Assessing a chief complaint
A patient is an 18-month-old female, Samantha, whose complaints include bloody diarrhea and vomiting. No dehydration is present. To diagnose the patient, several questions and the analysis of historical and clinical findings are required.
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The questions should depend on the age of the patient because of the possibility to develop different diagnoses. For example, the possibility of viruses, including Norwalk virus, is observed in infants and young children only (Carson, Mudd & Madati 2016). Shigella or Salmonella are inherent to the patients of all ages. Escherichia coli are the bacteria that may be toxic and defined in children younger than four years (Farthing et al., 2013). Taking into consideration the fact that the patient is an 18-month old girl, her parents or caregivers should answer the following questions:
- How long has the bloody stool observed? And were the same cases observed before? (This question will help to clarify if the stool is acute or chronic)
- What is the color of the stool? (The changes in the color of stool could be the outcome of liver diseases as well as evidence of the changes in feeding)
- What is the color (tone) of the blood? (It could help to tract damages)
- Is the stool severe? (As a rule, the presence of severe stool in children may be the sign of bacterial dysentery or ulcerative colitis after the diagnosis of which the patient should be hospitalized in a short period).
- Is the child on bottle-feeding or breast-feeding? (The nature of food could be used to develop further diagnoses)
After the answers are obtained, the following diagnostic studies are required:
- The investigation of stool culture (to clarify if a bacterium or some parasite is the reason for the problem);
- Rotavirus tests (to inspect the flora of the patient);
- Blood and urine tests (to identify if there is a virus in an organism) (Reust & Williams, 2016).
Three differential diagnoses for the human patient
Regarding the symptoms like bloody diarrhea (resolved in 48 hours) and vomiting (subsided over 24 hours) in an 18-month-old Samantha, the following differential diagnoses could be offered:
Food Poisoning (ICD-10: A05.0)
It is the disease that is usually caused by the ingestion of foods that contain microbial or chemical toxins (Davis & Pavia, 2015). The age of the patient presupposes the use of milk. Milk could contain bacteria that are harmful to the child’s organism. Poor hygiene or inattentiveness of parents or caregivers could be the other reasons for getting a bacterium from the outside. The presence of the blood in stool is the signal of some infection that has to be removed as soon as possible.
Infectious Colitis (ICD-10: A09.0)
It is the disease that is usually diagnosed with diarrhea and vomiting (DuPont, 2012). Many infectious causes may be used to prove this diagnosis, and the doctors rely on the results of the laboratory tests. Therefore, this diagnosis is one of the most appropriate in the list regarding such symptoms as bloody stool and vomiting.
Intussusception (ICD-10: K56.1)
It is one of the most common diseases in infants under 2 years old who suffer from diarrhea and vomiting. The peculiar feature of this diagnosis in the absence of infectious causes. Abdominal pain could also be observed. Therefore, all additional symptoms and changes should be clarified to prove/disprove the chosen diagnosis.
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The most common causes
Vomiting is a serious disease that causes some unpleasant feelings and emotions in humans. Besides, it is a sign of serious health problems and concerns that should bother people. The symptoms that cause vomiting and nausea vary considerably and affect different organ systems. They include overeating, emotional stress, heart attacks, food poisoning, or intense pain. However, it is also necessary to remember that age is a crucial factor in dealing with vomiting. The following classification helps nurses to succeed in patients’ examinations:
Infants are patients under five years. The reasons for vomiting may be based on their behavior, and vomiting may be explained by rapid feeding, swallowing of huge amounts of air, or unpredictable overfeeding. Also, the causes of vomiting include allergies, food poisoning, brain disorder, intestinal obstruction, and meningitis (Naser & El-Najjar, 2016). Such diagnostic studies as the analysis of blood and the culture of the stool are required. Besides, the history of the current events should be covered to clarify the possible threats. Clinical evaluation and ultrasonography could also be required.
Vomiting in children aged between 5 and 12 may be caused by inflammation of the intestines, bowel viral, and colon bacterial, pharyngitis, pneumonia, harsh cough, peritonitis, and pelvic (Naser & El-Najjar, 2016). Clinical evaluation, the analysis of the stool culture, immunoassays for viral antigens, and ultrasonography are offered as the main diagnostic studies.
Adolescents are patients between 12 and 18 years. The causes of their vomiting may be such diseases as appendicitis that should be diagnosed with the help of ultrasonography, eating disorders that could be identified using clinical evaluation, or intracranial hypertension that is usually caused by a tumor and checked with the help of brain CT. Besides, it is necessary to remember that pregnancy may be the cause of vomiting. Therefore, girls should also take urine pregnancy tests. The patients of both genders need to take clinical evaluation to check if the reason for vomiting is/is not a reaction to drugs.
Carson, R.A., Mudd, S.S., & Madati, P.J. (2016). Clinical practice guideline for the treatment of pediatric acute gastroenteritis in the outpatient setting. Journal of Pediatric Health Care, 30(6), 610-616.
Davis, C.R., & Pavia, A.T. (2015). 50. Food poisoning. In D. Schlossberg (Ed.), Clinical infectious disease (pp. 342-348). Cambridge, UK: Cambridge University Press.
DuPont, H.L. (2012). Approach to the patient with infectious colitis. Current Opinion in Gastroenterology, 28(1), 39-46.
Farthing, M., Salam, M. A., Lindberg, G., Dite, P., Khalif, I., Salazar-Lindo, E.,… Krabshuis, J. (2013). Acute diarrhea in adults and children: a global perspective. Journal of Clinical Gastroenterology, 47(1), 12-20.
Naser, S.S.A., & El-Najjar, A.E.A. (2016). An expert system for nausea and vomiting problems in infants and children. International Journal of Medicine Research, 1(2), 114-117.
Reust, C.E., & Williams, A. (2016). Acute abdominal pain in children. American Family Physician, 93(10), 830-836.