NSG 6435 WEEK 5 DISCUSSION
How would you evaluate and manage a pediatric patient who has a painful swelling of the hands and feet, fatigue, or fussiness?
... [Show More] Which diagnostic studies would you recommend for this patient and why?
Painful swelling of the hands and feet, fatigue and fussiness can be a sign of many pediatric illnesses. Fatigue and fussiness are very general symptoms that can present in almost any pediatric illness, so as a practitioner the definitive symptom that should be given priority is painful swelling of the hands and feet. According to Burns, Dunn, Brady, Starr and Blosser
(2016), tender and painful joints can occur with trauma, infection, tumors, hemoglobinopathies, systemic lupus erythematosus, Lyme disease, or Henoch-Schönlein purpura, symmetrical painful swelling may indicate sickle cell crisis, and joint swelling presents with juvenile rheumatoid arthritis, joint effusion, synovitis, a sprain or torn meniscus, or osteomyelitis.
Due to the array of possible pathologies with this presentation, further testing is needed to determine an accurate diagnosis. Prudent diagnostic studies to further evaluate the child's condition includes: complete blood count (CBC) with differential, hemoglobin
electrophoresis, reticulocyte count, erythrocyte sedimentation rate, liver function tests, c-reactive protein, peripheral blood smear, and x-rays of the affected hands and feet. CBC with differential will give the practitioner some insight if an infection is present based on the white blood cell count and any abnormalities in the various subtypes of white blood cells, if an anemia is present based on the hemoglobin and hematocrit levels, or if a bleeding disorder is occurring through the platelet count (Burns et al., 2016). Hemoglobin electrophoresis separates hemoglobin molecules on a gel medium to differentiate between each variant and identify hematological pathology (Burns et al., 2016). Reticulocyte count will assess the functioning of the bone marrow and if it is the cause of any abnormalities seen in the CBC, while the erythrocyte sedimentation rate and c- reactive protein are inflammatory markers (Burns et al., 2016). Liver function tests will determine if the liver is involved in the disease process and is malfunctioning, and a peripheral blood smear will assess for overall blood cell abnormality (Burns et al., 2016) X-rays of the affected extremities are also important to rule out injury or trauma.
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