Case Study

Two nursing diagnosis for Stefan would include:

Risk for deficient fluid volume related to excessive losses of fluid through normal routes as evidenced by diarrhea. (Ackley, Ladwig, 2006, p. 430).

Risk for infection related to decreased skin integrity as evidenced by presence of diaper rash. (Ackley, Ladwig, 2006, p. 552).

Significant questions that I would find relevant to ask Stefan’s mother would be:

How many stools did Stefan actually have per day?

What was the consistency of the stools?

Have there been any particular changes in medication or intake of foods?

Is he able to keep anything in him or does diarrhea occur immediately after any PO intake?

Does it have any distinctive odor?

Has any other person in the family been sick?

Is there presence of a fever or a change in his behavior or demeanor?

Key points to cover in the review of systems should be any change of Stefan from his baseline status. A head to toe assessment should be completed as well as obtaining his vital signs, height and weight. Significant points to assess Stefan for are active signs of infection where his diaper rash is present. This would include redness, warmth, discharge or presence of a temperature. Assess for signs of dehydration by checking the integrity of the skin by assessing for turgor and texture. Check for other signs of dehydration including capillary refill time, changes in respiratory status, mental status and severe weakness. Borkowski (2004) also suggest assessing the pattern of the rash to determine if there is a yeast infection present as well as assessing if the areas of the diaper rash spread down the patient’s legs or to the genital areas. She also suggests assessing the infant’s mouth in case wondering hands have caused a spread to the mouth that would lead to thrush. (p. 468).

Kamat and Nield (2007) suggest the treatment of diaper rash leading to acute dermatitis should include figuring out why the diarrhea is present, and...