Exhibit: The Six-Week-Old Who Keeps Vomiting
An electronic record frame with four tabs and a notes panel; inside the growth tab, a weight-for-age plot with four points dropping across three faint percentile guides.
PATIENT: Male infant, 6 weeks old. UNIT: Pediatric assessment area.
TAB 1 · VITAL SIGNS
| Time | Heart rate | Respiratory rate | Blood pressure | Temperature, oral equivalent |
|---|---|---|---|---|
| 0800 | 148 | 42 | 78/48 | 98.9 °F |
| 1200 | 166 | 44 | 76/46 | 99.1 °F |
| 1600 | 179 | 44 | 74/46 | 99.2 °F |
TAB 2 · GROWTH
| Date | Age | Weight | Percentile band |
|---|---|---|---|
| Birth | 0 days | 7 lb 6 oz | 50th |
| +14 days | 2 weeks | 7 lb 9 oz | 40th |
| +28 days | 4 weeks | 8 lb 1 oz | 25th |
| Today | 6 weeks | 7 lb 12 oz | Below 10th watch |
TAB 3 · INTAKE AND OUTPUT, past 24 hours
| Feed | Offered | Taken | Emesis |
|---|---|---|---|
| 0600 | 4 oz | 4 oz | 3 oz, forceful, non-bilious, at 0625 |
| 1000 | 4 oz | 4 oz | 3 oz, forceful, non-bilious, at 1015 |
| 1400 | 4 oz | 3 oz | 3 oz, forceful, non-bilious, at 1420 |
| Wet diapers, past 24 hours | 3 | Previous 24 hours: 8 |
TAB 4 · IMMUNIZATIONS
| Vaccine | Date given | Status |
|---|---|---|
| Hepatitis B, dose 1 | Day of birth | Complete |
| 2-month cluster | Not yet due | Scheduled |
NURSES' NOTES · 1615 Caregiver reports the infant "throws up across the room" within thirty minutes of every feed for the past five days, and is frantically hungry again immediately afterward. Emesis is milky, never green. Fewer wet diapers since yesterday. During a quiet feed a firm, movable, olive-shaped mass is palpated in the right upper quadrant. Visible waves seen crossing the upper abdomen from left to right during feeding. Anterior fontanel slightly depressed. Infant is alert but irritable between feeds.
CANDIDATE TASK STRIP
- Which four cues support the emerging hypothesis?
- Which tab is not contributing to this decision?
- Which finding requires the fastest escalation?
Margin notehungry immediately after vomiting is the whole clue. Watch out: the blood pressure is reassuring and should not be. In an infant, blood pressure holds until compensation fails.
Takeawayin a pediatric chart the growth curve is a vital sign, and a falling percentile carries the same weight as a rising heart rate. → BOOK 07 · P4