iHuman Case Study – Common Pediatric Illnesses

NSG 6435 Week 6 Discussion
Discussion: iHuman Case Study – Common Pediatric Illnesses
Week 6 Discussion Common Pediatric Illnesses
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? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?
The world as currently constituted grapples with a myriad of pediatric conditions that require urgent attention from stakeholders. One of the conditions is acute diarrhea infection, a condition that is prevalent in both the United States’ citizens and individuals from visiting third world nations. In order to address the condition, multifarious therapeutic interventions including pharmacologic therapies such as antibiotics and non-antibiotics therapies have been employed to manage the condition and the ailments thereof. Cash and Glass (2014) observe that the improved knowledge on various aspects of the interventions such as prevention, diagnosis, treatment, as well as the impact of acute diarrhea has been leveraged and consequently played a fundamental role in the clinical management of acute diarrhea. This has led to the reduction of mortality rates although the situation still needs significant resources to combat.
When a child appears with symptomatology affiliated with acute diarrhea, asking their caregiver concerning the color of the stool – in other words whether it appears tar-like or black- forms the most fundamental question in the diagnostic procedure. The presence or absence of blood is crucial in determining the existence of gastro-intestinal bleeding in the child (Franco et al., 2018). If the appearance of the stool is tar-like, then this is indicative of bleeding within the upper part (tract) of the child’s gastro-intestinal tract. Importantly, Burns et al. (2013) observe that a clinician needs to be cognizant of the fact that the diarrheal causative agents in infants and children vary based on age. Intestinal infections like infant colitis influence the pathophysiology of bloody diarrhea in children under the age of one. However, for children over the above-mentioned age, intestinal infection are commonly caused by Crohn’s colitis and ulcerative colitis. Further questions that can be put to the caregiver include the following:
Has the child had any alteration in appetite levels?
During the period the child has been sick, have you noticed any changes in weight?
Has the child demonstrated any intolerance to certain food products?
Have the child felt nauseated and/or vomited during this period?
Did the stool from the patient indicate the presence of blood? If yes, can you describe the color and quantity?
Does the child indicate abnormal pain?
What is the location of this pain?
Does the pain radiate?
On a scale of 1-10, can you describe the intensity of the pain?
Can you describe the frequency and quality of the pain?
Most of the above questions will be asked to the caregiver of a child of any age. However, variations will occur as older children may have slightly different causative agents compared to infants or neonates. Studies also posit that if a child presents with blood in their stool, they ought to be immediately treated inasmuch as most of the observed cases do not show severity (Burns et al., 2013). Even then, it is imperative that patients whose stool indicates the presence of GI bleeding seek medical attention in which case an exam will be conducted contingent upon a patient’s age. The presented symptoms and individual situations form the bases that a doctor will use to determine the necessary test. However, a rectal exam, anoscopy and sigmoidoscopy otherwise commonly referred to as colonoscopy are the foremost assessment tests that will be considered for blood stools (Clark et al., 2017). Initially, the rectal exam will be undertaken by a clinician, wherein they will use their finger to analyze the anus’ internal parts in addition to observing the external ones.
What would be three differential diagnoses in this case?
Differential diagnosis will be necessary to eliminate some of the conditions that could also be attributable to causing acute diarrhea. Therefore, in the iHuman Case Study regarding Samantha Graves, the following three differential diagnosis were made:
Parasitic gastroenteritis
Viral gastroenteritis
Appendicitis
How do the common causes of vomiting differ in infants, children, and adolescents? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why?
Vomiting as a symptom has a high prevalence in children. As a result, they need to undergo a critical assessment upon observation of the same to determine the causes, which requires immediate medical attention. During the assessment process, numerous facets such as onset, frequency, and duration need to undergo consideration. In infants and neonates, studies reveal that acute viral gastroenteritis and gastroesophageal reflux disease primarily cause vomiting (Fleisher, 2014). Other important causes such as pyloric stenosis, intestinal obstruction, and intussusception may also cause vomiting in infants. On a lower scale, food intolerance and sepsis can also manifest in infant vomiting. In children and adolescents, vomiting principally occurs due to viral gastroenteritis just like in infants. However, other causative factors such as bacterial enteritis and colitis, non-GI infections such as fever, appendicitis, and serious infections such as pyelonephritis, cyclic vomiting, intracranial hypertension, eating disorders, toxic ingestions, and adverse drug reactions may lead to vomiting in children and adolescents (Waheed, Malone, & Samiullah, 2018; Swani et al., 2016). Irrespective of the age of a person, the presence of bilious emesis needs serious and urgent attention and acquiring a patient’s historical medical record concerning persistent vomiting crucially aids the process. Other factors such as lethargy/listlessness, nuchal rigidity/photophobia/fever in older children, abdominal distention/peritoneal signs, inconsolability/bulging fontanelle in infant, and persistent vomiting alongside poor development or growth should worry a pediatrician. A history of neurologic manifestations or poor development indicates a metabolic disorder or a CNS. The presence of such findings crucially enables a physician to determine the severity of vomiting hence arrange for immediate intervention. Fleisher (2014) posits that the diagnostic test ordered needs to be directed by the causative agent of the vomiting. In CNS or abdominal pathology, imaging studies are recommended. Also, numerous specific cultures or blood tests are conducted to diagnose inherited metabolic disorders or even serious infections. However, in most cases, physicians normally order for blood tests since most vomiting episodes are as a result of infections.
References
Burns, C., Dunn, Brady, Starr, N. B., Blosser. (2013). Pediatric primary care. (5th ed.). Retrieved from
Cash, J. C. & Glass, Ch. A. (2014). Family practice guidelines, (3rd ed.). Retrieved from
Clark, A., Black, R., Tate, J., Roose, A., Kotloff, K., Lam, D., … Steele, D. (2017). Estimating global, regional and national rotavirus deaths in children aged <5 years: Current approaches, new analyses and proposed improvements. PLoS ONE, 12(9), 1–18. https://doi.org/10.1371/journal.pone.0183392 Fleisher, D. R. (2014). Management of functional gastrointestinal disorders in children: Biopsychosocial concepts for clinical practice. New York, NY: Springer. François, R., Yori, P. P., Rouhani, S., Siguas Salas, M., Paredes Olortegui, M., Rengifo Trigoso, D., … Kosek, M. N. (2018). The other Campylobacters: Not innocent bystanders in endemic diarrhea and dysentery in children in low income settings. PLoS Neglected Tropical Diseases, 12(2), 1–15. https://doi.org/10.1371/journal.pntd.0006200 Sawni, A., Vaniawala, V. P., Good, M., Lim, W. Y., & Golec, A. S. (2016). Recurrent Cyclic Vomiting in Adolescents. Clinical Pediatrics, 55(6), 560–563. https://doi.org/10.1177/0009922815594233 Waheed, A., Malone, M., & Samiullah, S. (2018). Functional gastrointestinal disorders: Functional gastrointestinal disorders in children. FP Essent., 466, 29-35. iHuman Case Study – Common Pediatric Illnesses This discussion assignment provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment, make sure you post your initial response to the Discussion Area . To support your work, use your course textbook readings and the South University Online Library.As in all assignments, cite your sources in your work and provide references for the citations in APA format. Start reviewing and responding to the postings of your classmates as early in the week as possible.Respond to at least two of your classmates’ initial postings.Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion.Cite sources in your responses to other classmates.Complete your participation for this iHuman Case Study – Common Pediatric Illnesses assignment . For this assignment, you will complete an iHuman case study based on the course objectives and weekly content.iHuman cases emphasize core learning objectives for an evidence-based primary care curriculum.Throughout your nurse practitioner program, you will use the iHuman case studies to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice. The iHuman assignments are highly interactive and a dynamic way to enhance your learning.Material from the iHuman cases may be present in the quizzes, the midterm exam, and the final exam. Here you can view information on how to access and navigate iHuman. This week, complete the iHuman case titled “Samantha Graves, Gastroenteritis”. Apply information from the iHuman Case Study to answer the following questions: 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? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why? What would be three differential diagnoses in this case? How do the common causes of vomiting differ in infants, children, and adolescents? What clinical or historical findings will indicate the need for diagnostic studies and why? Which diagnostic studies will you initially order and why? NSG 6435 Week 6 Assignment 3 Assignment 3: SOAP Note Each week, you are required to enter your patient encounters into eMedley.Your faculty will be checking to ensure you are seeing the right number and mix of patients for a good learning experience.You will also need to include a minimum of one complete SOAP note using the Pediatric SOAP Note template.The SOAP note should be related to the content covered in this week, and the completed note should be submitted to the Dropbox.When submitting your note, be sure to include the reference number from eMedley. Submission Details: Complete at least one SOAP note in the template provided. Name your SOAP note document SU_NSG6435_W6_A3_LastName_FirstInitial.doc. Include the reference number from eMedley in your document.