NSG 6435 Week 5 Discussion: iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

Sample Answer for NSG 6435 Week 5 Discussion: iHuman Case Study – Cardiovascular and Hematologic Disorders in Children Included After Question

NSG 6435 Week 5 Discussion: iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

NSG 6435 Week 5 Discussion: 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.

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, 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.

NSG 6435 Week 5 Discussion: iHuman Case Study – Cardiovascular and Hematologic Disorders in Children 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.

This discussion assignment on iHuman Case Study – Cardiovascular and Hematologic Disorders in Children 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 assignment.

ORDER NOW FOR AN ORIGINAL PIECE OF WORK NSG 6435 Week 5 Discussion: iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

For this assignment on iHuman Case Study – Cardiovascular and Hematologic Disorders in Children , 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 “Robert Ross.”

Apply information from the iHuman Case Study to answer the following questions:

Robert Ross is a 17 year-old male who presents with acute chest pain, palpitations, fever and malaise.He has had symptoms suggestive of a viral syndrome for the past week, but otherwise has no significant past medical history.

What questions would you ask to gather important diagnostic information?

How would you diagnose and manage this 17 year old male whose symptoms include palpitations, fever and malaise?

Which diagnostic studies would you recommend for this patient.Include the rationale for ALL diagnostics and Labs?

What physical exam findings and diagnostic results would be concerning to you and why? What would be three differentials in this case? Identify additional life threatening diagnoses that must be considered when a patient presents with acute chest pain.

What is the treatment (including rationale) for Robert and education for the family?

NSG 6435 Week 5  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.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:

enter your patient encounters into eMedley and complete at least one SOAP note in the template provided.

Name your SOAP note document SU_NSG6435_W5_A3_LastName_FirstInitial.doc.

Include the reference number from eMedley in your document.

NSG 6435 Week 5 Discussion: iHuman Case Study Sample

Week 5 Discussion 1 Cardiovascular and Hematologic Disorders in Children

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?

To evaluate a pediatric patient with painful swellings on the feet and the hand or with fatigue and fussiness. As a nurse practitioner, the procedure is to determine the pathophysiology, character of the swelling parts whether generalized or localized and the cause. The evaluation of patient age, past family and medical history, extra concurrent signs or illness, allergies and the current medications and weight gain. According to Schaefers et al, (2016) noted, comprehensive blood tests, including lactate dehydrogenase, uric acid, creatinine kinase, kidney function, liver function, electrolytes, complete blood count, and inflammatory are important.

A Sample Answer for the Assignment: NSG 6435 Week 5 Discussion: iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

Title: NSG 6435 Week 5 Discussion: iHuman Case Study – Cardiovascular and Hematologic Disorders in Children

In this case Miah presents with a two-day history of progressive, painful swelling in the left hand and right foot with dactylitis. She refrained from bearing weight or use her hands, further observations such as; standing and sitting (pelvis heights, lower limb lengths, alignment, hindfoot position, forefoot position, and foot arch and toes, these test and observation might not be possible because of Miah condition. The goals of pain assessment are to quantify and observe pain status so that interventions can be administer and the efficacy of those interventions evaluated. Available guidelines for the management of acute pain in general and sickle cell pain specifically recommend the use of standard pain measures, and advocate for regular documented pain assessment as an essential piece of pain management. The face, legs, activity, cry, consolability scale or (FLACC) scale is a measurement used to assess pain for children between the ages of 2 months and 7 years or individuals that are unable to communicate their pain. The scale is scored in a range of 0–10 with 0 representing no pain. In 2014 Walsh, (2014), noted that multicomponent interventions are needed to optimally deliver life-changing medications to these children and should include routine monitoring of adherence.

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