between DS and HD is lacking, although a genetic modifier on chromosome 21and 22 has been proposed. Perhaps the most clinically significant implication of this association is the understanding that patients with DS have been shown to experience higher rates of Hirschsprung-associated enterocolitis when compared with patients without DS (Halleran., Ahmad, H., Maloof, Paradiso, Lehmkuhl, Minneci,& Wood, 2020)
Pediatric SOAP notePlan1)Stabilize the patient and call the ambulance for higher acuity admission 2)Patient will need continuous cardiac and pulse oximetry monitoring. 3)He needs supplemental oxygen therapy (titrate to O2 saturation greater than 92%).3) Two large bore IVs are needed for rehydration. 4)Once completed patient can be reassessed for needs.5) Child protective services will need to be contacted for signs and symptoms of abuse (Chiocca, 2015)Abused children returned to an abusive environment without intervention are highly likely to be maltreated again and are at an increased risk for death (UpToDate, 2019)SummaryT.A. is a 26 months old male patient who was brought to the ED by his mother. The mother reported for the past two days that the child has been showing signs of distress when she lifts him, and it seems that he is experiencing pain to his abdomen. She also reported that her son has not been eating and also has not passed stool and decreased urinary output. The mother reported his wet diapers to have a strong smell odor and dark in color. She mentioned that he had one episode of vomit. She reported that her son had fallen out of bed while sleeping and that may have caused injury to his abdomen. The mother also reported that her son had a ventricular septal defect (VSD), which has now been resolved after surgery. The mother reported that her son is not being himself and showing reduced energy levels. The mother mentioned that she is a single mother and has a lower socioeconomic status and cannot afford to send her child to daycare. Therefore, her neighbors and her boyfriend look after her son while she is at work.
Pediatric SOAP noteOn physical examination, the patient appeared having low energy levels and ill Rapidly breathing noted with a heart rate of 160 bpm (tachycardia) and a low blood pressure Hypotension). A 3/6 systolic murmur was heard upon auscultation. The abdomen was visibly distended with substantial epigastric bruising and reducible 2.0 cm umbilical hernia. Lab tests were ordered, a complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis. The imaging test ordered an abdominal CT scan of the abdomen showingduodenal hematoma. Venous shows pH 7.2, WBC was 19,000, potassium 6, BUN 45, CREA 2.0, H&H 9,27. and wasAmylase115 (i-human)The differential diagnosis in this case are Hirschsprung disease (HD), systemic inflammatory response syndrome (SIRS), child abuse, and AKI. The common causes of SIRS may include the adverse impact of infective, traumatic or chemical-based stimuli, infective swelling or inadequate blood circulation (Churpek, et al., 2015). Because the patient had a fall, it could have possibly resulted in the trauma causing SIRS. The common symptoms of SIRS include hypothermia or fever,
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- Summer '17
- NSG6435 Discussion