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Consider the scenario involving Vernon at the beginning of this chapter. He is an 18-month-old who has had vomiting and diarrhea for several days. The assessment of body weight los, skin turgor, and level of activity suggests moderate dehydration. Vernon refuses attempts at feeding him orally, his pulse becomes rapid, and his blood pressure decreases. Voiding is decreased and capillary refill is slow. Vernon is admitted to the short stay unit and an intravenous infusion is started.

 

1.       Based on his age, what oral fluids might be best to offer to Vernon? What questions will you ask his mother about his normal fluid intake at home?

2.       What additional assessment will you performon Vernon t gather further information about his state of dehydration?

3.        Since Vernon has had vomiting and diarrhea, he is proba bly deficient in an electrolyte present in high quantities in these body fluids. What electrolyte, in addition to sodium. Is llkely deficient?

4.       4 A major nursing role is to plan care for Vernon while he is E in the unit to rehydrate him. Calculate his replacement and maintenance fluid needs. Formulate a plan of care to include the amounts of oral rehydration therapy he should be offered over the next several hours. Use evidence- based findings to provide the rationale for your planned interventions.

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Richard and Helen are a married couple in their mid-thirties. They have two daughters – Anne, aged 14, and Clare, aged 6. They recently separated. Their relationship has deteriorated dramatically since Richard became unemployed and he now believes that Helen is having an affair with a woman. The children are currently living with Helen, but Richard wishes to care for them full time. Helen has petitioned for divorce and Richard has applied for a residence order. At the same time, Anne and Clare’s teachers have become concerned about both the girls’ behaviour. Anne’s schoolwork is deteriorating and she has been involved in bullying. Clare’s teacher is particularly concerned because she has noticed that Clare has become increasingly withdrawn whereas previously she was very lively. One day the teacher notices that Clare has bruises on her thighs, but she refuses to explain their cause. The teacher passes this information to social services. When the social worker contacts the parents, Helen claims that Richard must have caused the bruises when he took the girls out at the weekend. Richard denies the allegation. Anne has told the school nurse that her father smacks her and her sister but does not want the nurse to tell anybody about this. Consider how this case should progress.

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