NU581 Pediatric Case Study

NU581 Pediatric Case Study

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Purdue University Global

NU581 FNP II Clinical – Children and Adolescent Health Focus

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NU581 Pediatric Case Study

Pediatric dehydration in a 12-month-old can quickly become a medical emergency, especially when it is accompanied by persistent vomiting, reduced urine output, lethargy, and significant weight loss. In this case, Alison demonstrates several classic signs of moderate to severe dehydration, including dry mucous membranes, absence of tears, a dry diaper for several hours, elevated heart rate, and decreased activity. Prompt assessment, fluid replacement, and identification of underlying causes such as infection are essential to prevent complications and ensure recovery.

Case Overview: Pediatric Dehydration in a 12-Month-Old

Alison, a 12-month-old child, presented with a 12-hour history of persistent vomiting and an inability to tolerate oral intake. By the time of evaluation, she appeared lethargic, had dry lips and skin, was not producing tears while crying, and had not urinated since early morning. These symptoms immediately raised concerns for dehydration and possible infection.

Additional findings included fever, tachycardia, respiratory distress, and notable weight loss compared to her weight recorded two weeks earlier. Subsequent diagnostic testing revealed pneumonia, metabolic abnormalities, and evidence of dehydration.

Primary Nursing Concerns

The nurse’s initial assessment identified several urgent concerns that indicated worsening dehydration:

• No urine output since 7:00 AM (suggesting decreased renal perfusion)

• Absence of tears when crying

• Dry lips and dry skin

• Lethargy and reduced responsiveness

Together, these findings suggest moderate to severe dehydration requiring immediate intervention.

Initial Vital Signs and Clinical Assessment

Alison’s initial assessment findings included:

• Temperature: 101°F

• Apical heart rate: 150 beats per minute

• Respiratory rate: 40 breaths per minute

• Blood pressure: 90/48 mmHg

• Current weight: 21 lbs 6 oz (9.5 kg)

• Weight at 12-month visit (2 weeks earlier): 24 lbs 2 oz

The documented weight loss of approximately 2.75 pounds in a toddler is clinically significant and supports the diagnosis of dehydration.

Three Key Nursing Assessment Concerns

Based on the vital signs and examination findings, the nurse should prioritize assessment of:

Fever

An elevated temperature may indicate an underlying infectious process contributing to vomiting and dehydration.

Tachycardia

Alison’s heart rate is elevated for her age and may be a compensatory response to fluid loss and fever.

Significant Weight Loss

Rapid weight loss in pediatric patients is one of the most reliable indicators of acute dehydration.

Questions the Nurse Should Ask the Parent

A thorough history is necessary to guide treatment decisions. Important questions include:

• When did the vomiting begin, and how frequently has it occurred?

• Has Alison consumed any food or fluids during the past 24 hours?

• Has she received any medications at home?

• Does she have any known medication or food allergies?

• Has she experienced diarrhea, coughing, ear pain, or exposure to sick contacts?

These questions help determine the severity of illness and identify potential underlying causes.

Priority Nursing Interventions

Given Alison’s condition, immediate nursing interventions should include:

• Initiating intravenous (IV) fluid therapy to correct dehydration.

• Admitting the patient for close monitoring and observation.

• Administering prescribed medications for nausea, fever, and infection.

Additional interventions include monitoring intake and output, obtaining laboratory specimens, and reassessing vital signs regularly.

Comprehensive Physical Assessment Findings

Further examination revealed several significant findings:

Respiratory Findings

• Chest congestion

• Bilateral coarse breath sounds

• Slight expiratory wheeze

• Dry cough

• Nasal congestion

Ear Examination

The left tympanic membrane appeared:

• Bulging

• Erythematous

• Tender upon palpation

These findings are consistent with acute otitis media.

Diagnostic Procedures Performed

The healthcare team completed the following:

• Urinary catheterization

• Peripheral IV insertion

• Complete blood count (CBC)

• Comprehensive metabolic panel (CMP)

• Blood cultures

• Erythrocyte sedimentation rate (ESR)

• Urinalysis and urine culture

• Lumbar puncture using aseptic technique

• Chest X-ray

Acetaminophen Order Evaluation

Following fluid resuscitation, the physician ordered:

Acetaminophen 650 mg every 4 hours as needed for pain or fever.

Is This Order Appropriate?

No. The order is inappropriate for a 12-month-old child weighing approximately 9.5 kg.

Pediatric acetaminophen dosing is typically:

• 10–15 mg/kg per dose every 4–6 hours

• Maximum daily dose: 75 mg/kg/day

For Alison:

• Appropriate dose range: 95–142.5 mg per dose

A 650 mg dose significantly exceeds recommended pediatric dosing guidelines and places the child at risk for acetaminophen toxicity and liver injury. The nurse has a professional responsibility to question unsafe medication orders before administration.

Nursing Responsibilities During Medication Administration

Nurses are responsible for ensuring safe medication administration through adherence to established standards.

The Rights of Medication Administration

• Right patient

• Right medication

• Right dose

• Right route

• Right time

Additional responsibilities include:

• Reviewing allergies.

• Understanding indications and contraindications.

• Monitoring for side effects and adverse reactions.

• Documenting administration accurately.

• Evaluating patient response to treatment.

Developmental Concerns Identified

After treatment, Alison’s fever improved, and she produced a wet diaper. However, her mother reported that Alison:

• Refused to hold her bottle independently.

• Would not stand without assistance.

Why Is This Concerning?

By 12 months of age, many children can:

• Hold and manipulate a bottle or cup.

• Pull to stand independently.

• Cruise along furniture.

• Begin taking independent steps.

Failure to achieve these milestones may indicate developmental delay or underlying neurologic, musculoskeletal, or environmental concerns. These findings warrant further developmental screening and pediatric follow-up.

Laboratory Findings

Alison’s laboratory results included:

Concerning Laboratory Values

Elevated Creatinine

A creatinine level of 5 mg/dL is critically elevated in a pediatric patient and may indicate acute kidney injury or severe dehydration.

Low Carbon Dioxide (CO₂)

A CO₂ level of 15 mEq/L suggests metabolic acidosis, which commonly occurs in children experiencing prolonged vomiting, dehydration, and ketosis.

Additionally, the presence of large ketones in the urine supports poor oral intake and increased fat metabolism.

Final Diagnosis and Hospital Admission

Following stabilization and additional testing, Alison’s chest X-ray demonstrated left lower lobe pneumonia. Given her dehydration, fever, and respiratory findings, the physician admitted her for:

• Observation

• Intravenous fluid therapy

• Antibiotic treatment

• Ongoing respiratory monitoring

• Repeat laboratory testing

SBAR Handoff Communication Example

Effective handoff communication promotes patient safety and continuity of care.

Situation

Alison is a 12-month-old female admitted with dehydration, fever, lethargy, and newly diagnosed left lower lobe pneumonia. Her current temperature is 99.2°F following treatment.

Background

The patient experienced persistent vomiting for approximately 12 hours and was unable to tolerate oral intake. Her mother reported no urine output since 7:00 AM and progressive lethargy at home.

Assessment

The patient is currently stable following IV fluid administration. She has produced urine, her fever has improved, and diagnostic imaging confirmed pneumonia. Laboratory findings indicate dehydration with metabolic abnormalities.

Recommendation

• Continue IV fluid therapy.

• Monitor intake and output closely.

• Administer prescribed antibiotics and antipyretics.

• Perform ongoing respiratory assessments.

• Monitor laboratory values and vital signs.

• Encourage oral fluids as tolerated.

• Conduct developmental follow-up after discharge.

Key Takeaways

Pediatric dehydration can progress rapidly, particularly in infants and toddlers. Alison’s presentation highlights the importance of early recognition of dehydration symptoms, comprehensive nursing assessment, safe medication practices, and prompt intervention. Healthcare professionals must remain vigilant for underlying infections and developmental concerns while ensuring effective communication during transitions of care.

References

American Academy of Pediatrics. (2024). Dehydration. HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/dehydration.aspx

Hockenberry, M. J., & Wilson, D. (2023). Wong’s nursing care of infants and children (13th ed.). Elsevier.

Kliegman, R. M., St. Geme, J. W., Blum, N. J., Shah, S. S., & Tasker, R. C. (2024). Nelson textbook of pediatrics (22nd ed.). Elsevier.

NU581 Pediatric Case Study

MedlinePlus. (2025). Dehydration in children. U.S. National Library of Medicine. https://medlineplus.gov/dehydration.html

World Health Organization. (2024). Pocket book of hospital care for children: Guidelines for the management of common childhood illnesses (3rd ed.). https://www.who.int/publications/i/item/9789241548373