I just had an pre-interview assessment today for an RN position at Women's Shelter today and we had to answer this one question: It was a scenario about a 2 week old baby who lost 10% of its birth weight and is dehydrated the mom is new to Canada and doesn't speak English how would you handle the situation and what symptoms in your assessment would you look for? Basically I answered along the lines of assesment for...dehydration, sunken fontanels, sunken eyes, crying with no tears.. i would assess for respiratory infection crackles at lung bases, productive cough, amount and colour etc.. amount of wet diapers.. skin turgor.. obtain blood work for RBCs, elevated WBCs.. urine analysis. I would also assess for signs of abuse such as bruising, is the baby appropriately dressed, are there any unexplained injuries. The mother's behaviour If there is signs of abuse notify hcp and appropriate authorities document. I would get an interpreter. To ask the mom questions does she breast feed or bottle feed? Any complications during her pregnancy review the child immunization records. Any recent cold or flu ask about their living situation does she have other children. Financial situation? Is she on government assistance? Then i would collaborate with social work if abuse is not suspected. Social work can refer her to the proper resources such as housing, ESL classes to improve her prospective income. Etc.. thats what I wrote among those lines. Do you think I am on the right track? Any feedback would be great. They gave us no way to prepare since the job ad was already taken down. Thanks
I mentioned on my test once I stabalized the infant by providing fluids, and applying oxygen , and obtaining blood work that then I would go about finding resources for the mother. There was no information in the test that the infant required transfer to the emergency. Sorry, but I can't remember everything I wrote. So it may not be in my original post. I get your point, but you should ask if that was done instead of accusing me of not doing so. However I had to answer based on the job description at hand yes, the physical assessment is imporant but also have to take into consideration the underlying causes and as nurses at this facility they want you to take into the consideration social determinants of health. If the child is at risk for dehydration do to the environment of the mother or due to her lack of finances why is it a bad idea to refer her to those services once the child had been stabalized?? The question asked how would YOU handle the situation not what the priority actions are. I included my assessment and physical interventions but it doesnt stop there once those are implemented, I need to tackle all possible underlying causes and that includes social factors as well to prevent it from happening again. YES there are certain immunizations given to the child at birth based on the mothers health history and because the mother is new to Canada, the baby could have recieved HepB or HBIG its very possible! that is why I asked during my assessment I appreciate your feedback bfrom the get go you have been very negative and condescending first your asking if the facility gave me permission to disclose the question?? Obviously they did not express their permission but I didn't sign any confidentiality agreement not to ask about it and I did not repeat the question verbatim nor did I disclose the name of the organization/facility or agency or town or city in which this facility is in. If you have an issue with it you can contact the facility and let them know about my posting or the administrators of the page. Overall, whether you like it or not there are so many reasons why the infant could be dehydrated yes digestive problems, but also respiratory infection, neglect or abuse or maybe the mother cannot adequately provide nutrition to her infant. based on the limited information provided we cannot really say exactly why thats why there is really no right or wrong answer to the question. Therefore, I am just looking at feedback from different points of view not responses from people that state their answer is the be all end all.
At 2 weeks old the infant should be at least birth weight. they do loose some weight the first few days of birth, but should have gained it back by 10 days and definitely 2 weeks. I would say that kid is going to the ER to be evaluated for severe dehydration >9% weight loss. If it was 2-4% weight loss I would be more inclined to do everything you did and make sure interventions are in place to get the infant hydrated.
Having recently done a peds rotation, we had an issue like this that the PICU MD addressed in depth and was actually focusing on how the ER missed the critical 12% weight loss as severe dehydration and took half the night, 5 hrs before calling PICU MD to admit the kid (this is from a trauma center with a peds ER) It is just really easy to miss because babies and kids compensate so well... The MD was really emphasizing that you can't always depend on the s/s and have to really look at the big picture. Err on the side of caution. Hence the reason for my answer...
My past paramedic experience taught me that kids are fine until they are not... They compensate so well that the don't go downhill like adults, they CRASH. I have severe asthmatics kids go from 50-60 resp a minute to 0 in a heartbeat. I am not sure about now, but when I was a medic years ago, we almost never did BP's on kids because if their BP was below normal, they were already crashing and had plenty of other symptoms to illustrate that.
The intake admission revealed the child is dehydrated and in a crisis, the mom is in crisis mode and people in crisis are not able to readily absorb information, they need to be guided through doing the most important steps in order to deal with the crisis, that is the role of the nurse in this situation. It is NOT the time to be discussing English classes. An experienced nurse would not get hung up on plowing through with a generic shelter admission assessment and making sure they included the social determinants of health, when they know the baby is at risk of dying. Experienced nurses and experienced social workers do not want another shelter death like baby Jordan Heikamp's.
Labelle13
19 Posts
I mentioned on my test once I stabalized the infant by providing fluids, and applying oxygen , and obtaining blood work that then I would go about finding resources for the mother. There was no information in the test that the infant required transfer to the emergency. Sorry, but I can't remember everything I wrote. So it may not be in my original post. I get your point, but you should ask if that was done instead of accusing me of not doing so. However I had to answer based on the job description at hand yes, the physical assessment is imporant but also have to take into consideration the underlying causes and as nurses at this facility they want you to take into the consideration social determinants of health. If the child is at risk for dehydration do to the environment of the mother or due to her lack of finances why is it a bad idea to refer her to those services once the child had been stabalized?? The question asked how would YOU handle the situation not what the priority actions are. I included my assessment and physical interventions but it doesnt stop there once those are implemented, I need to tackle all possible underlying causes and that includes social factors as well to prevent it from happening again. YES there are certain immunizations given to the child at birth based on the mothers health history and because the mother is new to Canada, the baby could have recieved HepB or HBIG its very possible! that is why I asked during my assessment I appreciate your feedback bfrom the get go you have been very negative and condescending first your asking if the facility gave me permission to disclose the question?? Obviously they did not express their permission but I didn't sign any confidentiality agreement not to ask about it and I did not repeat the question verbatim nor did I disclose the name of the organization/facility or agency or town or city in which this facility is in. If you have an issue with it you can contact the facility and let them know about my posting or the administrators of the page. Overall, whether you like it or not there are so many reasons why the infant could be dehydrated yes digestive problems, but also respiratory infection, neglect or abuse or maybe the mother cannot adequately provide nutrition to her infant. based on the limited information provided we cannot really say exactly why thats why there is really no right or wrong answer to the question. Therefore, I am just looking at feedback from different points of view not responses from people that state their answer is the be all end all.