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- D/t acute viral gastroenteritis

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- Pre-school aged
- Erikson's stage of initiation vs. guilt
- Piaget's Pre-operational stage of cognitive development

Patient acted appropriately for his developmental age considering the circumstances. Regarding Erikson's stage, the patient did not show much initiative while he was in hospital and often relied on his parents (ex. asking them to carry him to and from the bathroom). However, it is important to note that the hospital is a challenging place for a child to demonstrate initiative, and his parents stated that he has been "much needier" since being sick. It is not uncommon for children to regress while they are sick and hospitalized, which is likely the case for this pt. It is also important to note that the patient was terrified of health care staff which could have affected my assessment. I utilized developmentally appropriate communication styles (ex. crouching to eye level, gaining trust of parents first et c.) and practiced atraumatic care by incorporating his parents into his care, completing the scariest/most painful tasks last and offering choice when possible (Temp. in mouth or armpit? what flavour popsicle?).

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Family:
- Pt's family was very supportive of one another and took turns staying with the child to give each other a break.

Child:
- He was very distressed when hospital staff was in the room and his parents and family were excellent at calming him down.
- He played on the Wii to distract himself from the stress

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- Ondansetron 4mg PO Q8H PRN

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- Low sodium (134) -> likely d/t vomiting or dehydration

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- Good turgor
- IV site dry and intact
- moist and pink mucous membranes

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- Acetaminophen 290mg PO Q4H PRN
- Ibuprofen 193mg PO Q6H PRN

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4/10 abdominal pain via FACES scale

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- D5NS @ 30ml/hour
- IV Ceftriaxone 1447.5mg Q24H (incase of bacterial gastroenteritis)

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- Min. hourly intake: 58.8mls
- Min. hourly u/o: 19.3mls
- u/o of 360mls during shift (60mls/hour)
- Not drinking well

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- Chest X-ray: normal

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Labs taken on Nov.13th (day of admission) and Nov.14th (day of assessment)
- WBC: 7.8 (16.9H)
- Neutrophils: 4.8 (14.6H)
- Lymphocytes: 2.3 (1.0L)
- Monocytes: 0.7 (1.1H)

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- HR = 101
- BP = 105/67 (80)
- Temp = 36.7 (took tylenol two hours before assessment; admitted with low-grade fever)
- CWMS adequate; pulses strong; cap refill 2 secs

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- RR = 22
- Lung sounds clear
- Persistent, congested, unproductive cough.
- O2 sat = 99%

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A+O x3

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- The primary language of the patient and family was Punjabi, However, all family members spoke fluent and comprehensible english.
- When asked about the parents support during their child's hospital stay, they exclaimed "we have lots of support from our family, in our culture we all live together and take care of each other".

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- Admitting Dx: Viral Gastroenteritis
- Bowel sounds hyperactive in all quadrants
- Pt denies nausea (was admitted with 2-day Hx of N+V and diarrhea)
- LBM: Nov. 14th (day of assessment); Parents described as "slightly loose, medium sized and dark brown".
- Pt not receiving adequate nutrition; Parents report that patient was "eating better today" compared to past 3 days; ate 25% of breakfast and 50% of lunch.
- Abdomen soft, but tender upon palpation.

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- Patient and immediate family lives with extended family, therefore, other family members provide child care for siblings and come to hospital to help out parents and patient.
- I asked the child life specialist to help calm my patient down and she gave him some prizes which he liked.

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Both parents and extended family present to provide physical (hygiene, mobilization) and emotional care.
Mom and Dad supportive of each other; take turns being at hospital
Mom is a strong advocate for patient, exceptional at consoling child
Pt unable to communicate with nurse as he is terrified of hospital staff; mom and dad are primary communicators/translators
Family is attentive to patient and hospital staff; follows direction from nurse (ex. filling out ins + outs sheet)

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Dad at bedside during day
Mom at bedside during evening and nighttime
15-year-old brother
10-year-old sister (speech and language delays)
Grandma and Aunt visit with siblings to help out parents

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D.H.
5 years old (DOB: 01/SEP/2017)
Dx: Acute Viral Gastroenteritis (contact precautions)
19.3 kg
PEWS score 1
DAT/AAT
No significant health hx (seasonal allergies)
Immunizations up to date
NKA
Born via SVD at term