). Pt S/S- dental caries, diaper rash, has not had immunizations up to date.DiagnosesPrimary Diagnosis-
Child abuse- Child abuse: ICD-10-CM T76.12XA -The Child Abuse Prevention and Treatment Act, characterizes child abuse as “any recent act or failure to act on the part of a parent or caretakerwhich results in death, serious physical or emotional harm, sexual abuse or exploitation” or “an act or failure to act which presents an imminent risk of serious harm.”7Although each state has their own defifnitiion of child abuse, most staes recognize 4 major types of child ause. These include neglect,physical abuse,emotional abuse,n as well as sexual abuse ( Kodner & Wetherman, 2013)SecondaryDiagnosisBlunt force trauma- S39-Duodenal hematoma-K26.0SIRS- E65.10PlanVaccines administered:No vaccination needed at this time, although he has not had his last set of vaccines dues at age 2 per his mom.. Initial resuscitation and stabilization:-Assess ABC’S.Admit Tommy to ICU for further management. Begin continuous cardiac monitoingr andContinuous pulse oximeterContinuous B/P to monitor vital signs.Strict intake and out put monitoring- Initial stabilization and manitining ABC is first priotiry(Ayhan, & Beyazit, 2019).Medications-Start IV access to administer IV isotonic-fluid boluses PRN isotonic saline of 20-60 mL/kg can go as high as 120mL/kg to rehydrate to therapeutic goal of fluid expansion (Djordjevic, Slavkovic, Marjanovic, and Zivanovic,2015)Diagnostic tests ordered:Skeletal survey-first line and crucial in assesseing child abuse cases(Jain, 2015)., CBC, UA, CMP, amylase,lipase,CT-imagingaing study of chices (Djordjevic, Slavkovic, Marjanovic, & Zivanovic,2015)Consultation:-Emergency consultation for surgery (Djordjevic, Slavkovic, Marjanovic, & Zivanovic,2015)Parent Education:
Educate mom on course of action and notifivation of child services protocol.Additionally ,Explain to Tommy;s Mom in a non confrontational tone, your role, and responsibiltities in reporting suspected or actual child abuse to the proper authorities. It is also important to educateher that you are an advocate for the child (Kodner &Wehterton, 2013).Inerventions to prevent child abuse in the primary care setting:Regualrly assess childs social function/historyAcknowledge the frustratins of parentinsDiscuss coping strategies for colicky babies or crying a lotRecognize the increasedrisk of abuse of childfren with disabiliitesScreen for domestic/intimate opartner violenceGuide parents in effective dispciplein strategies ( Kodner,& Wehterman, 2013)Non-medication treatments:As soon as child emergacny needs are metContact Poplice and Department of children and families to file abuse/neglect charges. Contact security for support. Daily wieghts. Follow-up: Revalate frewuenctly until stableSeek daycare or developmental program for tommy to attend-Tommy’s mom cannot afford daycare and has a highschool diploma. She has to rely on neighbors and her boytfrine to wacth tommy- Children in poverty have higher rates of abuse/maltreatment (Landers, Carrese, & Spath, 2019)Evaluation:
Downs syndrome is one of the most common chromosomal disorders among humans. Its is
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- Summer '17