MIAMI DADE COLLEGE

MEDICAL CENTER CAMPUS

SCHOOL OF NURSING

NUR 2310L: Pediatric Nursing Clinical Laboratory

Pre-Assignment Worksheet

Student’s Name _Chandrasekhar ____________ DATE ____10/05/2010_________________ Time:____________________________________

Client’s Initial: ___DK__ Admission Date _____10/03/2010________ Allergies:____NKDA______________________ Religion:_________________________________

Age: __11yr__ Sex: __M__ Race:________________________________ Diet:__Clear Liquid______________ Activity: ___As tolerated____________________

Admitting Medical Diagnosis (es) ___Hirschsprung's disease, Chronic constipation__________________________________________________________________________

Past medical History (include past surgical history)___Chronic constipation _______________________________________________________________________________

Present Surgical Procedures (include date):_________________________________________________________________________________________________________

Client’s understanding of illness:_________________________________________________________________________________________________________________

History of present Illness: ___Client has chronic constipation since birth and newly diagnosed with Hirschsprung's disease. Constipation has been worsening past 1 week

What medications are you taking you at home? Laxatives

Medications Time(s) Why?

______D5 ½ Normal Saline + 20 Meq KCL___ _____84 ml/hr_______________ _ To maintain nutritional & hydration status .

______MiraLax________________________ _____17 gr PO daily prn _____ _Constipation___________________________________

______Golytely _______________________ _____4000ml x 1 _________ _Stimulate bowel movements______________________

Are your medications causing any discomfort? _____NO_______________________________________

M-S I Forms/Case History 1

 Medications (s) Worksheet (Topical, PO, IM, SQ, IV)

CLASSIFICATION DOSE/ ROUTE/FREQUENCY MECHANISM INDICATIONS SIDE EFFECTS NURSING CONSIDERATIONS AND
NAME SAFE RANGE OF ACTION PATIENT EDUCATION

D5 ½ Normal Saline + 84 ml per hour IV Provides calories Provides Fluid overload, Explain purpose of administration to patient
20 Meq KCL & replace K+ that hydration and hypokalemia, and parents
caloric sources are passed from calories hypomagnesemia, Administer slowly to prevent phlebitis or
the body in the hypophosphatemia, sclerosis of the vein.
stool. glycosuria, Assess IV site frequently.
hyperglycemia Rapid infusions may cause hyperglycemia or
fluid shifts.
Assess for s/s of water intoxication

MiraLax 17 gr PO daily prn Acts as an Constipation Abdominal bloating, Assess patient for abdominal distention,
Laxatives osmotic agent, cramping, presence of bowel sounds, and usual pattern of
drawing water flatulence, nausea bowel function
into the lumen of Assess color, consistency, and amount of stool
the GI tract produced

GoLYTELY 4000ml x1 Increases the Constipation, Severe stomach pain Do not use this medication if allergic to
(Polyethylene glycol amount of water clean the bowel or bloating, gagging, polyethylene glycol or any other electrolyte
electrolyte solution) in the intestinal before choking, or solutions (such as Pedialyte or Gatorade), or
Laxative tract to stimulate colonoscopy, a vomiting, mild with a perforated bowel; a bowel obstruction or
bowel barium x-ray, or stomach cramps, severe constipation; or colitis or toxic
movements. other intestinal gas, rectal pain or megacolon
procedures irritation.

M-S I Forms/Case History 2

 PATHOPHYSIOLOGY- BRIEF TEXTBOOK PICTURE WITH CLIENT COMPARISON
Definition, Etiology, Pathophysiology, Diagnostic tests, Sign & Symptoms, Medical treatments & (3) References (Using APA format)

Hirschsprung disease is a developmental disorder of the enteric nervous system and is characterized by an absence of ganglion cells in the distal colon resulting in a

functional obstruction.

Causes: Congenital aganglionosis of the distal bowel defines Hirschsprung disease. Aganglionosis begins with the anus, which is always involved, and continues

proximally for a variable distance. Both the myenteric (Auerbach) plexus and the submucosal (Meissner) plexus are absent, resulting in reduced bowel peristalsis and

function. The precise mechanism underlying the development of Hirschsprung disease is unknown.

Symptoms: Delayed passage of meconium, abdominal distension and Constipation are classic symptoms of this disease.

Diagnosis: A barium enema is the mainstay of diagnosis of Hirschsprung’s, though a rectal biopsy showing the lack of ganglion cells is the only certain method of

diagnosis.

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M-S I Forms/Case History 3

 DIAGNOSTIC TESTS

X-RAY/ CT SCAN/ ULS/ MRI/EKG etc. RESULTS (Please include date of tests results)

KUB Modified fecal retention, obstruction in unspecified bowel gas pattern

10/04/10

Barium Enema Yet to perform the test.

10/04/10

M-S I Forms/Case History 4

CHEMISTRY NORMAL CLIENT’S VALUES HEMATOLOGY NORMAL CLIENT’S VALUES
PROFILE VALUES VALUES
DATE DATE DATE DATE DATE DATE

SODIUM WBC 4.8-10.8

POTASSIUM RBC 4.70-6.10
CHLORIDE HGB 12-16
CO2 HCT 36-48
CALCIUM MCV 80-96
GLUCOSE MCH 27-31
BUN MCHC 32-36
CREATININE PLATELETS 150-400
PHOSPHORUS
CHOLESTEROL DIFFERENTIAL
TOTAL PROTEIN 6.4-8.3 NEUTROPHILS 38-70
ALBUMIN 3.5-5.0 SEGMENTS 2-8
ALBUMIN/
GLOBULIN RATIO BANDS
AST (SGOT) < 31 LYMPHOCYTES 21-49
ALT (SGPT) < 41 EOSINOPHILS 0-7
TOTAL
BILIRUBIN <1.0 BASOPHILS 0-1
AMYLASE 28-100 MONOCYTES 0-7
LIPASE 13-60

COAGULATION STUDIES
PTT 23-35 sec
LIPID PROFILE PT 10.5-13.5
TOTAL INR 0.76-1.25
CHOLESTEROL
TRIGLYCERIDES BLEEDING TIME
HDL
LDL
CHO/HDLC Ratio
GGT

M-S I Forms/Case History 5

 URINALYSIS NORMAL CLIENT’S VALUES
VALUES DATE DATE DATE

URINALYSIS
COLOR
APPEARANCE
SP. GRAVITY MISCELLANEOUS TEST
PH TEST NORMAL CLIENT’S VALUES
VALUES DATE DATE DATE
GLUCOSE
KETONE
OCCULT BLOOD
PROTEIN
BILIRUBIN
UROBILINOGEN
NTRITE
LEUCOCYTE
CAST
WBC
RBC
CRYSTALS
SQUAMOUS CELLS/
EPITHELIAL CELLS

Relate the clinical significance of abnormal lab values above:

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 REFERENCES

Deglin, Judith, & Vallerand, April. (2007). Davis Drug Guide for Nurses (10th ed). Philadelphia:

F A Davis Co.

Beers, Mark, & Porter, Robert. (2006). The Merck manual of diagnosis and therapy. New Jersey:

Merck & Co., Inc..

Smeltzer, Suzanne, Bare, Brenda, Hinkle, Janice, & Cheever, Kerry. (2008). Brunner and Suddarth's Textbook of Medical-Surgical Nursing.

Philadelphia: Lippincott, Williams and Wilkins

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