Case Scenario 2: Mr. Jones has brought in his 3-year-old daughter Clara to be seen for vomiting and diarrhea for 2 days. He states that last night she vomited 3 times. She weighs 15kg. This morning she vomited her breakfast of pancakes and sausage.
- What more does the APRN need to know about Clara’s symptoms?
- What should the APRN look for in the physical examination?
- What are the signs and symptoms of dehydration?
- What are 3 differentials the APRN should consider?
- What is the calculation for pediatric volume replacement?
- What type of anticipatory guidance should the APRN give Clara’s father?
Based of the symptoms presented by Clara, it is possible she is experiencing gastroenteritis. As an APRN further questions, including what food she last ate prior to onset of vomiting and diarrhea? How many episodes of vomiting or diarrhea have occurred in the past 24 hours? Can parent explain the content in the vomit? Was there a presence of blood or mucus in the stool? Is anyone sick at home with similar signs or symptoms? Is Clara potty trained? If not, how many wet diapers has she had in the past 24 hours? If so, has there been a change in her urine output? How has her sleep pattern been the past couple of days? Any fever in the past 24 hours? Any recent travels? Has parent noticed any unusual rash? What is Clara’s medical and surgical history? What medications has parent given Clara so far and has it helped? What is her current medication and vaccination status?
Assessments include assessing Clara’s mucous membrane skin turgor, cap refill, and signs of sunken eyes for signs of dehydration. Assess abdominal area by inspecting possible distention, auscultating bowel sounds, palpating all four quadrants to assess tenderness. Signs and symptoms of dehydration are dry mouth and lips, no tears when crying, eyes appear sunken, no wet diapers, appear irritable and cranky, appear fatigue and lethargic, etc. (Children hospital of Chicago, 2023). The three differentials to consider are food poisoning, intussusception, and appendicitis. Pediatric volume replacement calculation entails the 4-2-1 rule; up to 10kg : 4ml/kg, 10-20kg: 2ml/kg, >20kg: 1ml/kg. Clara weighs 15kg, based of the calculation she will have about 50ml/hr intake (Georgopoulos & Novak, 2023). Anticipatory guidance includes hydration; encourage parents to administer or give patient as much fluids as possible such as Pedialyte to avoid severe dehydration, avoid carbonated drinks and fatty foods, promote effective hand hygiene at home, disinfect all surfaces, seek immediate medical care if patient is unable to keep fluid down with more obvious signs of dehydration, blood in stool and persistent fever (>102f).
References
Georgopoulos, G., & Novak, C. (2022). Dehydration & fluid replacement March, 2022. https://www.pedscases.com/sites/default/files/2.%20Dehydration_PedsCase_v9.pdfLinks to an external site.
Leung, A. (2025). Viral gastroenteritis in children. Viral gastroenteritis in children – Symptoms, Causes, Images, and Treatment Options. https://www.epocrates.com/online/diseases/794/viral-gastroenteritis-in-children#highlights-basicsLinks to an external site.
Dehydration in kids: Signs & treatment | Lurie children’s. (2023). https://www.luriechildrens.org/en/blog/dehydration-in-children/Links to an external site.
Maaks, D.L. G., Starr, N., & Gaylord, N. (2019). Burns’ Pediatric Primary Care (7th ed.). Elsevier – Evolve. https://online.vitalsource.com/books/9780323581967Links to an external site.