Case Study # 3

UNRS 314 Name _______________ Number _______

Ruptured Appendix

10 year old male presents to the ER with two day history of anorexia, loose stools x3, pain that
started in umbilical area and settled in the right lower quadrant. He started feeling a bit better so
mom encouraged clear fluids and gave him Tylenol for fever to 101.2. He was admitted during
the evening with fever to 104, diffuse abdominal pain, and abdominal distension. Upon admission
WBC is elevated and abdominal ultrasound is positive for ruptured appendix. He was taken to the
OR for surgery to remove a ruptured appendix. You are caring for him the post-op day 1.

Maintenance IV 24 hour fluid calculations ______________________

1 ½ maintenance IV ________________________________________
Weight 32.45 kg

Physician orders:
• IV Dextrose 5% in 0.45 Normal Saline @ 120 mL / hr
• NG to low suction
• Replace cc/cc NG drainage every four hours
• NPO
• Clindamycin IV 300 mg every 6 hours
• Gentamicin IV 66 mg every 8 hours
• Morphine Sulfate 3 mg IV every 3-4 hours prn for severe pain

MAR states Morphine last given at 0700

You are getting ready to prepare your am meds when the mother calls for pain medications. The
patient rates his pain as 8/10 using the Universal Pain Scale. His NG output at 0700 was 76 mLs.

At what rate would you regulate his IV fluids at ________ (mL/hour) to replace the NG fluid
loss for the last 4 hours?

Clindamycin 300 mg
Dosing: 20 – 40 mg / kg / day
Clindamycin is provided by the pharmacy in 50 mL of IV solution.

Medication Action: mg/kg calculations Nursing

Responsibilities
Labs:

Classification How fast can drug be Why this drug?

administered IV?
Gentamicin 66 mg
Dosing: 2 – 2.5 mg / kg/dose (every 8 hours)
Gentamicin is provided by the pharmacy in 50 mL of IV solution

Medication Action: mg/kg calculations Nursing

Responsibilities
Labs:

Classification How fast can drug be Why this drug?

administered IV?

Morphine Sulfate 3 mg
Morphine is provided as 10mg / mL
Dosing: 0.1 to 0.2 mg / kg / dose

Medication Action: mg/kg calculations Nursing

Responsibilities
Labs:

Classification How fast can drug be Why this drug?

administered IV?

How much would you need to draw up to provide the accurate dose of Morphine Sulfate
_________________

Critical thinking: What is the major side effect of Clindamycin therapy? What specific
clinical manifestations would you need to watch for? What drug would need to be added
to the medication regime if this complication develops? What CAM is often given to
diminish the potential for this complication?

In administering Gentamicin why might the physician ask for the pharmacy to do the
dosing based on peak and trough lab values?