Case 2S [symptoms] 10 month male presents to pediatrician’s offic.pdf

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Case 2 S [symptoms]: 10 month male presents to pediatrician’s office with chief complaint of fever and rash. In usual state of health until 4 days prior to presentation when developed fever, fussiness and decreased appetite. Mom thought maybe had thrush again because she noted some white spots in his mouth a day after the fever started but they went away on their own. Last night she noticed that his eyes started to appear more red and irritated, is now coughing and very congested and this morning developed rash on face prompting visit ROS [review of systems]: as above, no emesis, no constipation or diarrhea, +fewer wet diapers than usual PMHx [past medical history]: full term, uncomplicated pregnancy and delivery, neonatal jaundice but did not require phototherapy, thrush at 6 weeks and 3 months of age treated with nystatin SHx [social history]: lives with parents and 2 yo sibling who is enrolled in child care. Flew to California with family 3 weeks ago to visit grandparents, no other travel hx. Imm: UTD [up to date] Exam: T- 39.8 [temperature, C]; R -34 [respiratory rate]; P -120 [pulse]; BP-85/62 [blood pressure]; Pox-98% in room air [pulse oximetry, oxygenation of blood] Gen [general]: Alert, fussy infant on mom’s lap, crying with exam HEENT [head, eyes, ear, nose, throat]: Normocephalic/atraumatic, anterior fontanelle fibrous but flat, extraocular movements intact, pupils equal and reactive to light, +conjunctival erythema bilaterally without discharge or crusting, nares congested, oropharynx erythematous with sloughing of buccal and labial mucosa. Tympanic membranes erythematous but with intact landmarks and light reflex Neck: supple full range of motion, +1cm bilateral anterior cervical lymphadenopathy RESP [respiratory]: mildly tachypneic with fair air exchange all fields, +subcostal retractions no intracostal or suprasternal accessory muscle use, diffuse crackles audible on auscultation all lung fields no wheezing or rhonchi COR [cardiac]: tachycardic, regular, nl s1 and split s2, no murmurs, rubs or gallops Abdomen: soft, normoactive bowel sounds, nontender non distended, no hepatosplenomegaly, no masses GU [genital/urinary]: circumcised tanner I male, no rashes Skin: diffuse erythematous blanching maculopapular rash most prominent/confluent on face, neck, and upper trunk, palms and soles spared, no desquamation Extremities: warm and well perfused a) What were the spots in the infant’s mouth that the mother mistook for thrush? b) What is your diagnosis, and which symptoms lead you to this conclusion? c) Which tests will you order to confirm this diagnosis (give the name and state what is being measured)? d) The patient is up to date on his vaccinations, so why was he susceptible to this disease? Where did he likely contract the disease? e) In an uncomplicated form, this condition is not usually fatal, but what can cause fatalities for patients with this infection? f) A similar patient might be admitted to the hospital or might not fo.

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b) What is your diagnosis, and which symptoms lead you to this conclusion?
c) Which tests will you order to confirm this diagnosis (give the name and state what is being
measured)?
d) The patient is up to date on his vaccinations, so why was he susceptible to this disease? Where
did he likely contract the disease?
e) In an uncomplicated form, this condition is not usually fatal, but what can cause fatalities for
patients with this infection?
f) A similar patient might be admitted to the hospital or might not for this condition (depending
both on the physician’s judgments and specific details of the patient’s presentation). Give several
reasons why you might NOT admit this patient, and several reasons why you MIGHT (your
reasons might not pertain to this exact patient).
g) IF the patient is admitted to the hospital, the patient will stay in a room with negative air
pressure, and all staff interacting with the patient will need to wear N95 respirators. Why are
these precautions necessary?
Solution
a) The spots in the infant's mouth may be due to Strep throat. I mean the mother mistook them
for fungal infection; but may be it is a bacterial infection.
b) Maculopapular rash on the skin led to this conclusion. This type of rashes appear in bacterial
infection; they occur when beta-lactam antibiotic is given. The child had visited California 3
weeks back; may be he develped infection that time.

SOAP NOTE Name: N.C Date: 10/26/2020 Time: 09.30 h Age: 5-year-old Sex: M CC: "I have sore throat" HPI: A 5 y/o Hispanic male presents to the clinic complaining of sore throat that started 3 days ago. Describes that occasionally feels like “piercing or burning” pain that it is constant. Also, that is very painful to swallow. Mother states patient developed cold symptoms (cough, sneezing) about 5 days ago, sore throat started 3 days ago, and fever of 101.5 F began 24h ago. Patient added that the pain varies in intensity, rated anywhere from 8 to 9 on a Wong-Baker scale when eating or drinking, but at this moment rated his pain at 5. Reports that pain is not radiating to any surrounded area and “is better when drinking sips of a cold liquids like water or Kool-Aid or takes Ice cream”. Mother also states that fever somehow is relieved by rest and Tylenol. Confirms that his appetite has decreased in the last 3 days. Medications: Tylenol OTC PO PRN PMH Allergies: NKDA Medication Intolerances: None Chronic Illnesses/Major traumas: None Hospitalizations/Surgeries: None Immunizations: - According to CDC for his age group, he is up to date with the following vaccines • Influenza 2019 • Tdap 5th dose • MMR 2nd dose • Polio IVP 4th dose • Chickenpox (Varicella) 2nd dose Family History: Mother: Alive – no significant medical history Father: Alive - HTN Sister: 8 years old healthy Brother: 2 days old healthy Social History Lives with both parents and siblings. Appears comfortable and happy with mother in the room. Neither parents smoke. Patient began kindergarten this year at local public school. General Patient reports sore throat, but overall healthy, appropriate weight and height for age, usually very active but mostly lying around the past few days per mom. Cardiovascular Denies chest pain or palpitations. Skin Denies rash, inflammation, pain, tenderness, or skin lesion. Respiratory Denies any cough, wheezing, hemoptysis, dyspnea, pneumonia hx, TB exposure or symptoms per mom, or SOB. Eyes Denies use of corrective lenses or glasses, blurred vision, or visual changes of any kind. ENT Denies ear pain, hearing loss, ringing in ears, discharge. Reports no sinus problems, or nose bleeding. Complains of sore throat and aggravating pain when swallowing. Goes to dentist every 6 months per mom. Gastrointestinal Denies diarrhea, abdominal pain, or heartburn. He had his last bowel movement this morning and goes at least once a day. Genitourinary Denies urgency, frequency or burning and pain with urination. Reports no hematuria or change in color of urine. Denies penile pain. Musculoskeletal Denies back pain, joint swelling, stiffness, or muscle pain. Heme/Lymph/Endo Denies fatigue. Mother states swollen/tender cervical lymph nodes. Patient is appropriate size and weight for his age. Neurological Denies any syncope, seizures, transient paralysis, paresthesi.

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is an upper respiratory tract bacterial infection associated with a characteristic rash, which is caused by an infection with pyrogenic exotoxin (erythrogenic toxin) -producing GAS in individuals who do not have antitoxin antibodies In the past. scarlet fever was thought to reflect infection of an individual lacking toxin-specific immunity with a toxin-producing strain of GAS. Subsequent studies have suggested that development of the scarlet fever rash may reflect a hypersensitivity reaction requiring prior exposure to the toxin.

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Heres another one. It is only a discussion but I need to reference the text and one outside source at least. You may choose any factor you like. Discussion: Respiratory Alterations In clinical settings, patients often present with various respiratory symptoms such as congestion, coughing, and wheezing. While identifying a symptom’s underlying illness can be challenging, it is essential because even basic symptoms such as persistent coughing can be a sign of a more severe disorder. Advanced practice nurses must be able to differentiate between moderate and severe respiratory disorders, as well as properly diagnose and prescribe treatment for their patients. For this reason, you must have an understanding of the pathophysiology of respiratory disorders. Consider the following three scenarios: Scenario 1: Ms. Teel brings in her 7-month-old infant for evaluation. She is afraid that the baby might have respiratory syncytial virus (RSV) because she seems to be coughing a lot, and Ms. Teel heard that RSV is a common condition for infants. A detailed patient history reveals that the infant has been coughing consistently for several months. It’s never seemed all that bad. Ms. Teel thought it was just a normal thing, but then she read about RSV. Closer evaluation indicates that the infant coughs mostly at night; and, in fact, most nights the baby coughs to some extent. Additionally, Ms. Teel confirms that the infant seems to cough more when she cries. Physical examination reveals an apparently healthy age- and weight-appropriate, 7-month-old infant with breath sounds that are clear to auscultation. The infant’s medical history is significant only for eczema that was actually quite bad a few months back. Otherwise, the only remarkable history is an allergic reaction to amoxicillin that she experienced 3 months ago when she had an ear infection. Scenario 2: Kevin is a 6-year-old boy who is brought in for evaluation by his parents. The parents are concerned that he has a really deep cough that he just can’t seem to get over. The history reveals that he was in his usual state of good health until approximately 1 week ago when he developed a profound cough. His parents say that it is deep and sounds like he is barking. He coughs so hard that sometimes he actually vomits. The cough is productive for mucus, but there is no blood in it. Kevin has had a low-grade temperature but nothing really high. His parents do not have a thermometer and don’t know for sure how high it got. His past medical history is negative. He has never had childhood asthma or RSV. His mother says that they moved around a lot in his first 2 years and she is not sure that his immunizations are up to date. She does not have a current vaccination record. Scenario 3: Maria is a 36-year-old who presents for evaluation of a cough. She is normally a healthy young lady with no significant medical history. She takes no medications and does not smoke. She reports that she was in her usual state .

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