A 3¾-year-old boy was admitted to the

A 3¾-year-old boy was admitted to the Children’s Hospital via the emergency room (ER) for management of a severe infection of the left side of his face and possible sepsis. The history of this illness began 24 hours earlier when he was struck in the area of his left eyebrow by a door knob when the door was suddenly opened with the patient on the other side. He was taken to a local emergency room where six sutures were used to repair the laceration. However, the next morning, he woke up with fever and marked painful swelling of the area about the injury. He was taken back to the ER for evaluation and was treated with oral trimethoprim/sulfamethoxazole (TMP/SMX). However, his condition worsened through the day and he came to the ER, where his vital signs revealed a fever of 104.2° F, with tachycardia (pulse = 180) and tachypnea (respirations = 48). His past medical history was remarkable for having a sore throat with a positive strep screen a couple of weeks earlier that was treated with amoxicillin. His immunizations are up to date. His family history is normal and he has a family dog, which occasionally licks his face. Examination on admission revealed the patient to be alert and oriented, with marked swelling of the left side of his face. No other associated injuries were noted, and the rest of his examination was normal. A computed tomogram (CT) of his face revealed the swelling of the soft tissue and some fluid (. Lab tests included an elevated white blood cell count at 17,900. Blood cultures were obtained and he was given a saline bolus and a dose of intravenous ceftriaxone and vancomycin in the ER before sending him to the pediatric intensive care unit, where the lesion was drained and cultured. The pus never grew an organism. Vancomycin and ceftriaxone was continued for the first few days, and then changed to clindamycin for the duration of 10 days of treatment. Again, cultures remained negative. 1: Recognize Cues (recognize signs and symptoms, abnormal vital signs) 2: Analyze Cues (Describe the relationship between cues and body system affected; what information is important?) 3: Prioritize Hypotheses (Use evidence to determine client issues/problems; Prioritize client issues/problems) 4; Generate Solutions (Plan nursing care based on priority hypotheses, what can the nurse do?) 5 :Take Action (Prioritize nursing care-prioritize the solutions) 6: Evaluate Outcomes (Evaluate nursing care, what signs and symptoms would show client is improving? What signs or symptoms would show the client was declining?

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