Galen College of Nursing - NURSING MISC

Hypertrophic Pyloric Stenosis Case Study

Mr. and Mrs. B arrive in the emergency department with their 5-week-old infant, S. B. As the triage nurse, you ask the couple why they have brought S. B to the ED. 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 that 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?

When does the vomiting occur, before or after feedings? How long after feedings? Does baby still seem hungry after vomiting? What color is in the vomiting? Does the infant seem to be in pain? (Perry, et al., 2018)

2. Your institution uses electronic charting. Based on the assessment described, which of the following systems would you mark as abnormal as you document your findings? State your abnormal findings and provide a brief narrative with the abnormal finding.

3. The emergency physician orders a complete blood count, complete metabolic profile, urinalysis, blood pH, and x-rays. The physician suspects dehydration and metabolic alkalosis secondary to hypertrophic pyloric stenosis. Which of the laboratory findings would you expect with metabolic alkalosis?

1. Na: 128 mEq/L, K: 2.6 mEq/L, Cl: 90 mEq/L, HCO3: 28 mEq/L
2. Na: 130 mEq/L, K: 5.7 mEq/L, Cl: 94 mEq/L, HCO₃: 22 mEq/L
3. Na: 130 mEq/L, K: 3.9 mEq/L, Cl: 98 mEq/L, HCO₃: 17 mEq/L
4. Na: 148 mEq/L, K: 4.1 mEq/L, Cl: 108 mEq/L, HCO₃: 13 mEq/L

4. What is the underlying cause of S. B.’s diagnosis of metabolic alkalosis?

5. Which of these clinical manifestations might you find with metabolic alkalosis? Select all that apply.

a. Increased respiratory rate b. Tetany

c. Increased risk for seizures

5. Hyperthermia

Neuromuscular irritability

6. Which of the following preoperative orders would you question?
   1. Vital signs q 4h
   2. Strict intake and output (I & O)
   3. 30 mL Pedialyte q3 h PO- Pt should be kept NPO as stomach is being decompressed and fluids are being restored parenterally.
   4. Place IV and begin D₅1/3NS at 50mL/hr