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6 Years old Female

Admitted to ER with fever x 4 days, abdominal pain, and vomitting. Elevated CRP 117.5 (High)

Recent travel to China

PEWs = 2

Constipated - no bm x 4 days

No past medical history

NKDA

Weight

Droplet precautions

No one else is sick in family.

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Mom at bedside.

Has two siblings ( 7 years, and 9 years)

Dad works full time.

Mom works part time.

Mom able to take time off from work

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Both parents are involved in patient's care, and very support of each other.

Strong support in place for instance, grandparents and aunt.

Mom gets updated by Pediatrician on the unit.

Mom states, she discuss daily prognosis with her husband.

Dad visits after work for few hours and drop off meals for mom. Dad and aunt gives mom breaks as needed.

Both parents are strong advocates for the patient with nurses.

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Grandparents are providing childcare for the sibling.

Grandparents are involved in the care of children.

Aunt prepare meals for they family, and help out as needed.

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D5NS with 20KCL at 26cc/hr

PEG 17G BID x 3 days then once daily

Tylenol PRN

Push PO fluids

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Jan 22/2024 at 0059

WBC 17.2H (Elevated)

Sodium 130L( Below normal)

Neutrophils 15.8H (Elevated)

Lymphocytes 0.7L (Below Normal)

K+ 3.8 (Normal)

CRP 117.5 H (Elevated)

Jan 22/2024 at 1224

WBC 6.9 Normal

Neutrophils 5.1H (Improved)

CRP 78.1H (Improved)

Sodium 136 (Normal)

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No bruises or laceration

Drsg D&I to IV site to Rt hand

CWMS satisfactory to Rt hand

IV site slightly swollen due to minimal movement to Rt arm

P: Elevated Rt arm, and warm compress

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FLACC scale used to assess pain and discomfort

Verbal response "No pain"

Patient is not crying or holding onto her stomach

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Monitoring urinary output (hat in the washroom)

Mom provided ins/out flowsheet to record

Urine clear amber.

No reports of pain or burning sensation when voiding

Last voided 220ml clear amber urine

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Jan 22, 2024

All indicators normal except

Urine Ketones Moderate H (Elevated)

Urine Leukocyte 25 H (Elevated)

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Monitoring intake

Adequate hydration +nutrition to maintain fluid balance

No further N/V today

Intake remains poor

On Bowel care protocol

Encouraged mobility

Bowel sound present x 4 quadrants

Today intake 30% at all meals

Pt had Small formed BM today on day 4

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Abdo US - Normal

No signs of appendicitis

Abdo XR - indicates constipation. No obstruction.

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D5NS with 20KCL at 26cc/hour

Monitor ins/out every shift

Monitor IV site every shift

IV site to Rt arm slightly swollen

Today: IV fluid decreased to 13cc/hr

P: Elevate and warm compress to IV site

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CXR - Normal

Chest clear (No wheezes, No crackles)

Adequate air entry to lung bases

RR 22/min regular and symmetrical

O2 sat 99% RA

Cap Refill < 2 second

Sore Throat

Dry cough

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HR 74-131(HR elevated when pt had fever of 39.5)

Today: HR 92 regular and strong apical pulse

SBP 81-106, DBP 49-69 (Patient did had episode of low BP 81/49)

Today: BP 92/58 (Normal)

S1+S2 Normal

Skin color appropriate

CWMS satisfactory

Cap refill <2 seconds

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on D5NS with 20 KCL at half maintenance

Hypo Na resolved (Na130L to 136)

Intake improved to 30% at meals

Today - IVF decreased to 13cc/hr

P: Repeat CP7 tomorrow

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Pt is sleepy, but easy to arouse.

Responding well.

Sedation scale 0

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Monitor fever

Treat fever with PRN Tylenol

Dx: viral likely, unlikely bacterial

Encourage PO intake

Notify Pediatrician once PO intake improves to reassess IVF

Monitor BMs

Continue with Peg BID

Repeat CP7 tomorrow.

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24hrs vitals: 36.3 (1300), 38.0 H(1500) - 37.3 - 38.9H (2000), 36.9 (2300), 39.5 (0230) - 36.3 (0800hr)

Pt remains afebrile today

PRN Tylenol Effective

Cool compress to forehead as needed

(Bold readings are elevated)

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Influenza, Covid pending

Resp Viral spec pending, RSV pending

24hr Blood culture Negative

CMV, EBV pending

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School age

Erikson- Industry & Inferiority

Begins with losing teeth, coordination improves

Understands time

Becoming cooperative, and more social

Enjoys choices

Offered choice of juice with Tylenol Liquid