Clinical reasoning paper: A pediatric clinical problem This is a clinical reasoning paper of a pediatric case that involves an analysis that includes the nursing, path physiology, pharmacology, primary health, and psychosocial science. The case under discussion is of Ellen Shields two years old born of Australian parents at normal gestational age. Ellen is admitted to the Accident and Emergency (A& E) Department of a small country hospital. As per Mrs. Shields, Ellen usually has a good appetite but has experienced intermittent bouts of diarrhea since commencing solid food. These bouts generally last for 24 hours and resolve themselves.
Ellen’s usual weight is 9.8 kg and height 86 cm. in this particular case Ellen developed diarrhea two days previously, which did not resolve as earlier. The next day Mrs. Shields visited the chemist who advised her to give Ellen, whose weight was then 9 kg, oral rehydrating solution (ORS) 80 mls per hours over four hours and to stop solid food for 24 hours. Ellen had drunk only around 30 mls per hour over the four hours as she seemed to dislike the taste and ultimately showed minimal improvement.
Then as per her neighbors suggestion gave Ellen flat lemonade at around 60 mls per hour. Ellen drank this willing but neither her diarrhea (which increased) nor her condition improved. By 10.00 on the day Mrs. Shields felt that Ellen was sicker and although wanted to sleep most of the time was did wake during her frequent nappy changes for loose smelly stools. On admission her parameters were T 388 P 140 Resp 36 weight 8 kg. Medical officer ordered by phone: Oral Panadol for pyrexia, tepid sponge PRN, 100 ml/kg of ORS to be administered over four hours with an additional 10 mls per kilogram for each additional stool.
The RN administered the Panadol and commences a tepid sponge. MO indicated that Ellen’s condition was to be reviewed hourly throughout these four hours. The MO also stated that Ellen was to be discharged if her condition improved with instructions to inform mother of the maintenance fluid requirement, continue a normal diet and to see MO in 24 hours or to contact either the hospital or the clinic if she was worried about Ellen. Assessment criteria to be carried out and its importance in Ellen’s management: Literature’s view: Diarrhea is a condition of frequent passing of loose or watery or unformed stools.
It can be said as one of nature’s way to throw off the unwanted things out of the system. Roughly on a estimate passage of three of or four stools a day. Diarrhea is estimated to be one of the most common diseases in infants and young children. Acute diarrhea is one that exists less than two week and chronic is the one that exist more than two week.
It may be mainly due to malnutrition, unhygienic condition and poor health. In many countries it is the leading cause of death. (Bhakru, 2000)The diarrhea is of two types, simple, that may be accompanied by gripping pain in stomach and vomiting. This may be due to any reason as colitis or intolerance or any type of gut disorder. This most of the times revert back by itself. Infective diarrhea on other hand is the most common form of diarrhea occurring in kids.
This may be due to any organism as bacteria, virus and other pathogens. This type of infection is mainly due to food or water contamination. The infectious diarrhea is of two types, first form with a slow onset with gradual and loosened bowel with five to ten times of motion a day. Thin traces of mucus may occur in with fever. It may run an mild course or may eventually turn out to a inflammatory condition. The second form on other hand is of sudden onset with marked vomiting, fever, with large green mucous stools that may contain blood.