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Acetaminophen 80mg/ml oral liquid 201mg (2.5ml) PO Q6-8H PRN

Ibuprofen 40mg/ml oral liquid 134mg (3.4ml) PO Q6-8H PRN

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Oseltamivir 6mg/ml oral liquid 30mg (5ml) PO BID

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D5NS @ 15ml/hr

Discontinued at the end of writers shift to assess for ability to maintain adequate hydration without need for IV fluids

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Serology/Viral Panel

CBC/Hematology

Chemistry

Chest X-ray

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Resp Rate = 39 resps/min (high end of normal)

Nasal congestion

Mouth breathing

O2 saturation = 95% (low end of normal)

Pt. showed no signs of increased WOB or SOB however was visibly breathing from his mouth due to nasal congestion

Serology: RSV +, Influenza A +, and Adenovirus +

Chest X-ray: images suggest infection present otherwise healthy lungs

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Low interest in food and oral liquids

Eating small amounts of solid food

Mom encouraging Pedialyte, water, and solid foods

Chemistry: BUN 1.3(low), Albumin 26 (low), Total Protein 54 (low), Alkaline Phosphate 93 (low), Chloride 112 (high)

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G.G.

2 years old

Admitted for Dehydration and Gastroenteritis

13.4kg

PEWS score = 0

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No pain noted, however given the types of illnesses the patient has, it is important to continuously assess for pain as headaches, sore throat, body aches, etc. can be common with these types of viral illnesses

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Hx of Diarrhea and vomiting

Bowel movement returned to normal, no vomiting for the last 10 hours

Serology: Adenovirus +, e-coli +

Chemistry: BUN 1.3(low), Albumin 26 (low), Total Protein 54 (low), Alkaline Phosphate 93 (low), Chloride 112 (high)

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Ondansetron 4mg/2ml injection 2mg IV Q12H

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Hx of Fever

Serology: RSV +, Influenza A +, Adenovirus +, and E-coli +

CBC: Hgb 132 (high), Hct 0.40 (high)

BP = 94/60 (normal)

Temp (axillary) = 36.9 (normal)

HR = 105 bpm (normal)

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Mom and dad at bedside

Dad going back to work full time

Family in Philippines

No siblings (parents first child)

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Mom and Dad are present to support patient

Parents advocate well for patient

Mom and dad supportive of each other: Dad helps mother with language barriers when information is unclear, Mother helps dad to remember certain data such as last diaper changes and food amount.

Patient able to express needs such as crying when uncomfortable

Parents communicate well with HCP

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Hx of lethargy

Alert and Oriented

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Informational resources provided to parents by HCP about the viral illnesses the patient has such as: informational sheets on RSV, Influenza A, Adenovirus and E-coli

Family in Philippines, not many resources here

Both parents present in patients life and have been at bedside supporting patient through illness

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Patient stages of growth:

In transition from Sensorimotor to Preoperational stages: The patient is currently not at a developmental stage to see other perspectives and therefore he may not understand the need for invasive interventions to improve condition or why he is in a strange place. During my assessment I tried to encourage my pt. to explore the medical equipment but he had little interest and just wanted to hug his mom while I assessed, he also may not understand cause and effect which could be influencing his reluctance to drinking fluids and eating food.

Autonomy vs shame & doubt: During this stage a child should be gaining some independence with some reliance on caregivers, however due to his illness my patient was very reliant on his mother and did not want any independence. However, he showed independence in form of autonomy over his body such as pushing away the nasal suction, refusing to eat, and showing signs of frustration when he did not want to do something. Given the situation his reliance on his mom is a normal finding.

Patient Findings: Lack of interest in play, lack of interest in surroundings, pt. was heavily reliant on mom for comfort. Parents reported pt. had lost a significant amount of weight. Pt. was inactive, mostly wanted to sit in bed, lay with mom and watch tv shows. Pt. did not speak when asked, this could be r/t to language barrier, mom was unclear when asked.