The pediatric ward

Overnight summaries below. Put the list in the order you would physically see them, most urgent first, then commit.

1. 1 · Room 5

   15 years49 kg

   Abdominal pain, day 1, admitted for observation; appendicitis not excluded.

   Pain moved to the right lower quadrant at 04:00. Vomited twice. Declined breakfast. Nurse: 'She would not let me press her tummy.'

   HR 112, BP 112/70, RR 20, T 38.2.

   Feeding:

   Nil by mouth since 04:00 on the nurse's judgement.

   Output:

   Passed urine; pregnancy test negative on admission.

   Caregiver:

   Mother at the bedside; patient asked for the interview to be private yesterday.

2. 2 · Room 4

   3 weeks3.5 kg

   Jaundice on phototherapy, day 2, breastfed.

   Bilirubin 06:00 fell to well below the phototherapy line. Feeding every 2 to 3 hours. Weight up 20 g.

   HR 136, RR 42, T 36.8 (under the lights).

   Feeding:

   Breastfeeding well, mother's supply established.

   Output:

   Seven wet diapers, four yellow stools.

   Caregiver:

   'When can the lights come off? I want to hold her.'

3. 3 · Room 1

   8 months8.1 kg

   Bronchiolitis, day 4, on 1 L nasal cannula.

   Oxygen weaned from 2 L to 1 L at 03:00. Two brief desaturations to 88 percent during feeds, self-resolved.

   HR 152, RR 52, SpO2 94 percent on 1 L, T 37.6.

   Feeding:

   Taking about 60 percent of usual volumes by mouth, coming off to breathe.

   Output:

   Four wet diapers overnight.

   Caregiver:

   'She seems better, but she goes blue for a second when she drinks.'

4. 4 · Room 2

   6 years21 kg

   Asthma exacerbation, day 2, salbutamol spaced to 4-hourly.

   Slept. One dose at 02:00 for wheeze; no oxygen since 22:00.

   HR 104, RR 24, SpO2 96 percent on air, T 36.9.

   Feeding:

   Ate breakfast.

   Output:

   Normal.

   Caregiver:

   'Can we go home today? I have work.'

5. 5 · Room 3

   12 years38 kg

   New type 1 diabetes, transitioned from insulin infusion to subcutaneous yesterday.

   Glucose 4.1 at 03:00, treated with juice per protocol; 7.2 at 06:00. Nurse: 'He cried after the 3 a.m. check.'

   HR 78, BP 110/70, T 36.7.

   Feeding:

   Ate dinner; reluctant at breakfast.

   Output:

   Normal.

   Caregiver:

   'He says he does not want any more needles. His father is not here; they separated last month.'

Overnight summaries below. Put the list in the order you would physically see them, most urgent first, then commit.

1. 1 · Bay 1

   18 months10.3 kg

   Gastroenteritis with moderate dehydration; failed oral rehydration at 01:00, intravenous fluids started.

   Sodium 148 on the admission bloods. Fluids running at deficit plus maintenance. Two wet diapers since 03:00.

   HR 128, BP 92/58, RR 28, T 37.6.

   Feeding:

   Sips of oral rehydration solution now tolerated.

   Output:

   Two wet diapers, three loose stools.

   Caregiver:

   'Can I give her the bottle now she is keeping the sips down?'

2. 2 · Bay 2

   20 months11.5 kg

   Simple febrile seizure with otitis media, admitted for observation because it was 22:00 and the parents were frightened.

   No further seizures. Slept. Temperature 38.0 at 05:00, antipyretic given.

   HR 118, RR 26, T 37.4.

   Feeding:

   Breakfast eaten.

   Output:

   Normal.

   Caregiver:

   'Will it happen again? Should we have a machine at home?'

3. 3 · Bay 4

   4 years17 kg

   Limp with fever; hip effusion on ultrasound; awaiting orthopedic aspiration this morning.

   Kept nil by mouth from 02:00 for theatre. Temperature 38.8 at 04:00. Pain controlled with regular analgesia.

   HR 134, BP 98/62, T 38.4.

   Feeding:

   Nil by mouth; maintenance fluids running.

   Output:

   Passed urine.

   Caregiver:

   'Nobody has told us what time the operation is.'

4. 4 · Bay 3

   10 days3.1 kg

   Poor feeding and a temperature of 36.2; full sepsis evaluation done, antibiotics started at 23:30.

   Temperature 36.4 to 36.9 under a warmer. Fed 30 mL by tube twice. Cerebrospinal fluid white cells 6. Blood culture no growth at 8 hours.

   HR 158, RR 46, SpO2 98 percent, T 36.6 (warmed).

   Feeding:

   Nasogastric top-ups; attempted breastfeeding once, tired quickly.

   Output:

   Two wet diapers overnight.

   Caregiver:

   Mother expressing milk; father asking whether the 'lumbar thing' was necessary.