Question 1349

Question Answered step-by-step R.O. is a 12-year-old girl who lives with her family on a farm in a… R.O. is a 12-year-old girl who lives with her family on a farm in a rural community. R.O. has four 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 (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 (VS), complete blood count (CBC), and complete metabolic panel 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 (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. An abdominal CT (computed tomography) confirms a diagnosis of appendicitis. R.O.’s white blood count (WBC) is 12,000 mm3 . 1. Identify the clinical manifestations exhibited by R.O. that most clearly reflect the classic presentation of appendicitis. 2. Discuss why R.O.’s presenting clinical manifestations make diagnosis more difficult; identify two other possible diagnoses. 3. The abdominal CT confirms that R.O. has appendicitis. Which of these orders are appropriate? Explain rationale. If the order is inappropriate, explain why. Emergency Department Orders: 1. Make patient NPO. 2. Place a peripheral IV and begin D5 NS at 80 mL/hr. 3. Administer Fleet Enema. 4. Administer morphine sulfate 2 mg IV q2h for pain. 5. Obtain surgical consent from patient. Obtain consent from parents and assent from patient. 6. Administer cefotaxime (Claforan), a broad-spectrum antibiotic, at 150 mg/kg/day q6h. 4. R.O.’s weight is 42 kg, and height is 155 cm. Calculate her maintenance fluid needs 4. Mr. and Mrs. O. give informed consent, and R.O. assents to the surgery after the procedure is explained to her. Why is it important for R.O. to provide her assent for the procedure? 5. What should be included in the preoperative teaching for R.O. and her parents? 6. Identify five priority nursing considerations. 7. Using SBAR, what would you communicate to the surgeon? 8. What will you consider as part of your nursing management of R.O.’s pain? 9. What should you consider in your approach to help R.O. cope with the procedure? 10. In anticipation of R.O.’s discharge, identify expected outcomes that must be achieved before her leaving the hospital. 11. You provide discharge teaching to R.O. and her parents. Which of these statements would indicate that more teaching is required? a. “We need to return if R.O. begins vomiting again or develops a fever.” b. “R.O. should wait 2 weeks before returning to her gymnastics program.” c. “We will keep the incision clean and call if we see redness or drainage.” d. “R.O. can advance her diet to the regular foods that she likes to eat.” Health Science Science Nursing NUR 1025C Share QuestionEmailCopy link Comments (0)

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