Miah Zavarro
21 month y.o. female
2’7” / 10.4kgs (BMI 16.8)
C/O Swollen Hands / Feet
V/S: BP 90/58; T 98.6; HR 134; RR 28; Ox 98%
Interview
... [Show More] Progress: 0/5 Progress: C/C Sx:
Associated Symptoms:
PMH:
SH:
Etiology: ROS:
Questions:
Interview Opening:
• How can I help you today?
HPI:
• Has she had swelling like this before?
a. Similar episodes at 6 and 11 months; seems like every 4 months • What do you think has caused this to happen?
• Any other symptoms or concerns we should discuss?
a. Decreased appetite & swollen belly • When did her swelling start?
a. 2 days ago
• Is there any pattern to when her selling occurs?
a. Following colds
• Has there been any changes in her swelling problem over time?
a. Not really, just seems severe this time
• Where more precisely is the swelling
a. Hands and feet
• Does anything make her swelling problem better or worse?
a. Improves with rest, fluids, motrin, and time • Has she noticed swelling in any part of her body?
a. Yes hands and feet
• What treatment has she had for her swelling problems?
a. Motrin, rest, and fluids
• How severe is her swelling
a. Severe
• Is her swelling problem better or worse at any time of day, week, or year
a. I don’t know but she’s had this before • How long doe her swelling last?
a. Constant since it started
• Does she have pain anywhere? If so, Where?
a. She has pain and swelling in her hands and feet • Does she have pain/discomfort when she is at rest?
a. Yes, hands and feet hurt all the time
• Is she taking aspirin or NSAIDS? How much and how often?
a. Motrin, just what the bottle says to give for fever • Does she have nausea and/or vomiting?
a. No, appetite is off but hasn’t thrown up • Does she have diarrhea?
a. No
• How is her appetite? Any recent change?
a. Fine, no recent change
• How many wet diapers does your child make per day?
a. I don’t know why you are asking me this • Does she have night sweats?
a. No
• What are the events surrounding the start of her swelling problem?
a. She had a cold a week ago
• Does she have new weakness in an arm, leg, or her face?
a. No
• Has she gained or lost weight unintentionally and despite normal appetite and exercise?
a. No
• Does she have a cough?
a. No, she hasn’t had any cough or breathing symptoms in the last few days. Only minor cold symptoms last week • Is she short of breath?
a. No
• Does she wheeze?
a. No
• Do milk or dairy products worsen her symptoms?
a. No
• Does she have pain/discomfort when she urinates?
a. No
• Does she have a rash?
a. None that I’m aware of • Does she have a sore throat?
a. No
• Are her swollen glands painful, tender, hard, ord draining?
a. No
• Does her swollen lymph nodes come and go?
a. Not a problem
• How often does she have swollen lymph nodes?
a. She doesn’t have that problem
• Is she having any trouble with her vision?
a. No
• How many words does your child say?
a. What does that have to do with this • Has your child seen a dentist yet?
a. What does that have to do with this
• How many stools diapers does your child have per day?
a. Why are you asking me this • Any problem moving her ankles?
a. No
• Is there an stiffness in her ankles?
a. No
• Any problem moving her back?
a. No
• Is there any swelling in her eyes?
a. No
• Is there any swelling in her face?
a. No
• Any problem moving her feet?
a. Yes, it seems to hurt her • Any problem moving her toes?
a. Yes, it causes her pain
• Is there any stiffness in her toes?
a. No
• Is there an stiffness in her hips?
a. No
• Any problem moving her legs?
a. No
• Any problem moving her wrist?
a. No
• Is there any swelling in her hands?
a. Yes
• Does she have tremors?
a. No
• Does she have any problems walking?
a. Yes, she is refusing to walk; were you not listening to what I said • When did her walking problems start?
a. She stopped walking yesterday; one day after the swelling and pain in her hands and feet started.
• What are the events surrounding the start of her waling problems?
a. It was preceded by the hand and foot pain and swelling • Does anything make her problems walking better or worse?
a. Drinking lots of fluids, sleep, and motrin help her feel better
• Does she have any pain or other symptoms associated with her walking problems?
a. I can tell that her feet and hands are swollen and really hurt • Has she had walking problems like this before?
a. Well, the last time she had an episode like this she wasn’t walking yet, but she didn’t want me to hold her in the
• How often does she have these walking problems?
a. This is the first time. She hadn’t yet starting walking when she had those other episodes
• Does anyone in her family have similar problems walking?
a. I don’t know I adopted her from Haiti
• Has she had or been exposed to someone with hepatitis?
a. No
• Has she been exposed to tuberculosis?
a. No
• Has she recently traveled? Where did she go?
a. No
• Is she exposed to second hand smoke?
a. No
• Has anyone else you know developed these symptoms?
a. No
• Does she have a problem with fatigue/tiredness?
a. Yes, if she’s not fussy and irritable she is asleep • When did her fatigue / tiredness start?
a. A week ago. I expected her to feel better after the cold resolved, but she’ still fatigued along with the hand and foot symptoms
• What are the events surrounding the start of her fatigue/tiredness?
a. She had a could one week ago
• Does anything make her fatigue/tiredness better or worse?
a. Rest, is all
• Has she ever had anything like this before?
a. Yes, she’s had problems with her hands and feet before • Does she have acute gastrointestinal bleeding?
a. No
• Any changes in the frequency of her bowel movements?
a. No
• Does she have a problem with constipation?
a. No
• Is she coughing up blood?
a. No
• Does she awaken at night short of breath?
a. No
• Is she having any difficulty sleeping?
a. No
• Describe a typical night’s sleep?
a. Seems normal to me
• Does she have unusual heartbeats (palpitations)?
a. No
• Does she have any pain in her abdomen?
a. Yes, I think she does. She indicates that her tummy hurts, and it doesn’t look a little swollen to me. She doesn’t want me to touch it.
• When did her abdominal pain start?
a. Two days ago, along with the hand and foot symptoms
• What are the events surrounding the start of her abdominal pain?
a. She seems to have had discomfort for the last two days
• Does anything make the pain in her abdomen better or worse? [Show Less]