A 3-month-old child presents to the emergency room with her mother. The mother reports that the baby is not acting like herself and she is having a hard time arousing the baby. Upon inspection the baby is wrapped in blankets in her car seat sleeping. The nurse unwraps the baby and feels heat radiating off the child.
The vital signs are as follows:
Temp104°F Rectally
HR150 bpm
RR32 bpm
SpO299%
BP66/32 mmHg (54 MAP)
The child is not opening their eyes or crying. The nurse notices the fontanelle is sunken in and the baby’s skin is hot but dry.
The nurse needs to give a fluid bolus of fluids over 15-30 minutes. The formula for fluid replacement is 20 mL/kg (20 x 5.9). So this baby needs 118 mL of Normal Saline.
After the initial bolus, a recheck of vitals needs to occur to check hydration status.
The most concerning vital sign is the temperature of 104° F. The nurse needs to get an order for rectal Tylenol and administer it to the baby then recheck the temperature in 30 minutes.
The baby has received the fluid bolus and rectal Tylenol. The nurse checks another set of vitals and gets the following:
This nursing case study course is designed to help nursing students build critical thinking. Each case study was written by experienced nurses with first hand knowledge of the “real-world” disease process. To help you increase your nursing clinical judgement (critical thinking), each unfolding nursing case study includes answers laid out by Blooms Taxonomy to help you see that you are progressing to clinical analysis.We encourage you to read the case study and really through the “critical thinking checks” as this is where the real learning occurs. If you get tripped up by a specific question, no worries, just dig into an associated lesson on the topic and reinforce your understanding. In the end, that is what nursing case studies are all about – growing in your clinical judgement.