Question

Case Study # 1

Jordan is a 9-year-old boy who is a direct admit for observation. He has had a history of vomiting and diarrhea for 48 hours.

Subjective Data

Has a history of nausea and vomiting for 24 hours.

Has not voided today.

Is unable to tolerate oral fluids.

Objective Data

Vital signs: temp, 37.8º C; pulse, 120 bpm; resp, 24 breaths/min; blood pressure, 110/60 mm Hg

Weight: 34 kg

Hyperactive bowel sounds to auscultation

Questions:

1. When should the discharge teaching begin for Jordan and his family?
2. What is the best way to approach Jordan regarding the intravenous (IV) line that has been ordered?
3. What would be good distractions for a child of Jordan’s age?

Case Study #2

Susan is a 4-year-old girl with a 7-day history of fever and lethargy. Susan’s physician has ordered laboratory work that includes a blood culture.

Subjective Data

Susan has had fever for 1 week.

Her mother has noticed a decreased activity level.

Susan states she is “afraid” of needles.

Objective Data

Weight: 26.1 kg

Vital signs: temp, 39.3º C; pulse, 110 bpm; resp, 40 breaths/min; blood pressure, 108/54 mm Hg; oxygen saturation (O₂ sat) 100%

No abnormal findings on physical examination

Questions:

1. When should Susan’s nurse explain the procedure to her?
2. To give Susan some control over this situation, what choices could be given to her?
3. What actions should the nurse take in this clinical situation? Prioritize the actions.

Discussion Topic: What is the Perez reflex? Why is it important to know how to elicit it? Discuss the use of the Perez reflex in collecting urine specimens from infants.

Answer 1

Perez Reflex

The reflex is elicited with the baby lying in prone position on a hard surface, eg; an examination table or mattress or held face down on the examiner's hand. Using moderate pressure, the examiner runs his index finger or thumb along the spine from the pelvis upward to the neck. In response to this stimulus, following actions occur;

• flexion of the lower extremities
• Lordosis of the spine, with elevation of pelvis
• Flexion of the upper extremities, with elevation of head
• Strong cry, leading in any cases to glotic spasm with apnea and occasional cyanosis
• Urination

This reflex should disappear by 4-6 months of age. Perez reflex is a symmetrical tonic neck reflex, if it is retained, it can affect the posture of child.

Perez Reflex is used to obtain midstream urine specimens for bacteriological investigations.