case study 1 pediatrics

headings with the questions answered please, will sent sample


Case Study #1 (Part 1):

Mr. and Mrs. B arrive at in the urgent care clinic with their 6 week old infant, S.B. As the practitioner, you ask the couple why they have brought SB to the clinic. Mrs. B states “My baby breastfed well for the first couple of weeks but has recently been throwing up all the time, sometimes a lot and really forcefully. He looks skinny and is hungry and fussy all the time.” You determine the couple is homeless and has been living out of their car for the past month. S.B. has had no primary care since discharge after delivery. 


  1. What additional information will you need to obtain from Mr. and Mrs. B.?
  2. What assessments would you need to do for S.B. based on the information that you have so far?


“Your primary assessment of the infant reveals the following: S.B. is alert and fussy and consoles with a bottle of Pedialyte (per orders). His anterior fontanel is slighlty depressed and posterior fontanel cannot be palpated. You auscultate regular breath sounds at a rate of 18 breaths per minute. No adventitious sounds. Pulse ox is 98% on room air. Heart rate is 140 beats per minute with regular rate and rhythm. Brachial and pedal pulses are 3+ and equal. Abdomen is round and nontender to palpation. Positive bowel sounds in all 4 quadrants. Diaper is dry. S.B. moves all extremities and there are no rashes noted. Rectal temperature is 98.9. There is a quarter-sized flat red area on the occiput that “has been there since he was born” according to the mother. Slight “tenting” was noted.

When interviewing the mother she states that S.B. has only been drinking breastmilk, and will vomit very soon, if not immediately after feeding. She describes the vomiting as projectile, and says that the baby is hungry again after vomiting. 

You transport S.B. to radiology and he vomits a large amount of clear fluid. Patient returns to the room in his mother’s arms, awake and alert. The mother appears anxious and states, “I don’t know what’s wrong with my baby! Why can’t you people tell me anything?”

  1. Your institution uses electronic charting. Based on the assessment described, which of the systems would you chart as abnormal as you document your findings? List the abnormal system, along with the abnormal findings.
  2. With this new information, what might you add to your assessment and interview questions that you listed last week?
  3. What labs would you order for S.B.? Why?
  4. What are some differential diagnoses that you are already considering for S.B.

Now I’m going to add a few things: you have ordered a CBC, CMP, UA, blood pH, and x-rays. You have stated that you are concerned with hydration status and pyloric stenosis. So, here are your questions for the remainder of your case study: 1. Metabolic alkalosis is a concern for this patient. Which lab findings would you expect with metabolic alkalosis? a. Na: 128 mEq/L, K: 2.6 mEq/L, Cl: 90mEq/L, HCO3: 28 mEq/Lb. Na: 130 mEq/L, K: 5.7 mEq/L, Cl: 94mEq/L, HCO3: 22 mEq/Lc. Na: 130 mEq/L, K: 3.9 mEq/L, Cl: 98 mEq/L, HCO3: 17 mEq/Ld. Na: 148 mEq/L, K: 4.1 mEq/L, Cl: 108 mEq/L, HCO3: 13 mEq/L2. What is the underlying cause of S.B.’s diagnosis of metabolic alkalosis?3. Which of these clinical manifestations might you find with metabolic alkalosis? Select all that apply.a. Increased respiratory rateb. Tetanyc. Increased risk for seizuresd. Hyperthermiae. Neuromuscular irritability4. What additional assessment findings might reflect the consequences of prolonged vomiting in the infant?5. The abdominal x-ray reveals a distended stomach with minimal distal intestinal bowel gas. You decide to order an ultrasound, which reveals a thickened pyloric muscle. What is your final diagnosis, as well as 5 other differential diagnoses?6. You admit S.B. to the pediatric unit with a surgical consult. What are some socioeconomic/familial concerns that you may have in regard to his hospitalization, procedure, recovery, and overall health?



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