Evaluate school-aged patient with congenital hydrocephalus

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Reference no: EM133877186

Question

Called to the bedside to evaluate a school-aged patient with congenital hydrocephalus and seizure disorder who is post-op day 2 from externalization of his ventriculo-peritoneal shunt due to shunt infection. His output been hard to calculate since his foley was removed as the antibiotics for his shunt infection are causing diarrhea and everything is documented as "mixed" AM labs (drawn four hours ago): NA 131 K 3 Cl 92 Bun 8 Creat 0.2 Mg 1.8 Glu 90 Afebrile - hemodynamically stable / vital signs are unchanged and within normal limits for age On exam he is quietly playing in bed, appears comfortable, in no apparent distress, interactive with you when you walk in, bladder non-palpable and bladder scan on the unit is broken. His EVD is putting out <15ml q2h, is patent and is leveled, positioned appropriately and open to drain. What is your diagnostic and therapeutic plan for this patient's post-operative problem? straight cath x 1, and send urine for specific gravity and urine sodium. Consider weaning amount of narcotics patient is on. send serum chemistry, and serum osmolarity, recalculate I/O for your shift so far, consider dose of IV lasix x 1 and possible fluid restriction if sodium is less than 131 and serum osm <280 send serum chemistry, and serum osmolarity, recalculate I/O for your shift so far, consider 10ml/kg fluid challenge with NS if sodium < 131 and serum osm < 280 to stimulate kidneys and replace low sodium send serum chemistry and serum osmolarity,

Reference no: EM133877186

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