Discussion: iHuman Case Study – Common Pediatric Illnesses

NSG 6435 Week 6 Discussion

iHuman Case Study – Common Pediatric Illnesses – This discussion assignment on iHuman Case Study – Common Pediatric Illnesses (MedU Case Study – Developmental Evaluation and Screening) provides a forum for discussing relevant topics for this week based on the course competencies covered.For this assignment ON iHuman Case Study – Common Pediatric Illnesses, 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.

For this assignment on MedU Case Study – Developmental Evaluation and Screening (iHuman Case Study – Common Pediatric Illnesses), 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.

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 .

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?

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 https://digitalbookshelf.southuniversity.edu/#/boo…

Cash, J. C. & Glass, Ch. A. (2014). Family practice guidelines, (3rd ed.). Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780826168757/

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.

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.

Discussion: iHuman Case Study – Common Pediatric Illnesses SAMPLE PAPER

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?

Acute diarrhea infections are a usual health concern in the world including people within the United States visiting third world countries. Multiple methodologies on therapies including antibiotic as well as non-antibiotic have been applied to offer treatment to the usual ailments. The knowledge on prevention, diagnostic and treatment and the implication of acute diarrhea has come into view and has assisted in the process of clinical management (Cash & Glass, 2014).

The most crucial question to ask the caregiver is whether the stool appears black and tar-like. The presence of blood in diarrhea means that there is gastrointestinal bleeding. The stool appearing like tar is a result of bleeding the upper part of the digestive tract. It is important to realize that the agents causing diarrhea in children and infants differ depending their age (Burns, C., et al, 2013). The causes of bloody diarrhea for children of the age of one year or less are mostly intestinal infection such as infant colitis. For the children above the age of one year, the common causes of intestinal infection include ulcerative colitis and Crohn’s colitis. Examples of questions are:

–Any change in appetite?

– Did you note weight gain or loss?

-Do you observe any intolerance to certain foods?

-Any nausea and/or vomiting episode observed?

-Did the patient presents change in bowel habits?

-Did the patient presents any blood in the bowel movement?

– Describe color and quantity

-Any abdominal pain?

-Describe location and if it radiates

-Describe pain intensity in a scale 1-10

-Describe frequency, quality

Cases of blood in diarrhea should be treated immediately though most of the cases observed are not serious. However, patients who notice blood in their stool should seek medical attention. In this case, tests carried out depend on the age of the patients. The factors that the doctor should consider are the individual situation and symptoms exhibited. The most commonly applied tests to assess the reason behind the blood stools include a rectal exam, anoscopy, colonoscopy otherwise known as sigmoidoscopy. The initial diagnostic that the doctor may take is the rectal exam. In this exam, the doctor will use the finger to assess the internal parts of the anus and observe the external parts as well.

iHuman Case Study – Common Pediatric Illnesses – What would be three differential diagnoses in this case?

In the I Human case study of Samantha Graves, the differential diagnosis were:

-Viral gastroenteritis

-Parasitic 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 is a symptom that has frequently been reported in children. A critical assessment has to be carried out to determine the causes which may call for immediate medical attention. Several elements have to be considered including the onset, duration, and frequency of the vomit. At any age of human development, bilious vomiting has to be addressed urgently seriously and obtaining the past medical status of any persistent bouts of vomiting is crucial (InKoch & In Hasler, 2017). Children and young people with gastroenteritis have been realized to get better with the introduction of ondansetron. In the same line, ondansetron has also been discovered to reduce the population children as well as the young people in necessity of intravenous fluid therapy and step down the patients’ hospital visits by a significant margin. The National Institute for Health and Care Excellence developed a clinical guideline for vomiting and diarrhea as a result of gastroenteritis. The identification of the illness, examination, and management for the children under the age of five years concluded that prescription of antiemetic could not be recommended as at now. Nevertheless, more studies on the application of ondansetron were required, mostly looking at the probable risk of increasing diarrhea (National Institute for Health and Care Excellence, 2014).

In summary, we can rightly conclude that patients with diarrhea and vomiting should seek medical attention urgently. It should be noted that diarrhea is one of the most reported illnesses in the world. In fact, it is the primary cause of mortality for children under the age of four years. On the other hand, cases of vomiting should also be taken seriously so that it may be diagnosed early.

iHuman Case Study – Common Pediatric Illnesses References

Burns, C., Dunn, Brady, Starr, N. B., Blosser. (2013). Pediatric primary care. (5th ed.). Retrieved from https://digitalbookshelf.southuniversity.edu/#/boo…

Cash, J. C. & Glass, Ch. A. (2014). Family practice guidelines, (3rd ed.). Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780826168757/

In Koch, K. L., & In Hasler, W. L. (2017). Nausea and vomiting: diagnosis and treatment.

National Institute for Health and Care Excellence. (2014). Management of vomiting in children and young people with gastroenteritis: ondansetron.