iHuman Case Study: Cardiovascular and Hematologic Disorders in Children
1. How would you evaluate and manage a pediatric patient who has a painful
... [Show More] swelling of the hands and feet, fatigue, or fussiness? Which diagnostic studies would you recommend for this patient and why?
Painful swelling of the feet and hand, fussiness and fatigue could suggest the diagnosis of several pediatric diseases. When a pediatric patient is reported to present with the above symptoms, it is very important for the healthcare provider to first differentiate between the general and specific symptoms. Fussiness and fatigue are classified as general symptoms since they are common in several conditions. On the other hand, painful swelling of the feet and hands are specific symptoms, which must be prioritized in the diagnosis of the case provided. Several research findings suggest that pediatric patients experiencing painful and tender joints might be as a result of medical conditions such as trauma, hemoglobinopathies, Henoch-Schoenlein purpura, Lyme disease, systemic lupus erythematosus, and tumors infection. Consequently, asymmetrical painful swelling may indicate a sickle cell crisis (Chakravorty, & Williams, 2015). Additionally, swelling of the joints might be as a result of joint effusion, a sprain, synovitis, rheumatoid arthritis or torn meniscus.
As a result of the several differential diagnoses, further tests are required for an accurate diagnosis to be made. Such diagnostic tests include complete blood count (CBC) with differential, reticulocyte count, hemoglobin electrophoresis, erythrocyte sedimentation rate, c-reactive protein, liver function tests, peripheral blood smear, and an x-ray of the affected feet and hands (In McCance, & In Huether, 2019). The CBC with differential will help in providing some insight in case of the presence of infection based on the number of white blood cells or any abnormalities, anemia based on the hematocrit and hemoglobin levels, or bleeding disorder based on the platelet count. The hemoglobin electrophoresis is essential in the identification of any hematologic pathology. A reticulocyte count is crucial in evaluating the bone marrow functioning, as the c-reactive protein and erythrocyte sedimentation rate are inflammatory markers. The liver function test will help the physician find out if the liver is involved with the patient’s symptoms or malfunctioning. The peripheral blood smears are essential in evaluating the overall blood cell abnormalities. To rule out trauma or injury, an x-ray of the affected area is needed. The management will depend on the findings of the above tests, after which a treatment plan will be provided based on the diagnosis.
2. What physical exam findings and diagnostic results would be concerning to you and why? What would be three differentials in this case? [Show Less]