Question

Jordan is 9-year-old boy who is a direct admit for observation. He has a history of vomiting and diarrhea for 48 hours.
Subjective data:
nausea and vomiting for 24 hours
has not voided today
unable to tolerate oral fluids
Objective data:
vital signs: T 37.8, P 120, R 24, B/P 110/60
weight 34 kg
hyperactive bowel sounds all 4 quads

1. are is vital signs normal for his age ? What is abnormal
2. what would be a maintance IV rate for his weight?
3. What is the best way to approach Jordan regarding the IV that has been ordered?
4. What would be a good distraction for a child of Jordan's age?

Answer 1

From the above scenario,

Jordan is suffering from severe dehydration( >10%), as evidenced by oliguria for more than 12hrs, fever of 37.8⁰C, mild tachycardia and not able to tolerate oral fluids. This is due to diarrhoea and vomiting. Thats why he has hyperactive bowel sounds which is happening due to increased intestinal activities(due to diarrhoea or after eating and can be heard without a stethoscope).

• His vital signs including respiratory rate and blood pressure seems to be normal at this age whereas, temperature is very high and heart rate is slightly elevated.
• As he is not able to tolerate oral fluids, it is very essential to start IV fluids. First need to give bolus fluid of normal saline 20ml/kg followed by maintenance fuids( contains electrolytes due to risk of electrolyte imbalance in dehydration).
• Maintenance fluid calculation

1. If patient weight is <10kg, he should receive 100ml/kg/day fluids.
2. If patient weight is 10-20kg, he should receive 1000ml/day for first 10kg + 50ml/kg/day for each kg between 10-20kg.
3. If patient weight is >20kg, 1500ml/day for first 20kg + 20ml/kg/day for each kg over 20kg.

So, here patient weight =34kg

Therefore,

fluid requirement= 1500ml/day + 20ml/kg/day for remaining kg over 20kg

ie, =1500ml/day + (20*14)/day {14kg is the remaining weight over 20kg, 34-20=14kg}

=1500ml/day +280ml/day

=1780ml/day

=74.166ml/hr

• The best way to approach Jordan is to be reassure him.

1. Be honest.
2. Don't say lie to the children at this age like it won't hurts, because it does. Although the truth may cause some worry for children, even though lying causes mistrust between children and us. So better response is "it may hurt, but I will be here with you and if it hurts,the pain will last only a little while.
3. Also assure him that this will help you to leave from the hospital as soon as possible and you can play very quickly.

• The good distraction for children at Jordan's age is:

1. Let him blow bubbles
2. sing or count
3. Can play games on the computer or ipads.