Evaluating a Pediatric Patient with Painful Swellings

Pediatric Patient with Painful Swellings How I would evaluate and manage a pediatric patient who has a painful swelling of the hands and feet, fatigue, or fussiness Swelling of the extremities, fatigue, and fussiness are all non-specific manifestations of several pathologies in children. They are commonly associated with musculoskeletal and rheumatologic disorders but can also occur in other hematological and cardiovascular complications. The cause of the patient’s symptoms needs to be evaluated to know whether it is life-threatening on not. This can be determined through various means such as the vital signs, family history, current, and past patient medical history and laboratory testing.

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CLASS DISCUSSION QUESTION CASE 5

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First, I would carry out a complete health assessment to obtain subjective and objective data on the patient. During the process, I will evaluate the swelling to determine whether it is localized or generalized and whether there are any changes in the texture and color of the skin (McInerny et al., 2016). Also, I would be keen to assess the risk of life threatening conditions that might have caused the swelling. To manage the swelling, diuretic therapy or sodium and fluid restriction can be initiated.

The Diagnostic Studies I Would Recommend Complete blood count is recommended to check for possible infections through the WBC levels. It also aids in diagnosing anemia through the red cell indices. A peripheral blood smear is essential in the case to check for staining characteristics and shape of red blood cells which helps in diagnosing the type or presence of anemia (Lanzkowsky, 2016). Both ESR and CRP are recommended to check for inflammation which occurs due to the body’s immune response and indicates and underlying disease. Liver function tests are done to check for the functioning of the liver considering abdominal distension and hepatosplenomegaly. Lastly, I would recommend an X-ray of the swollen extremities to check for or rule out arthritis.

Physical Exam Findings and Diagnostic Results that are of Concern and Three Differentials in the Case The physical exam findings that are of concern include swelling of the extremities, systolic murmurs, enlarged spleen, jaundice, and a distended abdomen. Her x-ray indicates swelling of the soft tissues and thinning of the bony cortex. From the diagnostic tests, the peripheral blood smear shows the presence of normocytic normochromic sickle shaped red cells which are indicative of anemia (Allali et al., 2017). Both ESR and CRP levels are elevated indicating inflammation. Elevated WBC levels show the presence of an infection. The red cell

CLASS DISCUSSION QUESTION CASE 5

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indices show few RBCs with low Hb, hematocrit and MCV levels and elevated reticulocyte count. From the findings, the possible differential diagnosis in the case is septic arthritis, juvenile rheumatic arthritis, and acute anemia.

Treatment for Miah and Education for the Family It is certain that Miah has sickle cell disease (SCD) which compromises the normal functioning of the spleen and also increases the risk of severe infections. The treatment of SCD aims at preventing a crisis, managing pain and preventing infections. Acute and chronic pain is managed using analgesics such as opioids, NSAIDS, acetaminophen, and morphine.

Hydroxyurea therapy should be initiated as it helps increase fetal hemoglobin in children with SCD, reduce pain episodes and acute chest syndrome (Harley, 2013). To prevent infections, regular screening, antibiotic prophylaxis, and vaccinations are used. This helps in reducing morbidity and mortality associated with infections in SCD. Penicillin is used for antibiotic prophylaxis. Other treatment options include blood transfusion and bone marrow transplant.

The family needs to be educated on preventing infections and measures to put in place to achieve it. In children, fever is a major indicator of an infection hence the family should treat it with a broad spectrum antibiotic and seek medical care. Also, they should be educated about SCD, how to manage it and actions to take in case of a crisis. The parents should be able to recognize signs of infection, worsening anemia and organ failure early and initiate appropriate interventions (Allali et al., 2017). Lastly, they should understand that SCD is a lifelong disorder that requires continuous care.

CLASS DISCUSSION QUESTION CASE 5 References Allali, S., Brousse, V., Sacri, A. S., Chalumeau, M., & de Montalembert, M. (2017). Anemia in children: prevalence, causes, diagnostic work-up, and long-term consequences. Expert Review of Hematology, 10(11), 1023-1028.

Harley, M. N. (2013). Current treatments and prospective therapies to manage sickle cell disease. Laboratory Medicine, 44(4), e92-e96.

Lanzkowsky, P. (2016). Classification and diagnosis of anemia in children. In Lanzkowsky's Manual of pediatric hematology and oncology (6th ed.) (pp. 32-41). Cambridge, MA: Academic Press.

McInerny, T. K., Adam, H. M., Campbell, D. E., Foy, J. M., & Kamat, D. M. (2016). AAP textbook of pediatric care. American Academy of Pediatrics.

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