NSG6435 Week 5 Discussion.
How would you evaluate and manage a pediatric patient who has a painful swelling
of the hands and feet, fatigue, or fussiness? Which diagnostic studies would you
recommend for this patient a
...
NSG6435 Week 5 Discussion.
How would you evaluate and manage a pediatric patient who has a painful swelling
of the hands and feet, fatigue, or fussiness? Which diagnostic studies would you
recommend for this patient and why?
It is not normal for a pediatric patient to present with painful swelling of the hands and
feet, fatigue and fussiness without a specific reason. Given the adoptive history of this
patient, many differentials would need to be considered without a solid past medical and
family history to pull from. Dactylitis, musculoskeletal and abdominal pain are
considered vaso-occlusive pains, which are acute manifestations of sickle cell disease
(SCD) (Committee on Genetics., 2002). Most infants born in the United States are now
identified by routine neonatal screening. Pediatrics that are not, generally present to their
provider with reports of painful swelling of the hands and feet, severe anemia, acute splenic
enlargement, jaundice, or splenomegaly (Committee on Genetics., 2002). The most common
diagnostic screening tests for SCD done today are hemoglobin electrophoresis which detects
different types of hemoglobin in the blood, high performance liquid chromatography (HPLC) to
help identify which type of hemoglobin is present, and deoxyribonucleic acid (DNA) testing to
confirm the genetic makeup of the patient (Diagnosing Sickle Cell., n.d.). Once the diagnosis is
confirmed, management with young children is aimed at improving survival by reducing the
threat from infections. This is accomplished by early diagnosis, pneumococcal immunization,
antibiotic prophylaxis with penicillin in children under 5 years of age, prompt treatment when
infections do occ
ur, and nutritional counseling (Lanzkron, S., 2019).
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