GRADY HARRIS Ihuman Case Study “TUMMY ACHE” with Solution 2023, Exams of Nursing

Download GRADY HARRIS Ihuman Case Study “TUMMY ACHE” with Solution 2023 and more Exams Nursing in PDF only on Docsity! 1 GRADY HARRIS Ihuman Case Study “TUMMY ACHE” with Solution 2023 Questions(to mother) - Yields 100% 1. How can I help himtoday? a. He isn’t himself. He’s been whining and refusing to eat. I think he’s saying that his tummy hurts. When I took a look at his tummy, it had a big bruise. 2. Does he have any other symptoms or concerns we should discuss? a. Yeah, he vomited once last night, and he just keeps rubbing his entire stomach. He’s not his usual, cheerful self. He’s really low in energy and withdrawn. He pees less - you know, I’m not changing so many wet diapers, and his pee is dark and strong smelling. Um, oh, and you can see, he’s still kind of sweaty and clammy. He seemed to be breathing fast – maybe he’s nervous. 3. When did his abdominal pain start? a. About 2 days ago. 4. What are the events surrounding the start of his abdominal pain? a. My boyfriend says my baby fell from the bed during a nap and the problems started after that. I don’t really know what he hit when that happened, but all his problems started: whining, being really lowenergy or withdrawn, not eating, and peeing less. He even vomited once last night. 5. Does anything make the pain in his abdomen better or worse? a. He seems to be worse when I touch him, or pick himup. 6. How many wet diapers does your child make per day? a. Usually? I’m not always there to change them, but nowthere seems to be fewer. Also, his pee smells strong and it looks dark. 7. How many stool diapers does your child have per day? a. Normally? He usually poops once a day. I haven’t changed one in at least a day now. I’m a bit worried about that. 8. What childhood illnesses has he had? a. Other than all the fuss with his heart defect, he’s been a pretty healthy little guy. I mean, he’s slow - but that's what you get with Down Syndrome. Everything’s affected…his growth, he doesn’t really say many words yet, and he doesn’t pick new things up very quickly. That can be kind of frustrating, you know. 9. Are his immunizations up to date? a. Yeah, they are, except for the last ones. 10. Is he taking any prescription medications? a. Uh…no. Not anymore. He used to take medication for his heart problems, but since they fixed thathe doesn’t need them anymore. 11. Is he taking any over the counter or herbal medications? a. No, I don’t give himany of those things. 12. Has he had pain in his abdomen before? a. No, not like this. He has always eaten well and he’s never acted like this before. I can tell you that for sure. 13. Has he had any trauma to his abdomen? a. Maybe. He fell out of bed - maybe that’s the cause. 14. Does he have any allergies? a. No, he doesn’t have allergies. 15. Has he had any significant traumatic injuries or accidents? 2 a. He’s a real clumsy little guy. Always falling down, tripping over things, bumping into things and stuff. Doesn’t look where he’s going. I wouldn’t call that a huge, big accident though. He’s never hadany broken bones. 16. How is his family and family life? a. It’s just me and my three kids: my 6-month-old, my 5-year-old and my two year old. The father of my two-year-old is out of the equation, and never has been with us. Sometimes my boyfriend, who’sthe father of my 6-month-old, stays over. I'm a cashier at a retail shop - I mean I only graduated from high school - and so I don't make that much money and I can't afford daycare, so my neighbors really help me out. Sometimes my boyfriend looks after them, but he doesn't really like tobecause you know kids - they whine or cry at the same time it seems and he gets really on edge about it. 17. What and when did he last drink? a. I tried to give himsome water two hours ago. He won’t take anything. 18. Can you tell me about any current or past medical problems he has had? a. He was born with Down Syndrome and when he was a baby he had a problem with his heart. Part of that was he also used to have CHF and took medications, but that got better after his operation. He is a bit slower to learn things than some other children. But he has the biggest heart, and he justloves everybody. And he's otherwise healthy. Please help my baby! 19. Does he have diarrhea? a. No, I haven’t seen any. 20. Is there any blood in his stools or with his bowel movements? a. He hasn’t pooped in a while. So actually, I’mnot totally sure about that, but I don’t think so. 21. How long does the pain in his abdomen last? a. It’s been going on since it started. I mean, I wouldn’t bring himhere if I thought it was going away. 22. Tell me about the health of his grandparents, parents, and children. a. I’ve got anemia. My oldest has asthma. His birth father? I knownothing about his health. Don’t care to be honest. 23. Any previous medical, surgical, or dental procedures? a. My son had surgery to close a hold in his heart. I think they call the surgery “ASD”. I haven’t taken himto the dentist, though. I really should do that. 24. Does he bruise or bleed easily? a. Yes, he seems to get bruises really easily. He’s also a clumsy little guy, tripping over stuff all the time. 25. Does he have any skin problems? a. No, uh, that is, he’s a baby you know so he can get some diaper rash, but I think he’s fine. 26. Has he recently had an upper respiratory infection? a. Not recently…but he always seems to be congested. 27. Has he had any seizures? a. No, nothing like that. I think my boyfriend and neighbors would have told me that for sure. 28. Were there any complications with his birth? a. You mean besides his Down Syndrome? No, the birth itself wasokay, I guess. 29. Has he had any trauma to his head? a. No. Well, I mean, I don’t truly know. He could have hit his head when he fell. I’mreally worried, do you think he hit his head hard or something? 30. Is he exposed to secondhand smoke? a. Well…uh…I guess so. I do smoke – and so does my boyfriend – but we try to keep it away fromthe kids and we don’t smoke in the same room as them. 31. Have you noticed a sudden change of behavior or personality in him? 5 One episode of vomiting Related Lethargy Related Sweating Related Tachypneic Related Decreased urination, dark, strong-smelling urine Related Listless, ill appearing Related Decreased responsiveness Related Tachycardia Related Hypotension Related Abdominal distention; epigastric bruising Related Diffuse abdominal tenderness, guarding, rebound tenderness Related Atrial-Septal-Defect s/psurgical repair Unknown Dental Caries Related Down Syndrome, global developmental delay Unknown Lowincome, single parent w/multiple young children Unknown Small for age, Down Syndrome features Unknown 3/6 systolic murmur Unknown Reducible 2.0 cmumbilical hernia Unknown Fading (old) ligature marks Unknown Diaper Rash Unknown History of CHF Resolved Problem Statement Grady is a 26-month-old male w/Down Syndrome brought in by mother who reports that he has been “whining” about abdominal pain x2 days, one episode of vomiting, he is lethargic, sweating, breathing rapidly, and has decreasedurine output that is dark in color. Mother reports symptoms began after Grady “fell out of bed during his nap” while under the care of her boyfriend. She denies any knowledge of head trauma but reports that he is not eating or drinking. Denies prior injuries requiring medical attention. PMH significant for s/p ASD repair w/transient CHF in infancy. Child appears listless and pale. Differential Diagnosis - Yields 100% 6 Diagnosis Lead Alt MNM Blunt Abdominal Trauma X X Child Abuse (Acts of Commission) X X Systemic inflammatory response syndrome X X Traumatic brain injury X X Hirschprung’s disease X X Hernia, incarcerated/strangulated X X Henoch-Schonlein purpura X X Volvulus X X Orders - Yields 100% Amylase, serum Abnormal CBC Abnormal CMP Abnormal CTAbdomen/Pelvis Abnormal Head CT Normal Lactic Acid Abnormal Lipase Abnormal PT/INR Abnormal; critical Skeletal Survey Acute rib fracture, left 8th Healing rib fractures, right 4th and 5thOld rib fractures, right 9th and 10th CXRotherwise without evidence of active diseaseNG tube and foley catheter in place No free abdominal air Diffuse bowel distention No evidence of pneumonia as a source of infection No other evident fractures per limited survey of extremities 7 Urinalysis Abnormal Venous Blood Gas Abnormal Diagnosis (He has THREE) - Yields 100% 1. Blunt force trauma 2. Child abuse - act of commission Electronic Health Record Reason for encounter Grady is here today brought in by his mother with reports of "not being himself", he is whining and refusing to eat, and she thinks that he is trying to say that his tummy hurts. History of present illness Two-day history of decreased appetite and thirst with abdominal pain, one episode of vomiting, decreased urinary output withdark, strong-smelling urine noted indiapers. Mother reports that he has been low in energy and withdrawn, sweaty/clammy following a "fall frombed while napping" while under the care of her boyfriend. General Complaints of listlessness, fatigue, lethargy, decreased energy, denies fever. HEENT/Neck Mother denies throat pain, hoarse voice, and foul-smelling breath. Denies sinus problems, dysphagia, nose bleeds, nasal discharge, or dental disease. Denies ear pain, hearing loss, ringing in ears, discharge. Denies use of corrective lenses, redness, blurring, or visual changes of any kind. Cardiovascular Mother reports history of ASD with repair, transient CHF in infancy. Denies chest pain, palpitations, orthopnea, edema, peripheral cyanosis. Respiratory Mother isreporting more rapid breathing. Denies other respiratory complaints. Gastrointestinal Mother reports complaints of abdominal pain, one episode of vomiting. Mother denies diarrhea, constipations, red or tarry black stools. She reports that she has not changed a stool diaper recently. Genitourinary Mother reports decreased urinary output and dark, strong-smelling urine in diapers. Musculoskeletal/Osteopat hic Structural Examination Mother denies back pain, joint swelling, stiffness, or pain, fracture history. Neurologic Mother reports developmentally delayed due to Down Syndrome. Poor verbal communication. Denies syncope, seizures, black out spells. Mother reports that the patient is "clumsy" and "doesnot look where he's going", so he bumps into things a lot - implying unsteady gait. Integumentary/Breast Mother reports bruising to the patient's stomach, cool, clammy skin. Denies rashes, bleeding, or any lesions/moles. Reports occasional diaper rash. 3. Systemic inflammatory response syndrome (SIRS)