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Temperature: The temperature decreased from 38.8° C (101.8° F) to 37.6° C (99.7° F), which indicates a potential improvement in the infection response as the body temperature is coming down.

WBC count: The WBC count increased slightly from 14,000/mm³ to 15,000/mm³, which is still elevated compared to the normal range (5,000 to 10,000/mm³). This suggests that the body is still responding to infection and could indicate a worsening condition if the trend continues or remains elevated.

Weight-bearing ability on the affected leg: The improvement in weight-bearing ability suggests that the condition of the leg is improving. This indicates that the condition is improving as the pain or swelling may have decreased.

Wound assessment: The wound culture is still pending, and although there is no specific description provided, a pending culture and the general condition of the wound (which can be assessed for redness, warmth, or exudate) might still indicate a worsening condition if there is continued inflammation or signs of spreading cellulitis.

Gastrointestinal: Iron is better absorbed when the stomach is empty, so administering it between meals is the best approach to enhance its effectiveness.

Dental: Iron supplements can cause staining of the teeth, so brushing after taking the supplement will help prevent this issue.

Hematological: After a month of treatment with iron supplements, a follow-up blood test is necessary to evaluate the improvement in hemoglobin levels and to ensure the treatment is effective.

Condition most likely experiencing:

Pelvic Inflammatory Disease (PID)

Actions the nurse should take:

1. Place the adolescent on bedrest in semi-Fowler’s position
2. Administer acetaminophen 650 mg PO every 6 Hr PRN pain

Parameters to monitor:

1. Temperature greater than 38.3°C (100.9°F)
2. Rebound tenderness

Rationale:

Pelvic Inflammatory Disease (PID). The client’s history of multiple sexual partners, mucopurulent cervical discharge, pelvic pain, and fever strongly suggests PID, a bacterial infection often caused by sexually transmitted infections (STIs) such as chlamydia or gonorrhea.

Urinary tract infection. UTIs typically present with dysuria, urgency, frequency, and suprapubic pain, which are not noted here.

Ectopic pregnancy. The client’s last menstrual period was 7 days ago, making pregnancy unlikely. PID symptoms differ from ectopic pregnancy, which presents with unilateral lower abdominal pain and possibly vaginal bleeding.

Acute appendicitis. Appendicitis typically causes right lower quadrant pain, nausea, vomiting, and rebound tenderness, which are not the primary symptoms here.

Place the adolescent on bedrest in semi-Fowler’s position – This promotes drainage of infected fluids and reduces the risk of abscess formation.

Administer acetaminophen 650 mg PO every 6 Hr PRN pain – This helps manage the pain associated with PID.

Temperature greater than 38.3°C (100.9°F) – A rising temperature may indicate worsening infection or sepsis.

Rebound tenderness – Can indicate peritoneal irritation, which may suggest complications such as peritonitis or an abscess.

Instruct the adolescent about the use of sitz baths. Sitz baths are used for perineal discomfort but are not a standard intervention for PID.

Administer an enema. An enema is unnecessary and could worsen the infection if peritonitis is present.

Vaginal bleeding. Vaginal bleeding is not a common symptom of PID.

Irritation of the phrenic nerve. Phrenic nerve irritation is associated with diaphragmatic irritation, such as in gallbladder disease or ruptured ectopic pregnancy.

Presence of a Cullen sign. Cullen’s sign (bluish discoloration around the umbilicus) is a sign of intra-abdominal hemorrhage, often seen in ruptured ectopic pregnancy or pancreatitis, not PID.

Condition Most Likely Experiencing: Crohn's disease

Actions to Take:

1. Record dietary intake
2. Provide a gluten-free diet.

Parameters to Monitor:

1. Albumin level.
2. Hemoglobin level.

Rationale:

Crohn’s Disease- Positive stool occult blood and positive leukocytes suggest intestinal inflammation and bleeding, which are characteristic of Crohn’s disease. Elevated C-reactive protein (CRP) (3.2 mg/dL) and WBC count (13,000/mm³) indicate inflammation and infection, common in Crohn’s disease flare-ups. Low albumin (3.4 g/dL) suggests malabsorption and protein loss, which occurs in Crohn’s disease due to chronic inflammation and poor nutrient absorption.

Appendicitis – Usually presents with localized right lower quadrant (RLQ) pain, fever, nausea, vomiting, and abdominal rigidity. The patient does not have classic signs of appendicitis.

Peptic Ulcer Disease (PUD) – Typically associated with H. pylori infection (negative in this case) and does not usually cause elevated CRP and WBC.

Celiac Disease – Would not cause elevated inflammatory markers (CRP, WBC) or stool occult blood.·

Record dietary intake.Nutritional deficiencies (e.g., low albumin) are common in Crohn’s disease. Keeping a food diary helps identify trigger foods that exacerbate symptoms.

Provide a gluten-free diet. While gluten-free diets are primarily for celiac disease, some Crohn’s disease patients may benefit from avoiding gluten and other inflammatory foods. Low-residue, high-protein diets are often recommended to reduce intestinal irritation and promote healing.

Administer an enema. Contraindicated in Crohn’s disease, as enemas can worsen inflammation and irritate the bowel.

Prepare for surgery. Surgery is not the first-line treatment for Crohn’s disease. It is only considered for severe complications (e.g., strictures, fistulas, or perforation).

Albumin level. Low albumin suggests malabsorption and protein loss, which should be monitored to assess nutritional status.

Hemoglobin level. Anemia (Hgb 11 g/dL, Hct 33%) suggests chronic blood loss from inflammation. Monitoring hemoglobin helps assess disease progression and response to treatment.

Abrupt decrease in pain level. This would be a concern for bowel perforation rather than an indicator of improvement in Crohn’s disease.

Abdominal rigidity. Not a typical assessment parameter for Crohn’s disease, but more relevant for appendicitis or peritonitis

Capillary refill 4 seconds (Cardiovascular) – Indicates poor perfusion and worsening dehydration.

Extremities cool (Integumentary) – Suggests impaired circulation, potential hypovolemia.

Reports no tears (Integumentary) – Sign of severe dehydration.

Lethargic (Neurologic) – Worsening mental status, could indicate hypovolemia or electrolyte imbalance.

Heart rate 112/min – Mildly elevated but not yet critical.

Respiratory rate 26/min – Within an acceptable range for a toddler.

Hyperactive bowel sounds – Expected with diarrhea.

Diaper area reddened – Needs care but not urgent

Severe Pain Management: The child's pain increased from 7/10 to 10/10, indicating worsening vaso-occlusive crisis. IV hydromorphone (Dilaudid) is a strong opioid analgesic commonly used for severe sickle cell pain when first-line options (e.g., morphine) are insufficient. Swelling and warmth in the right knee suggest ongoing vaso-occlusion and inflammation. Increased blood pressure (120/74 mm Hg) and respiratory rate (25/min) likely indicate pain-related distress.