NU581 Pediatric Case Study

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Purdue University Globle 

NU580 FNP II – Primary Care of Children and Adolescents’ Health

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Date

NU581 Pediatric Case Study

Pediatric dehydration in a 12-month-old is a medical condition that requires immediate assessment and treatment because infants can lose fluids rapidly. Early recognition of symptoms such as persistent vomiting, decreased urine output, lethargy, dry mucous membranes, and weight loss allows healthcare providers to begin prompt fluid replacement, identify the underlying cause, and prevent serious complications such as metabolic acidosis, acute kidney injury, and shock. This pediatric case study reviews the nursing assessment, clinical findings, interventions, diagnostic evaluation, medication safety considerations, and patient outcomes for a child hospitalized with dehydration and pneumonia.

Pediatric Dehydration in a 12-Month-Old

Alison, a 12-month-old female, presented with persistent vomiting for approximately 12 hours and was unable to tolerate oral fluids. Her mother reported that Alison had become increasingly lethargic, had not produced a wet diaper since early morning, and was no longer making tears when crying. During the initial examination, the child appeared ill with dry lips, dry skin, reduced activity, and signs consistent with moderate to severe dehydration.

Further evaluation revealed fever, tachycardia, respiratory symptoms, and significant weight loss compared to her well-child visit two weeks earlier. Diagnostic testing later confirmed dehydration complicated by left lower lobe pneumonia and metabolic abnormalities requiring hospitalization.

Primary Nursing Assessment Findings

The nurse immediately recognized several findings that required urgent intervention because they indicated worsening dehydration and poor tissue perfusion.

Key assessment findings included:

• No urine output since 7:00 AM

• Absence of tears while crying

• Dry lips and dry skin

• Lethargy with decreased responsiveness

• Persistent vomiting

• Poor oral intake

Together, these findings are consistent with moderate to severe pediatric dehydration and require immediate fluid replacement therapy.

Initial Vital Signs

Alison’s initial assessment demonstrated several abnormal vital signs.

• Temperature: 101°F (38.3°C)

• Apical Heart Rate: 150 beats/minute

• Respiratory Rate: 40 breaths/minute

• Blood Pressure: 90/48 mmHg

• Current Weight: 21 lb 6 oz (9.5 kg)

• Weight Two Weeks Earlier: 24 lb 2 oz

The loss of approximately 2.75 pounds over a two-week period represents significant acute weight loss and is one of the most reliable indicators of dehydration in infants and young children.

Priority Nursing Assessment Concerns

Fever

The elevated temperature suggested an infectious process that could explain Alison’s vomiting, dehydration, and respiratory symptoms.

Tachycardia

An increased heart rate is a common compensatory response to hypovolemia and fever. Persistent tachycardia may indicate worsening dehydration and inadequate circulating blood volume.

Significant Weight Loss

Rapid weight loss in pediatric patients strongly supports the diagnosis of acute dehydration because body weight closely reflects fluid status.

Questions the Nurse Should Ask the Parent

Obtaining a complete health history helps identify the cause of illness and guides treatment decisions.

Important assessment questions include:

• When did the vomiting begin?

• How many episodes of vomiting has Alison experienced?

• Has she been able to keep down any food or fluids?

• Has she received any medications at home?

• Does she have any medication or food allergies?

• Has she experienced diarrhea?

• Has she been coughing or pulling at her ears?

• Has she been exposed to anyone who is sick recently?

These questions help determine illness severity and identify possible infectious causes.

Priority Nursing Interventions

Prompt nursing interventions are essential to restore fluid balance and prevent further complications.

Immediate priorities include:

• Initiate intravenous (IV) fluid therapy.

• Admit the patient for close observation.

• Administer prescribed medications for fever, nausea, and infection.

• Monitor intake and output.

• Obtain ordered laboratory specimens.

• Reassess vital signs frequently.

• Evaluate hydration status throughout treatment.

Comprehensive Physical Assessment

A complete physical examination identified additional abnormalities involving the respiratory and ear assessments.

Respiratory Findings

The respiratory assessment revealed:

• Chest congestion

• Bilateral coarse breath sounds

• Mild expiratory wheezing

• Dry cough

• Nasal congestion

These findings raised concern for lower respiratory tract infection.

Ear Assessment

Examination of the left ear demonstrated:

• Bulging tympanic membrane

• Erythematous tympanic membrane

• Tenderness on examination

These findings are consistent with acute otitis media.

Diagnostic Tests Performed

To determine the underlying cause of Alison’s illness, several diagnostic procedures were completed.

These included:

• Urinary catheterization

• Peripheral IV insertion

• Complete Blood Count (CBC)

• Comprehensive Metabolic Panel (CMP)

• Blood cultures

• Erythrocyte Sedimentation Rate (ESR)

• Urinalysis

• Urine culture

• Lumbar puncture using aseptic technique

• Chest X-ray

Together, these tests evaluated hydration status, infection, kidney function, and possible sources of fever.

Acetaminophen Order Evaluation

Following IV fluid resuscitation, the provider prescribed:

Acetaminophen 650 mg every four hours as needed for pain or fever.

Was the Medication Order Appropriate?

No. This medication order is unsafe for a 12-month-old child weighing approximately 9.5 kg.

The recommended pediatric acetaminophen dosage is:

• 10–15 mg/kg per dose every 4–6 hours

• Maximum daily dose: 75 mg/kg/day

For Alison, the appropriate dose would be approximately 95–142.5 mg per dose.

A 650 mg dose greatly exceeds the recommended pediatric dosage and significantly increases the risk of acetaminophen toxicity and liver injury. Nurses have a professional and legal responsibility to question unsafe medication orders before administration.

Nursing Responsibilities for Safe Medication Administration

Medication safety remains a fundamental nursing responsibility.

Rights of Medication Administration

The nurse should always verify:

• Right patient

• Right medication

• Right dose

• Right route

• Right time

Additional nursing responsibilities include:

• Reviewing allergies

• Understanding indications and contraindications

• Monitoring for adverse effects

• Documenting medication administration accurately

• Evaluating the patient’s response to therapy

Developmental Concerns

Following treatment, Alison’s fever improved and she produced a wet diaper. However, her mother reported new developmental concerns.

She stated that Alison:

• Refused to hold her bottle independently.

• Would not stand without assistance.

Why These Findings Are Concerning

By 12 months of age, many children are expected to:

• Hold a bottle or cup independently

• Pull to stand

• Cruise along furniture

• Begin taking independent steps

Failure to achieve these developmental milestones may suggest developmental delay or underlying neurologic, musculoskeletal, or environmental concerns. Additional developmental screening and pediatric follow-up are recommended.

Laboratory Findings

Interpretation of Abnormal Laboratory Results

Elevated Creatinine

A creatinine level of 5 mg/dL is critically elevated for a pediatric patient and may indicate severe dehydration, decreased renal perfusion, or acute kidney injury.

Low Carbon Dioxide (CO₂)

A CO₂ level of 15 mEq/L indicates metabolic acidosis, which commonly develops following prolonged vomiting, dehydration, and ketosis.

The presence of large urinary ketones further supports inadequate caloric intake and increased fat metabolism.

Final Diagnosis

Following additional evaluation, Alison’s chest X-ray demonstrated left lower lobe pneumonia.

Because of dehydration, fever, respiratory findings, and laboratory abnormalities, she was admitted for:

• Intravenous fluid therapy

• Intravenous antibiotics

• Ongoing respiratory monitoring

• Repeat laboratory testing

• Close observation

SBAR Handoff Communication

Effective SBAR communication improves patient safety and continuity of care.

Situation

Alison is a 12-month-old female admitted with dehydration, fever, lethargy, and newly diagnosed left lower lobe pneumonia. Following treatment, her temperature has decreased to 99.2°F.

Background

The patient experienced persistent vomiting for approximately 12 hours and was unable to tolerate oral intake. Her mother reported no urine output since 7:00 AM and worsening lethargy before arrival.

Assessment

Following IV fluid administration, Alison is more stable, has produced urine, and her fever has improved. Diagnostic imaging confirmed pneumonia, while laboratory findings remain consistent with dehydration and metabolic abnormalities.

Recommendation

Continue the current treatment plan by:

• Maintaining IV fluid therapy

• Monitoring intake and output closely

• Administering prescribed antibiotics and antipyretics

• Performing ongoing respiratory assessments

• Monitoring laboratory values and vital signs

• Encouraging oral fluids as tolerated

• Scheduling developmental follow-up after discharge

Key Clinical Takeaways

Pediatric dehydration can rapidly progress from mild fluid loss to life-threatening illness, particularly in infants and toddlers. This case highlights the importance of early recognition, comprehensive nursing assessment, accurate medication dosing, and prompt fluid replacement. It also emphasizes the need to identify underlying infections, monitor laboratory abnormalities, evaluate developmental milestones, and communicate effectively during patient handoffs to improve outcomes.

References

American Academy of Pediatrics. (2024). Dehydration. HealthyChildren.org. https://www.healthychildren.org/English/health-issues/conditions/abdominal/Pages/dehydration.aspx

Hockenberry, M. J., & Wilson, D. (2023). Wong’s nursing care of infants and children (13th ed.). Elsevier.

Kliegman, R. M., St. Geme, J. W., Blum, N. J., Shah, S. S., & Tasker, R. C. (2024). Nelson textbook of pediatrics (22nd ed.). Elsevier.

NU581 Pediatric Case Study

MedlinePlus. (2025). Dehydration in children. U.S. National Library of Medicine. https://medlineplus.gov/dehydration.html

World Health Organization. (2024). Pocket book of hospital care for children: Guidelines for the management of common childhood illnesses (3rd ed.). https://www.who.int/publications/i/item/9789241548373