At 08.00, a nine-year-old boy called Harry Worth was admitted with 5% dehydration as a result of ongoing tonsillitis. His date of birth is 12th January 2015. His UMRN is E435678. He weighs 37kg. His mother is incredibly worried about him and appears anxious. Harry has a respiratory rate of 36, his Sats are 98, you take a pulse, and it is 155. His blood pressure is 122/66, and his temperature is 38.1.
He has commenced on two antibiotics and parental rehydration according to guidelines. At 9.00, you give a dose of Paracetamol and commence the IV parental fluid. The standard dosing for Paracetamol is 15mg/kg, and it comes in strawberry flavour at 24mg/ml.
Since admission, the patient has consumed a light breakfast, including toast and 100 mL of juice.
At 10.00, you give the first dose of Ceftriaxone 1.85g; the patient vomits 60mL and drinks 100 mL of water. By 10.00, he had consumed 150 grams of jelly and some crackers.
At 11.00, the patient urinates 200 mL
He eats a banana and 100 grams of ice cream for lunch at noon. At 12.00 you give the first dose of Vancomycin 555mg as an IV infusion.
At 13.00, he drinks another 100 mL of water and vomits 60mls again.
At 14.00, he urinates 150mls.
The next nursing shift will continue monitoring his fluid intake and output to ensure proper rehydration. Calculate his fluid balance chart and early warning score (EWS) and provide a handover to the afternoon staff, highlighting any deficits/actions.
1. Using the following formulas calculate the deficit fluid and maintenance fluid Harry requires
2. How many mL of Paracetamol would you give?
3. a) How many mL of Ceftriaxone will you need for the correct dose?
b) How many mL will you give Harry to ensure the medication has the correct concentration?
c) At what rate will you set the syringe driver to give the medication over the correct time?
4. a) How many mL of Vancomycin will you need for the correct dose?
b) How many mL of Vancomycin will you give Harry to ensure the medication has the correct concentration?
c) At what rate will you set the pump to give the medication over the correct time?
5. a) What is Harry’s EWS?
b) What actions will you take?
6. Please write the handover you would give the afternoon staff.
Please complete the fluid balance chart on the following page. Make sure you include all fluid input and output.
| Time | Intake | Output | ||||||||||||
| Oral | Intravenous Fluids | PU | BO | Vomit | Other | Sign | ||||||||
| Type | AMT | Type | Amount Absd | Type | Amount Absd | PIVAS | ||||||||
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| Previous Days Balance | 24 Hour Total Output | |||||||||||||
| Total Balance (+) | ||||||||||||||
| Total Balance (-) | ||||||||||||||
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