Diagnostics would need to be performed such as joint aspiration to examine the fluid to rule out septic arthritis, imaging of the joints such as x-ray, CT scan, or MRI, laboratory testing such as CBC, ESR, CRP, serum chemistries, urinalysis, and serum LDH (Kimura & Southwood, 2018). For Miah’s acute onset she would need throat culture and blood cultures, testing for Lyme disease, and an ASO titer (Kimura & Southwood, 2018). Due to her adoption status from Haiti, the suspicion of vaso-occlusive crisis mandates labs to rule out sickle cell disease. When assessing a pediatric child who complains of fatigue and irritability it is very important to complete a thorough assessment and history. Questions should be asked about sleep hygiene, sleep routines, medications, recent infections, symptoms that point to the child being ill currently, any diagnosed chronic illnesses, symptoms of shortness of breath, dizziness, weight changes, heart palpitations, fainting or anxiety problems (McCarthy, 2018). Irritability and fatigue can come from sleep disorders such as poor sleep hygiene or sleep disordered breathing (McCarthy, 2018). Medications can cause side effects such as drowsiness (McCarthy, 2018). Infections can cause fatigue such as the Epstein-Barr virus (McCarthy, 2018). Chronic illnesses such as asthma can make children short of breath and make them feel more tired (McCarthy, 2018). Patients with anemia have less red blood cells which carry less oxygen that causes fatigue (McCarthy, 2018). Metabolic problems such as hypothyroidism can cause feelings of fatigue (McCarthy, 2018). Depression or anxiety problems can also cause children to feel fatigued or irritable (McCarthy, 2018). Rare illnesses such as cancer and heart problems can also cause fatigue (McCarthy, 2018). The provider would need to draw labs to evaluate anemia using the CBC, blood smear, and reticulocyte count. In Miah’s case the hemoglobin electrophoresis test would be
specifically needed based on her symptoms and history to evaluate sickle cell as the source of the symptoms. When you combine her swollen hand and feet with the irritability and fatigue, the differential would be narrowed down. There would no longer be a concern for asthma or sleep disorders. The labs and diagnostics would then lead you to further narrow the diagnosis. The x-ray of Miah’s hands and feet would show any specific soft tissue swelling, arthritic changes, or bone issues. The blood culture and sensitivity would rule out septic arthritis or infectious source. The peripheral blood smear would look at what specific anemia is present and would detect the sickle shaped red blood cells. A CBC would assess for increased white blood cell that could indicate infection or inflammation, anemia, or changes in platelet function that would indicate issues with clotting. A reticulocyte count would help to assess whether the body is responding to the anemia and if it is appropriate for the degree of anemia going on. Obtaining a CRP and ESR level would be great indicators of acute inflammation going on in Miah’s body. Miah had some scleral icterus and an enlarged spleen
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- Summer '17
- Sickle-cell disease, MIAH, NSG6435 Week 5 Discussion