Hector Jimenez-Walker, 6-week-old infant who presented to the ED with acute dehydration and a history of projectile vomiting, irritability, and low urine output. Hector’s mother, who is an adult orthopedic surgeon, and father bring Hector to the ED. Hector’s father, Paul Walker, is the primary caregiver and said he visited their pediatrician one week ago due to concerns over frequent vomiting after feeds. Hector’s mother, Helena Jimenez, is breastfeeding and went back to work last week. Hector takes the pumped milk in a bottle well and the pediatrician recommended frequent burping, keeping upright after feeds, and return to the doctor in one week if no improvement. Despite following these instructions, the vomiting became more projectile and larger volumes over the weekend, causing the parents to seek out ED care. Hector’s last wet diaper was 6 hours ago, he has no tears, and his mucus membranes are pale and dry. Hector’s vital signs are: Heart rate 164 beats/minute, 35 breaths/minute, 88/48 mmHg, 38o C./100.4o F. Hector is somewhat lethargic, crying and whimpering with intervention and Hector has a weak cry. The parents state this is their first child. You responded correctly to 5 out of 6 evaluations: Category Your response Explanation Educational Increased acuity Hector’s parents admit this is their first child and they are worried about his care. Health Increased acuity Hector demonstrates a change in health status including vomiting and dehy LOC Increased acuity Hector appears dehydrated and has a weak cry. This indicates a change in L dehydration. Pain level Increased acuity Hector is irritable and crying, indicating some level of pain. Psychological Needs Increased acuity There is no evidence of increased psychological needs in this case. Safety Increased acuity All infants are at risk for injury. Hector is also at risk for injury due to dehydr Hector Jimenez-Walker 6-week-old infant who presented to the ED with acute dehydration and a history of projectile vomiting, irritability, and low urine output. Hector’s mother, who is an adult orthopedic surgeon, and father bring Hector to the ED. Hector’s father, Paul Walker, is the primary caregiver and said he visited their pediatrician one week ago due to concerns over frequent vomiting after feeds. Hector’s mother, Helena Jimenez, is breastfeeding and went back to work last week. Hector takes the pumped milk in a bottle well and the pediatrician recommended frequent burping, keeping upright after feeds, and return to the doctor in one week if no improvement. Despite following these instructions, the vomiting became more projectile and larger volumes over the weekend, causing the parents to seek out ED care. Hector’s last wet diaper was 6 hours ago, he has no tears, and his mucus membranes are pale and dry. Hector’s vital signs are: Heart rate 164 beats/minute, 35 breaths/minute, 88/48 mmHg, 38o C./100.4o F. Hector is somewhat lethargic, crying and whimpering with intervention and Hector has a weak cry. The parents state this is their first child. You correctly diagnosed 7 out of 10 options: Physiological Your Description Response Explanation Alteration in comfort True Hector is crying, whimpering, and is irritable. These indicate an a Altered gastrointesti nalfunction True Hector is vomiting, projectile at times, and is unable to retain anof dehydration, indicating an alteration in GI function. Altered renal False There is no evidence of altered renal function in this case. The la function allowed to continue, there is a risk for altered renal function. Decreased cardiac False Hector’s vital signs indicate that there is adequate cardiac outpu out put hyp ovol emi a. His bloo d pres sure is ade qua te for his age. If deh y and perf usio n