Visual inspection or the rectum reveals no fissures, bleeding, or masses. Soft, brown stool, guaiac-negative.
Musculoskeletal Full ROM x 4 extremities, spontaneous movement with weakness. No focal deficits or trauma. Slight pain on palpation of lower extremities. Neurological No evidence of gait abnormality, speech deficits present. No evidence of dyskinesia or tremor. Psychiatric Lethargic, listless, decreased the level of responsiveness but responds to verbal stimuli. In-house Lab Tests – document tests (results or pending) CBC CMP Lactic Acid PT/PTT Amylase Urinalysis Lipase Venous blood gases (VBG) Pediatric/Adolescent Assessment Tools (Ages & Stages, etc.) with results and rationale For adolescents (HEADSSSVG Assessment) Vital signs assessment tool, age appropriate Faces Pain Scale, 1-5 Home: Lives at home with mother, boyfriend, and two other siblings. Education: Mother can’t afford daycare. Neighbor and boyfriend care for the child while mother works. Eating: Normally eats a balanced diet with fruits and vegetables, good appetite. Activities: Normally very active and energetic, enjoys playing with age-appropriate toys and his siblings. Drugs: The mother admits to smoking in the home, denies drug/alcohol use of any kind. Safety: Denies guns or weapons in the home. Sits in a car seat, forward facing when riding in automobiles. Diagnosis
Systemic Inflammatory Response (R65.10) Volvulus (K56.2) Primary diagnosis Blunt Abdominal Trauma (Y04.8) Child Abuse: Act of Commission (T74.12XA) PLAN including education Trauma is the leading cause of morbidity and mortality in the pediatric population. The abdomen is the third most commonly injured anatomic region in children, after the head and the extremities. Abdominal trauma can be associated with significant morbidity and may have a mortality as high as 8.5%. The abdomen is the most common site of initially unrecognized fatal injury in traumatized children (Saxena, 2017). Any child with suspected abdominal trauma should be initially evaluated according to Advanced Trauma Life Support (ATLS) Guidelines. A focused primary survey aimed at rapidly assessing the ABCs ( A irway, B reathing, C irculation) remains the initial priority. Also, at the time of the primary survey, performing an abbreviated neurologic assessment (D) and completely exposing (E) the child to thoroughly search for injuries are appropriate (Saxena, 2017). Plan: Admit to ICU for further management. In all children with suspected inflicted injury, the abdomen should be thoroughly evaluated. This investigation may include laboratory assessment (e.g., liver function tests [LFTs], amylase level, lipase level, complete blood count [CBC], and urinalysis), diagnostic imaging (e.g., CT), or both to help detect abdominal injury (Scholer SJ, Pituch K, Orr DP, Dittus RS Continuous cardiac monitoring, pulse oximeter, and vital signs. Emergent surgical consult Provide oxygen supplementation for hypoxia Isotonic –fluid boluses as needed - An algorithm for volume replacement in the injured child (both hemodynamically stable and unstable) is important. Because of the unique compensatory
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- Summer '17
- abdominal trauma, Peritonitis, NSG6435 Week 7 Discussion