hand and feet pain and swelling. The patient is an adopted and of Haitian descent. She was born in the United States but, there is no family history is available. Dactylitis is clinically presented with sausage-like swelling of the fingers and toes. Clinical presentation of fingers and toes include swelling, slight redness, and deformity. Dactylitis can be unilateral or bilateral and is often involve unilateral or bilateral painful associated with leukocytosis and fever. Dactylitis, or hand-foot syndrome, is one of the earliest physical manifestations of sickle cell disease. Vaso-occlusive ischemia and infarction of the metacarpals and phalanges produces painful and often symmetric swelling of the hands, feet, or both. The symptoms resemble osteomyelitis or cellulitis, but unlike these conditions, the symptoms of dactylitis are self-limiting and usually resolve within a month (Dave, Pecker, Dietrich, Taylor, 2015). What would be three differentials in this case? The three differential diagnoses in this case are septic arthritis, psoriatic arthritis and sickle cell anemia. In SCD, the spleen doesn’t work properly or doesn’t work at all. This problem makes people with SCD more likely to get severe infections. What is the treatment for Miah and education for the family? The care plan for Miah is supportive care, pain management, and control of complications. The main goal of treatment is to improve survival by reducing the threat of infections. Miah should receive routine pneumococcal immunization, an antibiotic prophylaxis, nutritional counseling, and prompt treatment when infections and crises occur. Miah’s crises can be managed with analgesics and hydration. A combination of a nonsteroidal anti-inflammatory drug and opiate analgesics usually provide adequate relief. Nonpharmacological methods to decrease pain include warm compresses, relaxation, and massage. Miah’s mother should also be informed of avoiding triggers such as dehydration, cold and high altitudes, and vigorous activity or exercise. Avoid overhydration, which can precipitate acute chest syndrome. Parents should be informed to treat fevers that reach 101.5 with antipyretics (Iughetti et al., 2016). The child may need medical attention even if fever breaks. Also, parents should be encouraged to palpate the stomach for tenderness and spleen enlargement daily. Spleen enlargement suggests splenic
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