mechanisms of the injured child, hypotension secondary to hypovolemic shock is a late and ominous event. Early aggressive fluid resuscitation is indicated in injured children. Because young children have a disproportionately larger body surface area and less thermoregulation, preserving core temperature during the care of an injured child is important (Saxena, 2017). Skeletal survey, head CT, CT/abdomen/pelvis with contrast, and MRI with diffusion-weight imagery. Contact child protective services, police, and social work personnel Speech therapy referral after stabilization. Abdominal Pain A full thorough assessment is mandatory and imperative with this patient to determine the likely cause of his pain. Fever indicates an underlying infection or inflammation. High fever with chills is typical of pyelonephritis and pneumonia. Tachycardia and hypotension suggest hypovolemia (Attard,Corlett, Kidner , Leslie & Fraser, 2014). If a postmenarcheal girl is in shock, ectopic pregnancy should be suspected. Hypertension may be associated with Henoch-Schönlein purpura or hemolytic uremic syndrome. Kussmaul's respiration indicates diabetic ketoacidosis (Attard,Corlett, Kidner , Leslie & Fraser, 2014).
Abdominal assessment The breathing pattern should be observed, and the patient should be asked to distend the abdomen and then flatten it. After the child is asked to indicate, with one finger, the area of maximal tenderness, the abdomen should be gently palpated, moving toward (but not palpating) that area. The physician should examine for Rovsing's sign (when pressure on the left lower quadrant distends the column of colonic gas, causing pain in the right lower quadrant at the site of appendiceal inflammation), then gently assess muscle rigidity. Gentle percussion best elicits rebound tenderness. Deeper palpation is necessary to discover masses and organomegaly. In general, children with visceral pain tend to writhe during waves of peristalsis, while children with peritonitis remain quite still and resist movement. The hydration status of the child should be assessed. This assessment may give the clinician a indicative answer during the assessment of patient abdominal sounds. A child who struggles to communicate can be a very challenging assessment for the clinician. This is where parenting verbalizing how the child has been acting during a painful episode. Children who do not verbalize typically present with late symptoms of disease. Children up to the teenage years have a poor sense of onset or location of pain. The classic sequence of shifting pain usually occurs with appendicitis (Ang, Chong & Daneman, 201). In children who cannot verbalize, the initial 24-hour history of vague nausea or periumbilical pain may be unreported or go unnoticed, so these children more often present at the second stage of more visceral pain. However, any child with pain that localizes to the right lower quadrant should be suspected of having appendicitis. Thus, inquiry into the location, timing of onset, character, severity, duration, and radiation of pain are all important points but must be viewed in the context of the child's age (Ang, Chong & Daneman, 2011). Abdominal trauma can be accidental or intentional. Blunt abdominal
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- Summer '17
- abdominal trauma, Peritonitis, NSG6435 Week 7 Discussion , Pediatric Soap Note