Comprehensive Assessment and Fluid Management of a Dehydrated Pediatric Patient with Tonsillitis: A Case of Harry Worth

Comprehensive Assessment and Fluid Management of a Dehydrated Pediatric Patient with Tonsillitis: A Case of Harry Worth

At 08.00, a nine-year-old boy called Harry Worth was admitted with 5% dehydration as a result of ongoing tonsillitis. His date of birth is 12^th January 2015. His UMRN is E435678. He weighs 37kg. His mother is incredibly worried about him and appears anxious. Harry has a respiratory rate of 36, his Sats are 98, you take a pulse, and it is 155. His blood pressure is 122/66, and his temperature is 38.1.

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He has commenced on two antibiotics and parental rehydration according to guidelines. At 9.00, you give a dose of Paracetamol and commence the IV parental fluid. The standard dosing for Paracetamol is 15mg/kg, and it comes in strawberry flavour at 24mg/ml.

Since admission, the patient has consumed a light breakfast, including toast and 100 mL of juice.

At 10.00, you give the first dose of Ceftriaxone 1.85g; the patient vomits 60mL and drinks 100 mL of water. By 10.00, he had consumed 150 grams of jelly and some crackers.

At 11.00, the patient urinates 200 mL

He eats a banana and 100 grams of ice cream for lunch at noon.  At 12.00 you give the first dose of Vancomycin 555mg as an IV infusion.

At 13.00, he drinks another 100 mL of water and vomits 60mls again.

At 14.00, he urinates 150mls.

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The next nursing shift will continue monitoring his fluid intake and output to ensure proper rehydration. Calculate his fluid balance chart and early warning score (EWS) and provide a handover to the afternoon staff, highlighting any deficits/actions.

1. Using the following formulas calculate the deficit fluid and maintenance fluid Harry requires
2. How many mL of Paracetamol would you give?
3. a) How many mL of Ceftriaxone will you need for the correct dose?
4. b) How many mL will you give Harry to ensure the medication has the correct concentration?
5. c) At what rate will you set the syringe driver to give the medication over the correct time?
6. a) How many mL of Vancomycin will you need for the correct dose?
7. b) How many mL of Vancomycin will you give Harry to ensure the medication has the correct concentration?
8. c) At what rate will you set the pump to give the medication over the correct time?
9. a) What is Harry’s EWS?
10. b) What actions will you take?
11. Please write the handover you would give the afternoon staff.

Please complete the fluid balance chart on the following page. Make sure you include all fluid input and output.

Introduction

Effective fluid management and clinical observation are vital aspects of pediatric nursing care, especially for children presenting with dehydration secondary to infection. This case study focuses on Harry Worth, a nine-year-old boy admitted with 5% dehydration due to ongoing tonsillitis. Upon admission, Harry exhibited signs of systemic distress, including a raised pulse rate of 155, elevated temperature of 38.1°C, and mild tachypnea with a respiratory rate of 36 breaths per minute. His presentation reflects a moderate physiological response to infection and dehydration, requiring careful monitoring and evidence-based intervention.

The case highlights the importance of accurate calculations in pediatric dosing, fluid replacement, and early warning scoring (EWS) to ensure safe and effective treatment. It also underscores the nurse’s role in interpreting clinical data, maintaining fluid balance, and communicating essential information during handover to ensure continuity of care.

Through this case, key nursing responsibilities are examined, including the calculation of deficit and maintenance fluids, precise medication dosing, and the assessment of Harry’s ongoing condition through the EWS system. Each intervention—from the administration of antibiotics such as Ceftriaxone and Vancomycin to the monitoring of intake and output—plays a crucial role in promoting recovery, preventing complications, and reassuring an anxious parent.

Overall, this study provides an integrated approach to pediatric care, combining clinical reasoning, pharmacological accuracy, and compassionate nursing practice to support optimal patient outcomes in a hospital setting.

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