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    N158 nursing care of infants proctored exam (paediatrics)

    You are receiving report on a 12-year-old patient with Crohn's disease. Over the past 24 hours, the patient has shown the following changes: Weight loss of 1.2 kg Baseline heart rate increased from 110 to 138 bpm Blood pressure decreased from 100/64 to 82/50 mmHg Temperature increased from 37.8°C to 39.4°C 8 bloody diarrheal stools in past 12 hours What is the nurse's priority?

    Explanation & Rationale

    A. Reassure the caregivers parents this is expected in Crohn's disease: While flares are common in Crohn’s disease, the child’s hypotension, tachycardia, fever, and bloody diarrhea signal a severe and potentially life-threatening complication. Reassurance alone delays urgent care. B. Encourage oral rehydration and continue to monitor overnight: Oral rehydration is not appropriate when the child is showing hypovolemic signs such as hypotension and tachycardia. IV fluids and urgent medical evaluation are required instead of delaying overnight. C. Notify provider for signs of a severe flare and subsequent hypovolemia: The patient’s unstable vitals, acute weight loss, fever, and bloody diarrhea indicate severe fluid loss, anemia risk, and systemic inflammation. Immediate provider notification is critical to initiate aggressive IV fluids, labs, and possible hospitalization. D. Offer bland foods to reduce stool frequency: Diet modification may help in mild cases, but in this scenario, the child is unstable with hypovolemic shock indicators. Food interventions do not address the urgent fluid and hemodynamic needs.

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