Client Profile:
Malcolm is a 15-year-old male who moved with his 7-year-oldsister and 5-year-old brother, mother and father to Dorchester,Massachusetts 2 years ago. Malcom had a rash when taking PCN andwas told that he might have a PCN allergy. Mr. Donald is employedby a packaging company. Mrs. Donald is currently un-employed sincethe Covid-19 pandemic in April 2020. Malcom has been going to highschool remotely since April and done mid-June along with hissiblings. The family has met only a few of their neighbors andtends to keep to themselves. Money has been tight, and the motheris struggling with schooling from home.
History:
Malcolm woke up at2:00 AM screaming, telling his mother that his “stomach is killinghim”. He has an elevated temperature 37.9° C (100.2°F) and beginsvomiting. His parents administered 500 mg of acetaminophen orally,however, Malcolm has an emesis within 5 minutes of receiving it.The parents continue to monitor him for an hour and then Mr. Donalddecides that they should take Malcolm to the local hospitalemergency room. Mr. Malcolm wakes the other two children to bringthem along. The family all go to the hospital. Malcolm s isadmitted through the emergency department. On admission Malcolm’svital signs are tympanic temperature 38.5° C (101.3°F); pulse 118beats/minute; respirations 24 breaths/minute; blood pressure119/79; weight 50 kg (110 lb.); height 165 cm (65 in). Malcolmguards the lower right quadrant of his abdomen and is cussing. Anintravenous access is established, and a CBC with differential& Chemistry 7 panel for Na+, K+, Cl-, CO2, BUN, Cr, glucose issent to lab, and morphine sulfate 8 mg is administered for paincontrol. An abdominal ultrasound is prescribed to confirm thesuspected diagnosis. Malcolm’s lab results are:
CBC w/differential:
- RBC 4.49 M/uL,Hgb 9.2, Hct 27.6%, Plt 160,000 g/dL
- Leukocyte count is 21,000 cells/mmɜ (neutrophils 72%,Lymphocytes 21%, Monocytes- 5%, Eosinophils 1%; Basophils 1% )
Chemistry panel
- N + is 130 mEq/L; Cl- 98 mEq/L; K+ 4.0 mg/L; CO2 22 mEq/L; BUN19mg/dL; Cr 1.0 mg/dL; Glucose 68 mg/dL
Critical Thinking Questions
- What is your impressions of this case including pathophysiologyand potential complications?
- What is the rationale for pre-op orders?
- The preoperative instructions are given to the family. Mr. andMrs. Donald give consent and Malcolm assents to the surgery. Whatis the difference between consent and assent?
- What is the nurse’s responsibility in the consent?
- Malcolm undergoes an exploratory laparotomy andappendectomy.
- What are the priority nursing interventions in the recoveryroom
- After being admitted to his room, Mr. Donald says they must nowleave with the other 2 children and he return to work. They willreturn after dinner. Thoughts on what to say before theyleave.
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How will you communicate with Malcolmafter they leave?
- Discuss the rationale for post-op orders.
