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I. BIOGRAPHICAL INFORMATION
Name : B/o Lavanya Sharma
Age : 1 month 2 days
Sex : Male
Addre : S/o Mr. Suresh Bhind
Re!"g"on : Hindu
IP No. :
Adm" "on #n"$ : Pediatric ICU
%a$e o& adm" "on : 11/01/10%a$e o& h" $ory $a'"ng : 13/01/10
In&orman$ : Mother
II. %IAGNOSIS : A(#$e Ga $ro )n$er"$" *"$h Modera$e %ehydra$"on
III PR)S)NT HISTOR+
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III PR)S)NT HISTOR+
H/o e"er since one day mild to moderate de(ree does not decrease #ith medication*associated #ith re usal o eeds and decreased acti"ity.
Had history o one e$isode o e cessi"e cry lastin( or one hour.
I-. PAST M)%ICAL HISTOR+
Pa $ "!!ne ho ,"$a!" a$"on :Has history o abdominal distention and reason isun no#n.
A!!erg"e : N"!
Med"(a$"on : NS
-. BIRTH HISTOR+
An$ena$a! : Premature ru$ture o membrane
Na$a! 0 P!a(e o& B"r$h : Hos$ital
Mode o& %e!"very : !SCS
Ge $a$"ona! Age : months 22 days
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+0 yrs 52 yrs 3 yrs 3- yrs
21 yrs 2 yrs
1 month
-II. GRO1TH AN% %)-)LOPM)NT
$$ro$riate to the a(e o 1 month.
-III. IMM2NI3ATION
Name o& $he a(("ne T"me Remar'
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7= Ho#r %"e$ Re(a!!:• Baby o !a"anya is in 4P) since last 25 hours.
• Baby recei"ed I7& Isolyte P 108 2 ml at the rate o 12 ml/hr.
• lso recei"ed ) 9"e $ac ed cells and re$laced by %!.
• t 2 am baby recei"ed &resh &ro:en Plasma 2+ ml.
%egree o& Ma!n#$r"$"on :
;e(ree o malnutrition < actual #ei(ht/e $ected #ei(ht = 100
< 3 ( /3.+ ( = 100
< +. 8
I ;e(ree malnutrition
I. SL))PING PATT)RN
Baby slee$ decreased due to dehydration.
PH+SICAL ) AMINATION
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Head C"r(#m&eren(e : 3 cms
Che $ C"r(#m&eren(e : 3+cms
=. S'"n And M#(# Mem>rane
Co!or : 4ormal bro#n
)dema : bsent
Mo" $#re : Mild drynessTem,era$#re : Increased
T#rgor : Im$aired. Has s in $inch (reater than 2 sec.
Any A>norma! %" (harge : 4il
6ually distributed and blac in color.
L"(e : bsent
8. Na"!Change "n A,,earan(e : 4il
Cyano " : 4o
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Symme$ry : Symmetrical
Movemen$ : 4ormal
. )ye
)x,re "on : ;ull
La(r"ma$"on : 4ormal
Con #n($"va : Clear S(!era : ?hite
Cornea : Moist and round
P#,"! : %eacti"e to li(ht
45. )arA,,earan(e : 4ormal and symmetrical
%" (harge : 4il
Le "on : 4il
Any A>norma!"$"e : 4il
44. No e
A earan(e : 4ormal
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4;. Ne('
Genera! A,,earan(e : 4ormal
Tra(hea : Centrally located
Lym,h Node : 4o enlar(ement
Thyro"d G!and : 4on tender* irm
Sa!"vary G!and : 4ot $al$able
4=. Che $ And Re ,"ra$ory Sy $em
In ,e($"on : Barrel chest
Pa!,a$"on : 4o s#ellin(
Per(# "on : ;ullA# (#!$a$"on : 4o abnormal sounds
4
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Tenderne : 4o tenderness
4@. Gen"$a!"a
4ormal male (enitalia
4 . )x$rem"$"e
%e&orm"$"e : 4oS*e!!"ng/ )dema : bsent
M# (!e : Stren(thenin(
Lym,h Node : 4o enlar(ement
o"n$ : 4ormal mo"ements
F"nger and Toe : 4o abnormalities
75. Cen$ra! Nervo# Sy $em
B"r$h In #r"e : 4il
Se" #re : bsent
Sen ory Mo$or Change : %es$ond to shout and $ain ul stimuliGa"$ Change : $$ro$riate to a(e
Cogn"$"ve Change : $$ro$riate to a(e
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B!eed"ng : 4)
1orm In&e $a$"on : 4o
7;. P y(ho o("a! H" $ory
Genera! S$a$# o& $he Fam"!y:
'he baby belon(s to a middle class amily* #hose ather is doin( business andmother is $rimary school teacher* #ith the income abo"e %s 10000/ month. 'hey areli"in( in their o#n house #ith $ro$er li(ht and "entilation.
Re!a$"on h", *"$h $he &r"end and &am"!y:
Baby is the irst born male and lo"ed A ta en care by amily members.
7=. La>ora$ory "nve $"ga$"on
S!.No.
Inve $"ga$"on Re #!$ Norma! va!#e Remar'
4.7.;.
B!ood $e $Gro#, and RhHemog!o>"nSod"#m
O D ve
.8E475 me /d!
999999947948gm/d!4;
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M)%ICATIONS
Med"(a$"on name %o age Fre #en(y Ro#$e A($"on S"de e&&e($ N#r "ng re ,on ">"!"$"e1. I7& Isolyte P
2. In . Ce tra one
3. In mi acin
5. In . Metro(yl
+. In . denosine
-. In . 7it
. &&P. Pac ed Cell
trans usion. In . %antac
12ml/hr
1+0m(
2+m(
1+m(
1 m(
30 ml
-0 ml
3 m(
>"eryhourly
Bd
Bd
'id
'id
,,,,
,,,,,
Bd
I7
I7
I7
I7
I7
I7
I7
I7
I7
%e$lacement o luidelectrolytes
ntibiotic
ntibiotic
ntimicrobial
Coa(ulant
%e$lacement
%e$lacement
ntacid
&luid o"erload 4ausea and "omitin(
S#ellin(* redness* $ain*or soreness* loss oa$$etite* nausea*"omitin(* diarrhea*#ea ness
;i::iness* headache*diarrhea* nausea*
stomach $ain*ller(ic reactionD
Itchin( or hi"es*s#ellin( in your ace orhands* s#ellin( ortin(lin( in mouth orthroat* chest ti(htness .
Pain* s#ellin( and
tenderness at the site.ller(ic reactions*
4ausea* "omitin(
Calculate the luid re6uirementand administer at re6uired rate.&ollo# the sa ety $rinci$les odru( administration.Maintain ase$tic $recautionsdurin( dru( administration.
dminister the I7 in ections asslo#ly as $rescribed.Continuous monitorin( o "italsi(ns.
)bser"e the baby continuously orside e ects o dru(s.Ins$ect the site o in ectionre(ularly.
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AC2T) GASTRO)NT)RITIS 1ITH %)H+%RATION
INTRO%2CTION
In de"elo$in( countries o the #orld* in ectious diarrhea ills about 5 million $eo$le $er year. In the United States* it is estimated that children youn(er than + years o a(e e $eriencemore than 20 million e$isodes o diarrheal diseases each year* #ith about 500 deaths $er year attributed to such e$isodes. ;ehydration is the most im$ortant actor or the morbidity andmortality associated #ith diarrheal disease in India also. ;ehydration is lar(ely controllable byusin( rehydration thera$y E@uerrant A Steiner* 2000F.
%)FINITION OF GASTRO)NT)RITIS
n in ection or irritation o the stomach and intestines* caused by bacteria or $arasitesrom s$oiled ood or unclean #ater
short $ain ul illness a ectin( your stomach and intestines that is caused by bacteria inood or a "irus and that ma es you (o to the toilet re6uently
%"arrhea: &re6uent* loose* and #atery bo#el mo"ements. Common causes include(astrointestinal in ections* irritable bo#el syndrome* medicines* and malabsor$tion.
CA2S)S OF GASTRO)NT)RITISIn many cases* the cause o diarrhea cannot be ound. 'he ma or in ection causin( a(ents are
• Bacteria
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RIS FACTORS
• >atin( ood that irritates the stomach linin(
• &ood intolerances. Some $eo$le are unable to di(est a com$onent o ood* such aslactose* the su(ar ound in mil .
• >motional u$sets such as an(er* ear* or stress.
•
%eaction to medicines* such as antibiotics* blood $ressure medications* and antacidscontainin( ma(nesium.
• Intestinal diseases* li e in lammatory bo#el disease or celiac disease.
• &unctional bo#el disorders* such as irritable bo#el syndrome* in #hich the intestines donot #or normally.
• Some $eo$le de"elo$ diarrhea a ter stomach sur(ery or remo"al o the (allbladder.
• 'he reason may be a chan(e in ho# 6uic ly ood mo"es throu(h the di(esti"e systema ter stomach sur(ery or an increase in bile in the colon that can occur a ter (allbladder sur(ery.
s lon( as diarrhea (oes a#ay on its o#n* an e tensi"e search or the cause is not usuallynecessary.
SIGNS AN% S+MPTOMS OF GASTRO)NT)RITIS
B ' "($# P $" $ "($#
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disease.
;e$endin( on the cause* a $erson may ha"e bloody stools.
4o im$ro"ement e"en a ter 25 hours.
%"arrhea "n "n&an$
;iarrhea can be dan(erous in ne#borns and in ants. In
small children* se"ere diarrhea lastin( ust a day or t#ocan lead to dehydration. Because a child can die rom
dehydration #ithin a e# days.
Si(ns o dehydration in children includeD
• ;ry mouth and ton(ue.
•
4o tears #hen cryin(.• 4o #et dia$ers or 3 hours or more.
• Sun en abdomen* eyes* or chee s.
• Hi(h e"er.
• !istlessness or irritability.
• S in that does not latten #hen $inched and released.
Se"ere dehydration may re6uire hos$itali:ation.
)ne e$isode o bloody stool.
4o im$ro"ement.
Moderate ;ehydration $resent
;ry Mouth and !i$s.
4o tears #hen cryin(
4o #et dia$ers since 3,5 hour
Sun en eyes
Hi(h e"er 102 o&
Poor tur(or
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causin( the diarrhea.
Si(moidosco$y and Colonosco$y. ,,,,,,COMPLICATIONS
;ehydration.
>lectrolyte disturbances.
Hy$er or hy$onatremia* hy$o alemia* metabolic acidosis.
'ransient* due to "illous dama(e.
TR)ATM)NT
A e men$ o& dehydra$"on
M"!d dehydra$"on ;0
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G#"de!"ne &or F!#"d Managemen$ o& %ehydra$"on Re $ore "n$rava (#!ar vo!#me
4ormal salineD 20ml/ ( o"er 20min E%e$eat until intra"ascular "olumerestoredF.
Ca!(#!a$e 7=9hr *a$er need
Calculate maintenance #ater Calculate de icit #ater < Percent dehydration #ei(ht
Ca!(#!a$e 7=9hr e!e($ro!y$e needCalculate maintenance sodium and $otassiumCalculate de icit sodium and $otassium
Sodium de icit < #ater de icit 0 me6/lPotassium de icit < ?ater de icit 30 me6/l
Se!e($ an a,,ro,r"a$e &!#"d >a ed on $o$a! *a$er and e!e($ro!y$e needdminister hal the calculated luid durin( the irst hr* irst subtractin( any
boluses rom this amountdminister the remainder o"er the ne t 1- hr
Re,!a(e ongo"ng !o e a $hey o((#r
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@i"e boluses o 10,20ml/ ( o normal E0. 8F saline* #hich may be re$eated.;o not include this luid "olume in any subse6uent calculations.
Children #ith se"ere dehydration re6uire maintenance luids. 'hey may also need e trato re$lace luid de icit due to dehydration* and $ossibly more luid to re$lace abnormal on(oin(losses Ee( rom drain sitesF.
Ma"n$enan(e• !ess i in a basal state Eie "ery inacti"e lyin( in bedF. ,2+8
• !ess in children on mechanical "entilation #ith humidi ied (ases. ,2+8
• More in children #ith e"er. 910 to 208
• !ess in children #ith e cessi"e secretion o ntidiuretic Hormone E ;HFe( $neumonia*
menin(itis 7aries E,20 to 508F• More i unable to concentrate urine Ee( some renal diseases* ;iabetes insi$idusF 7aries
Ch"!dren *"$h modera$e $o m"!d dehydra$"on
F!#"d need
?ell children #ith normal hydration but no oral inta e re6uire an amount o luid that iso ten termed KmaintenanceK.
M i t l id i th t " l d il l id i t #hi h $l th i ibl l
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'he ollo#in( table may be used to estimate maintenance luid re6uirements.
1$ 'g = 8 @ 45 47 4= 48 75 ;5 =5
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N2RSING %IAGNOSIS D
;ehydration related to e cessi"e loss o luid.
Hy$erthermia related to in ectious $rocess.
;isturbed bo#el elimination $attern related to (astrointestinal in ection.
Im$aired $arental bondin( related to isolation o baby.Parental an iety related to childLs condition and its $ro(nosis.
%is or im$aired s in inte(rity related to dry and scaly s in.
Hi(h ris or urther in ection related to immature immune mechanism.
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N2RSING CAR) PLAN
ASS)SS
M)NT
N2RSING
%IAGNOSIS
PLANNING IMPL)M)N
TATION
)-AL2A
TION
OB )CTI-)
INT)R-)NTIONS
O> e($"veda$aPoor s intur(or.Increased
$ulse 1-2 bts/min.
;ecreasedelectrolytele"eli.e.sodium120me6/dl
$otassium3.1 me6/dl
;ehydration relatedto loss o
luid.
Baby#illachie"eandmaintainnormalhydration
status.
ssess thehydration status andde(ree o dehydration.
Calculatethe total #ater andelectrolyte loss in the
baby.
Monitor blood electrolyte le"el.
%estrict theenteral eedin(.
dministernormal saline as a
bolus to meet theimmediate luid andelectrolyte need o the
baby.dminister
the I7 luids tomaintain the normalhydration status.
ssessed thatchild has moderatedehydration .
Baby had -,108 o #ater loss.
Baby iselectrolyte le"el is lo#.
%estrictedenteral eedin(
dministered-0 ml o 4S in 20
minutes.
dministeredI7& Isolyte P 108 at therate o 12ml/hr.
Babyachie"ednormalhydrationstatus ase"idenced
by
im$ro"eds intur(or andnormalelectrolytele"el.Sodium133me6/dlPotassium
+.1me6/dl
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ASS)SSM)NT
N2RSIN
G%IAGN
OSIS
PLANNING
IMPL)M)NTATION
)-AL2ATION
OB )CTI-)
INT)R-)NTIONS
O> e($"veda$aIncreased
bodytem$erature.'em$102 o &
Hy$erthermiarelated toin ectious
$rocess.
Baby #illachie"enormal
bodytem$erature.
ssess the"ital si(ns.
Set the lo#
tem$eratur e in theradiant#armer.
Maintain $ro$er"entilation.
Maintainthehydrationstatus.
Pro"idecoldcom$ress.
ssessed that'em$,102 &
%adiant#armer is set
to thetem$eratureo o &
Maintainedthe normalroomtem$erature.
Maintainednormalhydrationstatus.
,,,,,
dministered
Babytem$erature reducedto .- o &.
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dminister anti,$yreticandantibioticsas
$rescribed.
In . Ce tra one
dministered.
ASS)SSM)
NT
N2RSIN
G
%IAGN
OSIS
PLANNING
IMPL)M)N
TATION
)-AL2A
TION OB )CTI
-)
INT)R-)N
TIONS
O> e($"ve
da$a
Baby is
admitted in 4ICU and
se$arated
rom the
mother.
lso
Im$aired
$arental
bondin(
related toisolation
o the
baby
Mother
#ill
achie"e
$ro$er bondin(
#ith the
baby.
ssess the
bondin(
le"el o
mother and baby.
llo# the
mother to see
'he baby is
one month
old* so it is
the im$ortant $eriod in
de"elo$in(
the bondin(
#ith the
mother.
Mother
understoo
d the
conditiono the
baby and
need o
maternal
bondin(.
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restricted the
breast
eedin(.
the baby as
re6uently as
$ossible.
> $lain themother about
the
im$ortance
o bondin(
bet#een
them.
> $lain the
mother
re(ardin( the
need or
isolation in
the $resent
condition o
the baby.
> $lain the
reason or
restrictin(
the breast
Mother sa#
the baby once
in 2,3 hours.
>ducated the
mother
re(ardin( the
im$ortance o
maternal
bondin(.
> $lained
mother
re(ardin( the
need or
isolation.
> $lained thereason behind
restriction o
breast
eedin(.
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eedin(.
ASS)SSM)
NT
N2RSIN
G
%IAGN
OSIS
PLANNING
IMPL)M)N
TATION
)-AL2A
TION OB )CTI
-)
INT)R-)N
TIONS
S#> e($"ve
da$a
Mother
as ed6uestions
re(ardin(
the
condition
and
$ro(nosis o
the baby.
O> e($"ve
da$a:
Mother
loo s dull*
Parental
an iety
related to
babyLscondition
and
$ro(nosis
.
Parents #ill
be ree
rom
an iety.
ssess the
an iety le"el o the
$arents.
> $lain indetail about the babyLs
condition and
treatment.
%eassure the
$arents by introducin(
$arents o babies #ith
same condition* #ho
are re(ained health.
> $lain the
need or se$aration o
the baby rom $arents.
;escribe
ssessed that*
they are an ious.
> $lained
re(ardin( the need orhos$itali:ation and
treatment.
%eassured the
$arents by introducin(
same diseased babies
#ho are re(ained health.
> $lained
about the need o
se$aration o the baby
rom $arents.
;escribed
Parents are
ree rom an iety as
e"idenced by (ood
interaction o $arents #ith other
$eo$le and
im$ro"ed acial
e $ression.
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sad and
#orried.
about the treatment and
ollo# u$ care.
Pro"ide
$sycholo(ical su$$ortto the $arents
about the treatment and
ollo# u$ care in detail.
Pro"ided
$sycholo(ical su$$ort tothe $arents.
ASS)SSM)
NT
N2RSIN
G
%IAGN
OSIS
PLANNING
IMPL)M)N
TATION
)-AL2A
TION OB )CTI
-)
INT)R-)N
TIONS
O> e($"ve
da$a:
S in is dry
and scaly.
Baby had +,-
e$isodes o
%is or
im$aired
s in
inte(rity
related to
dry and
Baby #ill
achie"e
and
maintain
(ood s in
te ture and
%eassess the
s in
condition.
Chec or the
s in tur(or
and te ture.
S in is dry
and scaly.
Baby has $oor
tur(or.
BabyLs
s in
te ture
and tur(or
im$ro"ed
to
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diarrhea scaly
s in.
tur(or. "oid
en"ironment
al irritants.
$$ly(lycerin or
s in.
dminister
$rescribed
dru(s
$$lied
(lycerin to
maintain s in
moistness.
dministered
I7& to
maintain
hydration o
the s in.
si(ni icant
le"el.
ASS)SSM)NT
N2RSING
%IAGNOSIS
PLANNING IMPL)M)N
TATION
)-AL2ATION
OB )CTI-)
INT)R-)NTIONS
O> e($"ve
da$a
Baby is one
month old
and e$t in
I7 line to
maintain
Hi(h ris
or
nosocomi
al
in ection
related to
immature
Baby #ill
be ree
rom
$otential
in ections.
ssess or
any in ection
a ter the
disease
occurrences.
ssess the
immuni:atio
Baby is ree
rom
ha:ardous
in ection.
Baby recei"ed
)P7 and
Baby is
$re"ented
rom
nosocomi
al
in ections
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hydration
le"el .
immune
mechanis
m.
n status o
the baby.
Maintain the
ase$tic $recautions
durin(
administratio
n o
medication
and other
$rocedures.
ee$ the
child clean
and hy(iene.
%estrict the
"isitors.
>ducate the
$arents
re(ardin( the
im$ortance
o
BC@ "accines
at birth.
Maintained
the ase$tic $recautions
durin(
administration
o medication
and other
$rocedures.
Maintained
the hy(iene o
the baby.
%estricted all
the "isitors
>ducated the
$arentsre(ardin( the
im$ortance o
immuni:ation
o the baby in
$re"entin( the
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immuni:atio
n o the baby
in $re"entin(
thein ections.
in ections.