no medical explanation (Jain, 2015)Other signs on X-ray of child abuse:Rib fractures, epiphyseal separation, digital fracturessternal, spinus process and clavicular fractures (Kodner &Wetherton, 2013).No active diseases notedDiffuse bowel distention- indicative of bowel in juryAmylase – Elevated 115 U/L- range 25-100- Amylase is a digestive enzyme and helps break down carbs. Elevated levels could mean problems with the pancreas (Fischbach, 2018).VBG: Venous pH 7.2-7.35-7.45-Low-? -Acidic bloodPvO2 < 65%- Abnormal- increased O2 consumption-fever, shivering. exercise, hyperthermia Lipase: 60 units/L- Elevated. -? problems with pancreases, kidney, or bowel (Fischbach, 2018).Lactic acid: > 4 mmol/L- Elevated-? bowel injury (Fischbach, 2018).CT abdomen/pelvis with IV contrast: CT scan of abdomen with oral contrast demonstrates a large central area of edema inclusive of collections of blood. Marked bowel distension. Findings consistent with duodenal hematoma (Fischbach, 2018).UA-concentrated urine with prerenal pattern-Important in all abdominal blunt force cases. ? dehydration, heart failure, excess vomiting, diarrhea or glycosuria (Djordjevic, Slavkovic, Marjanovic, & Zivanovic, 2015)Pediatric/Adolescent Assessment Tools (Ages & Stages, etc) with
results and rationale for adolescents (HEADSSSVG Assessment)The patient has Down syndrome. Mom states he grows and develop slowly. Also, He can say a few words and he started walking later than his other siblings. Downs syndrome is characterized by three copies of chromosome 21. Children are diagnosed with downs syndrome when a full or partial copy of chromosome 21 is present. The extra chromosome causes disruption in attaining milestones as well as the normal course of child development. Physical attributes of children with downs syndrome include, intellectual disability, flattened nose, flattened face, brachycephalic head, upward-slanted eyes, thick protruding tongue, low set ears, tooth ageniss, palmer creased, atlantoaxial instability as well as shortened extremities and height (Hollier, 2018). ASSESSMENT (Diagnosis – 3 Differentials and Primary)Include at least three differential diagnoses with ICD-10 codes. (Includes Primary dx and 2 differentials)Document Evidence based Rationale for ROS and each differential with pertinent positives and negativesPrimary diagnosisIs #1 on list of differentialsEvidence for primary diagnosis should be supported in the Subjectiveand Objective exams.Primary Diagnosis:Child abuse: ICD-10-CM T76.12XA Differential Diagnosis:Blunt abdominal trauma: -S39-Injury to the abdominal region that results from force or a direct hit to the abdomen ( Djordjevic, Slavkovic, Marjanovic, & Zivanovic, 2015). Patient s/s- rubbing abdomen, crying, pain, bruise 10 cm long, mom states boyfriend said Tommy fell out of bed. Septic shock-R65.21-Systemic infection that causes very low blood pressure. S/S- low body tempt, fever, chills, decreased urine output, rapid pulse, rapid breaths, nausea, vomiting, diarrhea, confusion, dangerously low B/P (Holier, 2018). Patient s/s- increased respirations, decreased urine output, increased respirations, increased pulse, vomited x1. No fever, no
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- Summer '17
- NSG6435 Discussion