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Patient is a 20 months old African American female who was brought to the pediatric office by her mother with a chief complaint of diarrhea and vomiting for 3 days. Mother stated that her stools as liquid and foul smelling, with no mucous, slime or blood. Mother states that her baby is unable to keep anything down, vomiting after each feeding, including water. Her baby has had about 5 episodes of diarrhea and 4 episodes of vomiting a day. Mother reports that her baby is not feeding well and her activity level has decreased, she looks weak and tired to her . And in the last few hours, she has a decreased number of wet diapers. Mother reports that her last weight at 18 month check up was 24 pounds .
Exam: VS T 37.0, P 110, RR 25, BP 100/75, weight 23 pound, HT 33.7 inches . She is alert, sitting on her mother's lap , looks tired and cries sometimes during the exam. HEENT: anterior fontanel closed, minimal tears, lips dry, mucous membranes tacky, no oral lesions or erythema, TMs normal. Her neck is supple. Heart exam reveals mild tachycardia, no murmur. Lungs are clear. Abdomen is flat, soft, and non-tender with hyperactive bowel sounds. No wet diaper during the exam. Moves all Her extremities. No rashes present. Her capillary refill time is less than 3 seconds and her skin turgor is slightly diminished.
Possible Diagnosis: Gastroenteritis and Dehydration
Reflect on a this pediatric patient above who presented with gastrointestinal disorders during your Practicum clinical experience. Describe your experience in assessing and managing the patient and his or her family as their primary care practitioner. Include details of your "aha" moment in identifying the patient's disorder as relates to your class reading and references. Then, explain how the experience connected your classroom studies to the real-world clinical setting.
Class Reading /References
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.
?Chapter 32, "Gastrointestinal Disorders" (pp. 739-788)
•Diagnosis, management, and prevention of rotavirus gastroenteritis in children by Parashar, U.D., Nelson, E.A., Kang, G. in BMJ. 2013 Dec 30;347:f7204. doi: 10.1136/bmj.f7204. Copyright 2013 by BMJ Publishing Group. Reprinted by permission of BMJ Publishing Group via the Copyright Clearance Center.
•Blackmer, A. B., & Farrington, E. A. (2010). Constipation in the pediatric patient: An overview and pharmacologic considerations. Journal of Pediatric Health Care, 24(6), 385-399.
Centers for Disease Control and Prevention. (2003). Managing acute gastroenteritis among children: Oral rehydration, maintenance, and nutritional therapy. Morbidity and Mortality Weekly Report, 52(RR-16), 1-20. Retrieved from http://www.cdc.gov/mmwr/PDF/RR/RR5216.pdf