysuria, or diarrhea. There is no odor to Maria’s urine and it is clear in color. However, Maria’s mother reports that she is urinating about every 15 minutes and that she is not playful. The nurse asks Maria’s mother to bring her to the clinic today for further evaluation. When Maria arrives at the clinic, the nurse obtains her vital signs. Maria’s oral temperature is 99.0°F (37.2°C). Her blood pressure is 88/50 mm Hg, radial pulse is 110 beats per minute, and respiratory rate is 30 breaths per minute. Maria’s weight today is 40 pounds (18.2 kg). The nurse notes that Maria weighed 44 pounds (20 kg) at her 4-year checkup just 1 month ago. Maria has poor skin turgor and her mucous membranes are dry and sticky. The nurse notes that Maria’s skin color is pale but there are no rashes. Her pupils are equal and reactive to light. Maria’s neck is supple and without lymphadenopathy. Her lung sounds are clear bilaterally and with unlabored respirations, and heart sounds are regular and without a murmur. Maria’s abdomen is soft, with active bowel sounds in all four quadrants. Her radial pulses are 3+ bilateral and strong. The pediatrician orders a urinalysis and a basic metabolic profile. The urinalysis reveals a low specific gravity of 1.002 g/mL. Glucose in urine is negative. Maria’s sodium is 166 mEq/L and her blood glucose level is 100 mg/dL. The pediatrician suspects nephrogenic diabetes insipidus secondary to the lack of the kidney’s appropriate response to normal levels of ADH. It can be caused by drugs or chronic disorders, such as kidney failure, sickle cell disease, or polycystic kidney disease. The pediatrician decides to admit Maria to the hospital for a water deprivation test. Critical Thinking Questions 1. What is your analysis of the findings from this scenario? 2. What are the priority nursing diagnoses at this time? 3. What are the expected nursing outcomes related to this scenario? 4. Discuss the nursing interventions related to this scenario. Chapter 31 Case Study: Dag Barstow Scenario: Dag is a 2-year-old boy whose father brings him to the pediatrician’s office with a chief complaint of a purple rash on his legs. The nurse notes that Dag has symmetrical purple patches on his buttocks and lower extremities. There is no associated urticaria (raised wheals that may itch) or erythema (redness). The nurse notes that Dag has nonpitting edema (swelling) of his scalp, eyelids, lips, ears, and scrotum, and the dorsal surfaces of his hands and feet. ?His vital signs are as follows: blood pressure is 98/59 mm Hg, oral temperature is 99.0°F (37.2°C), heart rate is 88 beats per minute, and respiratory rate is 25 breaths per minute. Dag’s weight today is 28 pounds (12.7 kg). ?Further assessment shows that no joint pain or swelling is noted. Dag’s knees, ankles, hips, wrists, elbows, and shoulders have full range of motion. His lung sounds are clear bilaterally, and his heartbeat is regular and without murmur. His oral mucous membranes are slightly sticky or dry. No erythema, petechiae, or purpura is noted in the oral cavity. His nares are patent, and his pupils are equal and reactive to light. ?Dag’s tympanic membranes are pearly gray with good landmarks. His neck is supple and without lymphadenopathy. His skin turgor is rapid (< 2 seconds). Dag’s urine color is dark yellow. He is complaining of cramping abdominal pain without vomiting. His father says that he has some nausea and his appetite is decreased. Dag only ate half of his breakfast today. The father also noticed that his last bowel movement had some mucus. Dag’s stool is positive for occult blood. His urinalysis is positive for blood, casts, and protein. ?Dag is diagnosed with Henoch-Schönlein purpura with edema and gastrointestinal involvement. Because Dag has renal involvement, he is admitted to the hospital for medical treatment. Critical Thinking Questions 1. What complications might Dag encounter secondary to his diagnosis of Henoch-Schönlein purpura?? 2. What are the priority nursing diagnoses at this time? 3. What are the expected nursing outcomes related to this scenario?
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