NSG 6430 iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

NSG 6430 iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

NSG 6430 iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

iHuman Case Study: Mia Zavarro V4

How would you evaluate and manage a pediatric patient who has a painful swelling of the hands and feet, fatigue, or fussiness? Which diagnostic studies would you recommend for this patient and why?

Painful swelling of the feet and hand, fussiness and fatigue could suggest the diagnosis of several pediatric diseases. When a pediatric patient is reported to present with the above symptoms, it is very important for a healthcare provider to first differentiate between the general and specific symptoms. Fussiness and fatigue are classified as general symptoms since they are common in several conditions. On the other hand, painful swelling of the feet and hands are specific symptoms, which must be prioritized in the diagnosis of the case provided. Several research findings suggest that pediatric patients experiencing painful and tender joints might be as a result of medical conditions such as trauma, hemoglobinopathies, Henoch-Schoenlein purpura, Lyme disease, systemic lupus erythematosus, and tumors infection. Consequently, asymmetrical painful swelling may indicate a sickle cell crisis (Chakravorty & Williams, 2015). Additionally, swelling of the joints might be as a result of joint effusion, a sprain, synovitis, rheumatoid arthritis or torn meniscus.

As a result of the several differential diagnoses, further tests are required for an accurate diagnosis to be made. Such diagnostic tests include complete blood count (CBC) with differential, reticulocyte count, hemoglobin electrophoresis, erythrocyte sedimentation rate, c-reactive protein, liver function tests, peripheral blood smear, and an x-ray of the affected feet and hands (McCance & Huether, 2019). The CBC with differential will help in providing some insight in case of the presence of infection based on the number of white blood cells or any abnormalities, anemia based on the hematocrit and hemoglobin levels, or bleeding disorder based on the platelet count. The hemoglobin electrophoresis is essential in the identification of any hematologic pathology. A reticulocyte count is crucial in evaluating the bone marrow functioning, as the c-reactive protein and erythrocyte sedimentation rate are inflammatory markers. The liver function test will help the physician find out if the liver is involved with the patient’s symptoms or malfunctioning. Also, the peripheral blood smears are essential in evaluating the overall blood cell abnormalities. To rule out trauma or injury, an x-ray of the affected area is needed. The management will depend on the findings of the above tests, after which a treatment plan will be provided based on the diagnosis.

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What physical exam findings and diagnostic results would be concerning to you and why? What would be three differentials in this case?

In the provided case of Mia, the physical examination findings that are of importance include systolic murmurs,

NSG 6430 iHuman Case Study - Cardiovascular and Hematologic Disorders in Children
NSG 6430 iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

swelling and warmth of the right foot and left hand (dactylitis), the antalgic gait, abdominal tenderness and distention, and splenomegaly. These findings are important since the patient is suspected of having a sickle cell crisis. The sickle cell disease is a genetic disorder characterized by abnormalities in the oxygen-carrying hemoglobin molecules in the red blood cells. There are several common orthopedic complications of sickle cell disease such as Dactylitis, Leg ulcer, Osteoporosis, and vertebral collapse, Avascular necrosis of the hip, Pathological fracture, Arthritis, Growth retardation, and skeletal immaturity, Osteomyelitis, Septic arthritis (Al-Salem, 2016). However, based on the presenting sign and symptoms, Mia might be suffering from any of the following 3 differential diagnosis: psoriatic arthritis since it also presents with dactylitis; septic arthritis which also presents with joint swelling and pain; juvenile rheumatoid arthritis which also presents with joint pain (Abdelgawad & Naga, 2014).

In SCD, the spleen doesn’t work properly or doesn’t work at all. This problem makes people with SCD more likely to get severe infections. What is the treatment for Miah and education for the family?

In young children suffering from sickle cell disease, the leading cause of death is an invasive bacterial infection. Numerous infections can cause death as a result of a compromised immune system due to spleen dysfunction, hence the need for antibiotic prophylaxis to prevent this risk. All the patients from 2 months to 5 years should be given penicillin, after which evidence-based research indicates that there are no clinical benefits in continuing the use of the antibiotic regimen (Lewis, 2015). According to pediatric clinical practice guideline for the management of SCD, children between 2 months to 3 years are administered with 125mg penicillin, twice a day while those who are between 3 to 5 years are given 250mg penicillin twice a day. The appropriate family education will include more emphasis on the severity of the risks that are associated with bacterial infection, the fatality rate associated with meningitis and septicemia, importance of keeping the patient hydrated, how to avoid hypoxic state that is associated with exertion, importance of the patient being vaccinated especially for Streptococcus pneumoniae, and when to seek for medical attention especially when the fever of the patient is 101.3°F or 38.5°C as a result of the risk of severing infection. The family should also be educated on maintaining high hand hygiene when handling the patient to prevent infections.

References

Abdelgawad, A., & Naga, O. (2014). Pediatric Orthopedics: A handbook for primary care physicians. New York, NY: Springer

Al-Salem, Ahmed. (2016). Medical and Surgical Complications of Sickle Cell Anemia. New York, NY: Springer International Publishing.

Chakravorty, S., & Williams, T. N. (January 01, 2015). Sickle cell disease: a neglected chronic disease of increasing global health importance. Archives of Disease in Childhood, 100(1), 48-53.

Lewis, M. E. (2015). Sickle cell disease: Genetics, management, and prognosis. New York, NY: Nova Biomedical.

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children. St. Louis, MO: Elsevier.