Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th
Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition Case Study Ruptured Appendix_Student View Scenario: A 12-year-old female is admitted to the pediatric intensive care unit (PICU) postoperatively. The child had a ruptured appendix which required an open appendectomy. During the procedure, she became hypotensive and dopamine was required to maintain her systolic blood pressure. Her blood pressure continues to be low. Upon Admission to PICU: Weight: 45 kg Heart rate: 82 bpm Temperature: 100.9 °F Pulse oximetry: 99% on 1 L/min Respiratory rate: 16/min. Arterial blood pressure: 72/46 mmHg; MAP: 60 mmHg Intake/output: 2055 mL and 240 mL (1.33 mL/kg per hour) MAR: Dopamine 10 µg/kg per min, currently infusing 0.9% Normal Saline plus 5% Dextrose with 20 mEq/L KCL currently infusing at 85 mL/hour. Piperacillin/tazobactam 3 g IV every 6 hours Morphine 2.5 mg IV q4 PRN for pain Physical Assessment: General: alert, awake, and oriented × 3 Pain: reported as 8 out of 10 Respirator: clear upon auscultation Capillary refill: < 3 seconds Extremity pulses: +2 Abdomen: soft, tender to palpation. Incision dressing is dry and intact Labs: Glucose: 53 mg/dL Potassium: 3.8 mEq/L Sodium: 134 mEq/L Hemoglobin: 11 g/dL Hematocrit: 33% White blood cells: 22000/mm3 NGN Item Type: Extended Drag and Drop Indicate which nursing action listed in the far left column is appropriate for the potential postoperative complication. Note that not all nursing actions will be used. Nursing Action Potential Postoperative Complication Appropriate Nursing Action for Postoperative Complication 1. Administer antibiotic therapy as ordered. Deep vein thrombosis 2. Advance diet as tolerated. Bleeding or abscess 3. Administer antiemetics as ordered. Peritonitis 4. Initiate sequential compression devices (SCDs). Fluid/electrolyte imbalance 5. Administer intravenous (IV) fluids as ordered. 6. Monitor laboratory findings: Blood studies.
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