Case Study

Client Profile

Nathan is a 6 year old first grader who lives with his mother and older brother, 8 year old Micah. Nathan has been a healthy child with only occasional upper respiratory infections. His mother diligently kept up with his immunizations and all of his pediatric check-ups. He started first grade 2 weeks ago and is always eager to go to school. His level of growth and development is appropriate for his age and he quickly developed friendships with his classmates.

Case Study

Yesterday afternoon when he came home from school, Nathan began having episodes of abdominal pain and diarrhea. His stools have been intermittent, foul smelling, watery, and according to Nathan's mother, "float in the toilet". He refused to eat or drink anything since that time so Nathan's mother calls the pediatrician. At the pediatrician's office Nathan is listless, his skin is warm and dry, and he complains that his "tummy hurts". His urine specific gravity is 1.040, his heart rate is 120 beats/minute, his respirations are 30 breaths/minute, and his blood pressure is 78/46. His stool is negative for blood and his complete blood count results are as follows:

Hematocrit: 50%

Hemoglobin: 16.5 g/dL

Platelets: 455,000 cells/mm3

Red blood cell count: 5.2 million cells/ mm3

White blood cell count: 11,300 cells/ mm3

Because he continues to refuse to eat or drink, the pediatrician recommends that he be hospitalized for further diagnostic testing.

Questions

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1. Because of Nathan's symptoms, the pediatrician prescribes arterial blood gases (ABGs) be drawn. What is the purpose of this prescription and what nursing implications are appropriate prior to drawing Nathan's ABGs?

2. Nathan's ABG results are: pH, 7.30; Pco2, 30 mm Hg; Po2, 90 mm Hg; oxygen saturation, 94%; and bicarbonate (HCO3), 22 mEq/L. Compare...