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? Evaluation and management of a patient who presents with painful swelling of the hands and feet, fatigue and fussiness would involve a complete history of the patient and family. In this case, Miah was adopted from Haiti and her intrauterine, birth, and family history is unknown. Considering Miah is African America, it is important to keep in mind that sickle cell disease occurs in about 1 of every 400 African American infant and 8% of African Americans are heterozygous carriers of the sickle gene, meaning they have sickle cell trait (Hay et al., 2014). By age 1, a child may present with symptoms of a moderately severe hemolytic anemia. These symptoms include pallor, fatigue, jaundice, dactylitis (hand and foot syndrome), fever, and enlarged spleen (Hay et al., 2014). History- fever, characteristic of symptoms, severity, location and number of involved joints, precipitating factors, relieving factors, associated symptoms, other medical conditions, inactivity, and complete reviewof systems. Physical Exam: General appearance, complete musculoskeletal exam, special attention to heart, lungs, skin and eyes since these organ systems are often affected in children with joint pain or swelling (Kimura,Southwood, 2018). Evaluate motor strength, ROM, gait, reflexes and musculoskeletal abnormalities. For this specific patient, diagnostic testing should include: CBC, Hgb electrophoresis, ESR, LDH, reticulocyte count, liver function test, peripheral blood smear, CRP and x-ray of joints. It would be beneficial to check a rapid plasma regain, blood culture and sensitivity, TB skin test and antinuclear antibody as well, to assess for arthritis. A CBC with differential will help identify the presence of an infection, anemia and/or potential bleeding disorders through platelet count analysis (Burns et al., 2016).Liver function test will determine if the liver is involved and functioning correctly. Hemoglobin electrophoresis helps identify hematological pathologies while peripheral blood smear assesses the number and morphology of RBC’s, WBC’s and platelets (Burns et al., 2014). CRP and ESR are
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- Summer '17
- Hematology, Sickle-cell disease, Miah Zavarro