Get Answer: Process Admitting Patient Question Guide

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Original Question

You are in the process of admitting a 9month old patient who is TPN dependent for short-gut after having NEC as a neonate. He requires TPN daily through a tunneled central line and he presents to the ED today with fever, tachycardia, tachypnea, congestion and erythema to the site. His extended viral panel is normal, You’ve given 20ml/kg of NS and his tachycardia is improved, he appears clinically improved now that he’s not febrile and has received one dose of vancomycin. You’re just about to call sign-out on this 9mo old with short gut and TPN dependence and presumed central line infection when the nurse brings you a rhythm strip and wants to know “if you’re ok with the T-wave being as high as the QRS in lead 2.” and the lab just called with an alert potassium of 7.5 and the ECG has peaked T-waves He’s afebrile and HR is 136, RR 36, SpO2 94% on 6lpm high-flow O2 (100%). weight 7kg. Past medical history: 34 week premature, NEC while in NICU, short-gut, TPN dependence He is NPO except meds and some “tastes of food” He takes no medications regularly after 20ml/kg NS with improved blood pressure and LOC, you started D5NS with 20mEqKCl/1000ml @ 30ml/hr and he has two working peripheral IVs. Situation: You’re about to admit this patient for presumed line infection and the admission orders are complete but now he has ECG changes and hyperkalemia Background: 9mo with TPN dependence and mild dehydration presents with fever, erythema to central line site and congestion an

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