Evaluation and management of a pediatric patient who has a painful swelling of the hands and feet, fatigue, or fussiness
The evaluation process of the pediatric patient would involve the collection of information about his past health records. I would be particularly keen to ask for any details about the diseases to which he has been treated since birth to try to create a relationship between the prevailing illnesses and the current symptoms. This would be followed by a close examination of the severity of the inflammations to determine the best approaches toward enhancing the wellness of the patient. The next step would be the application of a pain management process as further investigations of the symptoms continue. I would particularly be keen to ensure that the actual pain involved in the caregiving process is eliminated. It would be imperative to identify other symptoms that the patient might be portraying, and place them under close monitoring to identify any changes that might have serious implications on the patient’s health.
It is apparent that the highlighted symptoms are quite general based on the knowledge acquired on cardiovascular and hematologic disorders in children; hence, there is a need for certain diagnostic procedures to be performed to eliminate some of the possible illnesses based on the current symptoms. The main issue would be the determination of the specific illness, but there are numerous differences in symptoms that would come in handy in providing a clear picture of the illness. Before the determination of the illness, the patient would only be placed under pain management and close monitoring conditions as the tests continue. I would recommend diagnostic studies for sickle cell disease (SCD), Henoch-Schonlein Purpura (HSP), and Kawasaki disease. Blood tests would be done to eliminate the diseases while highlighting the actual illness.
Physical exam findings, diagnostic results and the differentials
As aforementioned, the three differentials, in this case, would be SCD, HSP, and Kawasaki disease. The diagnostic process would involve ruling out two diseases by focusing on the physical symptoms and blood tests. There are specific symptoms that would raise concerns that would identify the actual illness. For instance, if it is sickle cell disease, some of the symptoms that would raise concern include yellow skin and yellow whites of the eye, pain in the chest, lower back, and abdomen, severe anemia from the blood test, and the presence of infections. The severity of the symptoms would also be considered to determine the stages of the illness.
For HSP, the symptoms that would raise concern would include the classic rash associated with the disease, abdominal pain, and blood in the urine, which would indicate the presence of kidney disease, headache, and fever, among the already identified general symptoms (Davin & Coppo, 2014). The main concern with HSP is the condition of the kidneys. With Kawasaki disease, one would diagnose it by asking the parent whether the patient has experienced a fever that lasted at least five days. The presence of red eyes, body rash, swollen red lips, and swollen lymph nodes would also be an indication of the illness being the Kawasaki disease (Sanchez-Manubens, Bou, & Anton, 2014). Since the initial symptoms highlight the presence of fatigue and fussiness, it is apparent that the disease is highly likely to be SCD (Gravitz & Pincock, 2014). This is because the other two illnesses are not normally associated with fussiness.
The treatment for a patient with SCD and education for his family
Patients with sickle cell disease are associated with a spleen that is not fully functional, which lowers their ability to form defensive mechanisms against numerous infections. The low immunity associated with a defective spleen is the main cause of a high morbidity and mortality rate associated with sickle cell disease. Parents with pediatric patients suffering from sickle cell disease need to be educated on the most effective ways of managing the disease, and education should be focused on the provision of preventive measures. A qualified physician should handle a case where the spleen does not function properly or is fully dysfunctional. Placing the patient on medication with antibiotics is one of the best ways to reduce the risks of getting serious infections (Brousse, Buffet, & Rees, 2014).
Antibiotics such as penicillin have proved to be highly effective in protecting children from serious infections after being diagnosed with sickle cell disease. Children with sickle cell disease must also be taken for immunization to get vaccinations against the illnesses that are normally associated with children with low immunity. The normal vaccinations have to be received, as well as special vaccinations, which include influenza, meningococcus, and pneumococcus (Brousse, Buffet, & Rees, 2014). These preventive measures must be provided to minimize the risk of the child getting infections that would lead to a fatal end. Parents should also know that children with sickle cell disease have difficulty in maintaining a good weight. Regular weight measurements and tests for oxygen saturation must be conducted. Additionally, children must also receive screening for eye problems and hypertension. It is also necessary to monitor the cognitive development patterns of the child because it might be impaired, and the relevant interventions must be applied in such cases.
References
Brousse, V., Buffet, P., & Rees, D. (2014). The spleen and sickle cell disease: the sick (led) spleen. British Journal of Haematology, 166(2), 165-176.
Davin, J. C., & Coppo, R. (2014). Henoch-Schonlein purpura nephritis in children. Nature Reviews Nephrology, 10(10), 563-573.
Gravitz, L., & Pincock, S. (2014). Sickle-cell disease. Nature, 515(7526), S1-S1.
Sanchez-Manubens, J., Bou, R., & Anton, J. (2014). Diagnosis and classification of Kawasaki disease. Journal of autoimmunity, 48, 113-117.