The mother of the 7-week-old infant reports the baby has had fewer and fewer wet diapers and hasn’t stooled in 3 days despite having a ravenous appetite. The mother reports that the child has been vomiting with increasing force and volume over the past two weeks. The emesis just appears to be partially digested breastmilk and fluid. The infant appears well, but mucous membranes are dry, the child has a low-grade fever, and is tachycardic. Upon palpation of the abdomen, a small, olive-shaped mass is appreciated. A serum electrolyte panel reveals a sodium of 132, potassium of 2.7, chloride of 89, and a glucose of 92. The nurse performs which nursing action first?

Question

The mother of the 7-week-old infant reports the baby has had fewer and fewer wet diapers and hasn&rsquo;t stooled in 3 days despite having a ravenous appetite. The mother reports that the child has been vomiting with increasing force and volume over the past two weeks. The emesis just appears to be partially digested breastmilk and fluid. The infant appears well, but mucous membranes are dry, the child has a low-grade fever, and is tachycardic. Upon palpation of the abdomen, a small, olive-shaped mass is appreciated. A serum electrolyte panel reveals a sodium of 132, potassium of 2.7, chloride of 89, and a glucose of 92. The nurse performs which nursing action first?

Accepted Answer

Insert an IV and begin an infusion of D10W with 0.45% NaCl and 20 mEq of KCl. The patient is exhibiting signs of pyloric stenosis that has led to significant dehydration. This child requires fluid and electrolyte supplementation first and foremost. Once the child&rsquo;s fluid and electrolyte status has improved, the child will be taken for a pyloromyotomy. The child hasn&rsquo;t had wet diapers because of dehydration, not urinary retention. Additionally, a nasogastric tube to suction is unnecessary because the child has vomited everything out of the stomach; gastric decompression is not necessary.

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