CASE STUDY: Clinical Journal Entry: 1 to 2 pages
A 21 month old Caucasian baby girl was brought to clinic by her mother with complaint of her baby getting irritable, easy tired during the day and sleeps more than usual after small activities at the day care and now she just noticed her skin is pale especially around her hands and eyelids and her husband also confirmed that she did look pale. So they are here today for a checkup even though she notices no other developmental changes. Mother denies any s/s of GI bleed like tarry stool. She has been current with her immunization and has no other medical or surgical history.
An active toddler, with recent fatigue, has increase in sleeping, mild exercise intolerance.. She is a picky eater, enjoys small chicken, pork, and some vegetables, but loves milk and drinks about seven bottles of whole milk daily.
Family history reveals mother had anemia during her pregnancy. There is no history of splenectomy, gall stones at an early age, or other anemia in the family.
Vital Signs: Temperature 37.8 degrees C, Blood Pressure 95/50 mmHg, Pulse 144 beats/minute, Respiration 18 breaths/minute , Height 85.5 cm (50th %ile), Weight 13.2 kg (75th %ile). General appearance: He is a pale appearing, active toddler.
Reflect on the patient provided who presented with a hematologic disorder during your Practicum experience. Describe your experience in assessing and managing the patient and his or her family and follow up apt . Include details of your “aha” moment in identifying the patient’s disorder. Then, explain how the experience connected your classroom studies to the real-world clinical setting.
Readings( Provide 2 more Credible , recent 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 26, “Hematologic Disorders” (pp. 557–584
Running Head: EVALUATION OF DERMATOLOGICAL DISORDER 1
EVALUATION OF DERMATOLOGICAL DISORDER 2
WK 5 Journal Entry
Assessment and Management of Paediatric Dermatologic disorder
NURS – 6541N – 1
Dermatology disorders are an infection and abnormal appearance of the skin. Mostly repented by skin lesions, the skin disorder serves as an indicator of an underlying internal disease for examples internal cancer, GI disorders or endocrinopathies. Dermatological disorders are best examined before treatment or diagnosis but the most suitable is clinical acumen and appropriate laboratory tests. Origin of dermatological disorders are of different types including; bacterial infections, hereditary conditions, vascular lesions, tumors, and growths.
Examination of a Paediatric Dermatological Disorder
Early on Monday morning, a mid-age African American mother walks into the clinic carrying a 10 old month infant. The parent complains of the Childs’ difussed pruritic rash , and relapsing skin dryness, inflammation and erythema for the last 2 week. Mother states that infant has been current with immnuization . Mother denies any fever, diarrhea, or decreased appetite , no exposure to a new medication or change of detergent at the onset of the rash. The only medical history is chronic dry skin and urticaria that has been wel controlled. Other than occasional itching, otherwise, well developed , well nourished infant. From examining the infant, it was evident that the child’s skin was affected by lesions that occur as a result of irritation and scratch marks. The disorder seems to have affected the face and flexural parts of the body mostly. Upon abrasion the affected parts the child tends to remain calm, indicating that the affected parts are sensitive to touch.
Upon further examination, the skin is dry and staph aureus. Other symptoms are papules and vesicles, erythema, skin infections and secondary erosions and lichenification (Stevens & Godstein, 2014).
From the symptoms and medical examination,V/S was within normal range , then it was concluded that the patient as suffering from Eczema and contact dermatitis (atopic and discoid) that is most common among infants that are in their early childhood especially for one year. It is associated with the immune response of the infant and if the condition is not contained it results in secondary bacterial infections especially around the flexural joints. It serves as a barrier of the epidermal barrier function (Burns, 2013).
Management of Dermatological Disorder
The eczema disorder is managed through manipulation of the environment such as education on the removal of prickles. Adequate skin care includes consistent application of emollients for clear skin (Dermnet.com, 2011).
Clindamycin 600mg po q8 hrs for 7 days
Atarax 10mg every 6 hrs at night for itching
Zyrtec 5mg po once a dat duing the day for itching /allergy
Mometasone ointment 0.1% topical BID
Apply Vasaline externally 4 times a day to all the skin
Bland skin care and Bleach bath was discussed with infant mother, Booklet on children’s allergy and skin problems was given to the monthe. If not responding to emollients, mother will call the clinic .Further Education provided to the parent includes: Giving frequent short baths (5-10 minutes) to relax, remove irritants, allergens and germs, and moisturize skin. Household bleach can help control overgrowth of germs. Add 1 tablespoon to a baby bath or cup to a big tub, Use a gently liquid cleansing product sparingly to wash face, body and scalp and Immediately apply a liberal amount of moisturizer to the entire body. You may gently pat skin dry (do not rub!) or apply directly to damp skin.Provided information on the important of reading product labels , provided list of Safe choices which includes: plain (not baby) petroleum jelly or plain mineral oil.
The childs nails need to be trimmed, avoid overheating and avoid exposure to complex topical products, including creams or lotions, diaper wipes, dryer sheets and fabric softener and the need to wash new clothing before wearing. The skin infections should be treated adequately through bathing with bleach and oral antibiotics (Dermnet, 2014). Mother was also refered to dermatology for further allergy testing and treatment and then f/u if symptoms does not improve.
My “aha” moment was when I examined the patient and observed the skin symptoms and the allergic reactions. This was a connection to the classroom studies that linked the symptoms to my week 7 studies and clinical exposures to different skin diseases during my practicum rotations starting from week 1.
Dermatological disorders among infants is a critical case and should be contained and treated as soon as possible before it becomes critical or life threatening. Parental and medical care is therefore of significance in this case.
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.
DermNet New Zealand Trust. (2014) DermNet NZ. Retrieved from http://www.dermnetnz.org/
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America by Stevens, D.L., Bisno, A.L., Chambers, H.F., Dellinger, E.P., Goldstein, E.J.C., Gorbach, S.L., Hirschmann, J.V., Kaplan, S.L., Montoya, J.G., & Wade, J.C. in Clinical Infectious Diseases , 59(2), 10-52.