Foundations of pediatric nursing when caring for clients with health alterations.

      Scenario You are working in a large urban pediatric clinic after-hours. A mother brings her 6-month-old daughter, Vivi Mitchell, to the clinic for rhinorrhea, congestion, fever, and cough. Upon assessment, you identify the child has wheezing upon auscultation and on inspection, you identify retractions. • The child is in less than 10th percentile of weight and has a cardiac history of Patent Ductus Arteriosus (PDA). • Born at 36 weeks gestation. • Mother states this child doesn’t go to day care but her two other children ages 2 and 3 do attend daycare. • T- 102.1 HR 140 RR 40 BP 83/58 Pulse ox 96% • A swab for respiratory syncytial virus (RSV) is positive. Doctor orders - Nasal bulb suction and saline drops PRN, Tylenol 15mg/kg Q4 PRN for fever, Albuterol nebulizer in office and push po fluids as tolerated. After the albuterol neb treatment, respirations are 36 and oxygen saturation is 100%. Wheezing has diminished. Mom is an ER nurse and the doctor feels comfortable that she has a nebulizer at home and can return to pediatric afterhours or ER if needed. Client is discharged with these orders: • methylprednisolone 0.4 mg/kg oral BID for 3 • Albuterol Q4 hours for 24 hours, then Q 6 hours for 24 hours, and Q6 as needed. • Call if needed prior to the Q4 dose. • Manage fever with Tylenol and continue hydration and nasal bulb suction Q6 while awake. • Return for re-evaluation in 3 days