NSG 6430 iHuman Case Study – Common Pediatric Illnesses
NSG 6430 iHuman Case Study – Common Pediatric Illnesses
iHuman Case Study: Samantha Graves V3 PC
Which essential questions will you ask a pediatric patient or his or her caregiver when the presenting complaint is bloody diarrhea? Will these questions vary depending upon the child’s age? Why or why not?
A presumptive bleeding and accurate diagnosis can only be reached at by a complete pediatric complaint history. Nevertheless, age-related, and etiology-specific essential questions can be addressed to the caregiver. For instance, ask about the chronicity or acuteness of the bleeding, the quantity, and color of the blood in the stool, or vomit, history of straining, anticipated symptoms, trauma and abdominal pain (Shane et al., 2017). For more insight about the bloody stool, questions relating to the history of the foods consumed by the child, drugs used and changes in stool color throughout the day are also important.
The questions asked regarding pediatric complaints vary depending on the child’s age group. However, questions regarding bloody diarrhea are consistent across various ages, apart from older children who are at high risk of Crohn’s disease or ulcerative colitis (Carson, Mudd, & Madati, 2016). Focusing on these disorders, the patient will be asked questions revolving around, their weight changes, pain during defecation and cases of delayed growth.
What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?
Normally, the color of the stool of a child should either be brown, mustard yellow or green. However, in case of any changes such as a black stool, occult blood cultures, ova, and parasite need to be obtained. Other diagnostic tests that will be required will depend on the medical history and symptoms of the patient. In case of continuous episodes of bloody diarrhea, several tests such as a complete blood count (CBC), erythrocyte sedimentation rate (ESR), c-reactive protein (CRP) and basic metabolic panel (BMP) should be ordered. Least invasive diagnostic tests need to be ordered first before any imaging is carried out due to radiation exposure which is extremely dangerous for minors (Benninga et al., 2016). In case the test results are not conclusive with the diagnosis; a CT scan or abdominal ultrasound may be necessary for addition to a colonoscopy.
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What would be three differential diagnoses in this case?
For the case provided, the 3 main differentials to be considered are appendicitis, gastroenteritis – either viral, parasitic or bacterial- and intussusception. Based on the patient history of presenting illness and the symptoms displayed, Samantha might be suffering from the above-mentioned differentials in addition to dehydration. The abrupt onset of vomiting and diarrhea is a good indication of gastroenteritis (Benninga et al., 2016). Consequently, excessive diarrhea and vomiting, especially in pediatric patients, lead to dehydration or hypovolemia. The high risk in children is due to the fact that they have an increased surface area to volume ratio and are also unable to communicate their symptoms or when they need electrolyte replenishment or rehydration.
How do the common causes of vomiting differ in infants, children, and adolescents?
Starting with infants, vomiting usually presents as a sign of an infection, congenital gastrointestinal abnormalities or abnormalities in the central nervous system. Additionally, both infants and young children normally experience vomiting when suffering from several diseases such as gastroesophageal reflux disease, gastroenteritis, soy or milk allergies, intussusception, child abuse or pyloric stenosis (Srinivasan & Srinivasaraghavan, 2018). Among the older children population or the adolescents, conditions such as central nervous system disorders especially migraines, brain tumor or meningitis, intussusception, and pregnancy can lead to vomiting. However, the leading cause of vomiting among older infants or children is gastroenteritis, especially of viral origin. It usually has a sudden onset and self-limiting as it revolves within 24 to 48 hours. It can also result from the consumption of contaminated food. Since it’s of a viral cause that can easily be spread, patient education is required to enhance high hygiene for both the child and those handling them.
What clinical or historical findings will indicate the need for diagnostic studies and why?
A diagnostic workup is required in case of a rigid or firm belly, mass felt, abdominal distention, abdominal tenderness or severe pain, and bloody vomit among other symptoms. the above could indicate a serious condition which requires further investigations. The potential diagnostic studies required in such cases include CBC, pregnancy test for female adolescents, blood culture, abdominal x-ray, and CT scan. These abdominal studies will provide a clear and focused insight into what the patient is going through (Benninga et al., 2016). The tests should, however, be limited to pediatric treatment guidelines to avoid compromising their health even further. For instance, a blood culture or CBC could provide adequate information in case of infection to avoid further tests such as radiations which might endanger the child’s health.
Which diagnostic studies will you initially order and why?
Initially, after a thorough review of the patient’s history and symptoms, several diagnostic studies directed towards the cause of the patient’s condition should be ordered in addition to imaging studies, if necessary, in case of inconclusive findings from the lab tests. Such tests include, but not limited to complete blood count (CBC), erythrocyte sedimentation rate (ESR), C – reactive protein (CRP) and basic metabolic panel (BMP) (Shane et al., 2017). Imaging studies include CT scan and abdominal x-ray. These tests are recommended to review the cause of symptoms such as episodes of forceful vomiting among the newborns, abdominal pain, dehydration, bloody stool, bloody vomit, constipation, and abnormal urine frequency.
Benninga, M. A., Nurko, S., Faure, C., Hyman, P. E., St, J. R. I., & Schechter, N. L. (May 01, 2016). Childhood Functional Gastrointestinal Disorders: Neonate/Toddler. Gastroenterology, 150(6), 1443.
Carson, R. A., Mudd, S. S., & Madati, P. J. (January 01, 2016). Clinical Practice Guideline for the Treatment of Pediatric Acute Gastroenteritis in the Outpatient Setting. Journal of Pediatric Health Care: Official Publication of National Association of Pediatric Nurse Associates & Practitioners, 30, 6.
Shane, A. L., Mody, R. K., Crump, J. A., Tarr, P. I., Steiner, T. S., Kotloff, K., Langley, J. M., … Pickering, L. K. (December 15, 2017). 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clinical Infectious Diseases, 65(12), 1963-1973.
Srinivasan, S., & Srinivasaraghavan, R. (January 01, 2018). Fluid and electrolyte disturbances in childhood diarrheal diseases. Indian Journal of Practical Pediatrics, 20(1), 11-21.