An infant diagnosed with pyloric stenosis recently developed projectile vomiting. Which finding indicates to the practical nurse that the infant is becoming dehydrated?

A. Document strict intake and output: Monitoring fluid balance is essential after ventriculoperitoneal shunt surgery, as changes in intracranial pressure and fluid status can impact recovery. Accurate recording helps detect complications such as over- or under-drainage.

B. Place in Trendelenburg position: The Trendelenburg position is not recommended post-shunt surgery because it can increase intracranial pressure. Infants are generally positioned flat or with the head slightly elevated to promote optimal CSF drainage and reduce pressure on the surgical site.

C. Monitor body temperature every 4-hours: Regular temperature checks are important for early detection of infection, a common complication after shunt placement. Prompt identification allows timely intervention and prevents sepsis or shunt malfunction.

D. Measure head circumference daily: Daily head measurements help assess for increases in intracranial pressure or shunt malfunction. Tracking changes in head circumference is a critical component of postoperative neurological monitoring in infants.

E. Irrigate shunt and pump valve every 12-hours: Shunt irrigation is not performed by nursing staff; it is a sterile procedure performed only by specialized providers if indicated. Routine pumping or irrigation by the PN is not appropriate and can cause harm.

A. White blood cell count (WBC): WBC levels reflect immune function and infection status but do not explain neurologic symptoms such as numbness or tingling. Reviewing this value would not directly help determine the cause of the client’s reported sensations.

B. Albumin and protein: Low albumin and protein levels indicate poor nutritional status but are not directly linked to acute neurological symptoms like paresthesia. These values are more relevant for assessing edema, wound healing, or chronic illness.

C. Electrolytes: Abnormal electrolyte levels, especially calcium, potassium, and sodium, can cause nerve and muscle irritability leading to numbness, tingling, or weakness. Reviewing electrolyte results helps identify possible imbalances that could explain the client’s symptoms.

D. Hematocrit: Hematocrit reflects red blood cell concentration and oxygen-carrying capacity. While severe anemia may cause fatigue or dizziness, it is less likely to cause peripheral numbness or tingling compared to electrolyte disturbances.