Reference no: EM133920244
Client Profile
Sara and Mary are 2-month-old twins born at 35 weeks' gestation and weighing 2,272 gm, and 2,300 gm respectively. They remained hospitalized for 4 weeks to gain weight and were discharged to home weighing 2,600 gm each. They are scheduled to see the health care provider to begin their immunizations at 10 weeks of age. The twins' mother has taken an extended maternity leave to remain home with the twins until they are 4 months old.
Case Study
The twins' mother, Fran, noted that both infants, 9 weeks of age, had "runny noses" when she picked them up from daycare. The twins' father left at 5:00 am for a 5-day business trip and at 6?00 am Fran heard them both coughing. Their coughs sounded dry; however, when she checked them, they both had runny noses and felt warm to the touch. She took their temperatures; Sara's was 37.8C (100F)and Mary's was 38C (100.4F). She administered 15 mg/kg of acetaminophen. This lowered the temperatures; however, they continued to cough. Three hours later, both girls began exhibiting a high-pitched whooping sound when inhaling during their coughing attacks. When Fran noted the girls experienced brief apneic periods during their coughing spells and appeared "bluish" in color, she phoned her pediatrician and was told to go to the nearest emergency department. The girls were admitted t the pediatric nursing unit with a diagnosis of "rule out pertussis". Sara's leukocyte count is 31,000 cells/mm3 and Mary's count is 32,300 cells/mm3 on admission. Nasal and throat cultures and serology tests are pending. Intravenous access devices are placed on intravenous fluids of D5W with 0.225% sodium chloride is initiated at 20 mL/hour. Their oxygen saturations are continuously monitored using pulse oximetry and each is started on 0.5 L of oxygen per nasal cannula in response to the oxygen saturation readings o of 94% for Sara and 92% for Mary. Arterial blood gases are drawn from each infant with the following results:
Sara pH 7.35; Pco2 35 mmHg; Po2 90 mmHg; oxygen saturation 95% and HCO3 22 mEq/L
Mary pH 7.37; Pco2 37 mmhg; Po2 85 mmHg; oxygen saturation, 92% and HCO3 23 mEq/L
Sara's weight is 2.9 kg (6 lb, 8oz); Mary's weight 3.2 kg (7 lbs)
Questions
1. Which child should be seen by the nurse first and why?
2. What conclusions can you draw about the clinical manifestations, leukocyte counts and arterial blood gas results of the twins?
3. Explain the rationale for prescribing intravenous fluids for Sara and Mary.
4. Should the twins be place on respiratory isolation to protect the nursing staff? Explain your answer.
5. Identify complications associated with pertussis that Sara and Mary are at risk for developing.
6. Identify at least 4 nursing diagnoses for Sara and Mary.
7. The twins are prescribed erythromycin lactobionate 13 mg IV every 6 hours. Discuss why this agent is prescribed and if the prescribed dose is safe for Sara and Mary.
8. The twins respond favorable to treatment and following a week of hospitalization their health care provider discharges them to home. Fran and her husband Jack are preparing for discharge. Discuss appropriate discharge instructions for this family.