13 May A 6-month-old male patient presents to your clinic with his mother. The mothers chief complaint is that the baby has had a fever and diarrhea for sev
A 6-month-old male patient presents to your clinic with his mother. The mother’s chief complaint is that the baby has had a fever and diarrhea for several days and is not nursing as much as usual. The infant is quiet and warm, lung sounds are clear, heart sounds normal. No medical history, born healthy at 39 weeks 5 days via uncomplicated vaginal delivery, he is exclusively breastfed and is up-to-date on his vaccinations.
- What are 5 questions you would ask the mother next?(Include rationales for questions)
- What additional signs/symptoms would alert you that this infant may need to be transferred to the ER?
- What are your top 3 differential diagnoses? (Include ICD codes and rationales)
Submission should be in APA format. Include an introduction/conclusion, etc. Review rubric carefully before submitting.
United State University
Primary Health of Acute Client/Family Across the Lifespan: xxx
Gastroenteritis in Children
The presentation of the 6-months old male patient, brought in by the mother to the clinic is a requirement since the prenatal consent is needed for the best intervention. There was no medical history since when the baby was born healthy and has an exclusive breastfeeding that indicate that there are no previous warning signs.
Below are the questions I would ask the mother.
1. Ask of the mother about the onset of the symptoms, knowing when the symptoms began can assist determine the severity of the dehydration
2. Ask the mother, when she check the temperature of the baby, what does the thermometer show?
3. Have you given any over-the counter medication to help with the fever and diarrhea? If so, what medication is it, how often do you give it to the child, and when was the last time you gave it to him?
4. How many times has the child had diarrhea in a single day, what are the features of the baby's feces in terms of color, volume, and frequency and how many soiled diapers do you change every day on average?
5. Apart from your baby, is there anyone in your household that is ill? Is there a recent travel with the baby?
The questions directed to the mother of the 6-months old baby is important for the nurse practitioner to get the information that would drive the evaluation and diagnosis of the diseases. The mother sharing about the latest over-the counter medication would guide about the intervention that would be done that would ensure that there is no reaction that might affect the baby in a detrimental manner (Fries, 2020). The nurse practitioner’s questions are critical in guiding about the experiences with the baby since there was no medical history and gives a hint about the differential diagnoses that would be focused on to offer quality evaluation and care.
Addition symptoms and Signs that Needs ER
At 100.4 degrees Fahrenheit, a person has a fever. In many cases, doctors advise against treating fevers below 101°F. Due to the body's natural response to infection, a fever is a common sign of illness. Fever is a sign that your child's immune system is working properly (Fields, 2016). In case the child temperature is measured and stated temperature above 100.3°F, are sluggish, and aren't taking in any fluids should be sent to the emergency room immediately.
A consistent vomiting in the 6-months baby is a serious condition that demands for an immediate intervention and the child must be taken in an emergency room. Vomiting result to an excessive loss of fluids in the body of the baby and this puts the life at high risk (Fields, 2016). Taking the baby to the emergency room makes sure that the lost fluid is restored.
Fast breathing and Breathing Problems
The baby should be taken to an emergency room when fast breathing or difficulty is experienced because it is considered part of pediatric emergency. The issue of breathing challenges is an urgent intervention that a doctor needs to undertake taking the baby to the emergency room.
Other additional signs are difficult-to-rouse child with no tears or mucous membranes, blood in the stool, higher or lower respiration, reduced urine output, pale cool complexion with irritation, hollow eyes, and sunken fontanelles would all indicate that the infant should be taken to the ED (Munde, 2019).
Top 3 Differential Diagnoses
The differential diagnosis is an important clinical exercise that makes sure that the nurse practitioners highlight the disease that the patient is suffering from by eliminating those that share some signs and symptoms. Based on the patient’s mother and the medical history that shows that the baby was well all along until the current symptoms of diarrhea and fever, there are three top differential diagnosis that include
Parasitic gastroenteritis: ICD-10-CM B82.9 is a contagious disease or spread by an invading organism.
Rotavirus: ICD-10-CM A08.0 is a viral infection that produces gastrointestinal symptoms such as diarrhea and other gastrointestinal issues.
Acute Gastroenteritis: ICD-10-CM A08.19 is a condition caused by pathogenic bacteria such as Clostridium and Vibrio cholera present in the food or water supply
The three diseases are the top because they have related symptoms that can be confused by the nurse practitioners during diagnosis. The highlighted signs that is diarrhea and fever are present in the diseases highlighted and they also have kind of interrelation, and this demands for differential diagnosis to get the right disease for medication (Fries, 2020).
One of the most common causes of death among children in the U.S is gastroenteritis. To put it another way, it is when you get diarrhea for no apparent reason other than dehydration, and it might come on suddenly or gradually. Prevalence is highest amongst children as young age 5. Diarrhea in children is the most common reason for their hospitalization. The bacteria salmonella and shigella also cause severe gastroenteritis in children younger than five years old, but they are not the only cause. Giardia fragilis and Cryptosporidium are two parasites that can cause gastroenteritis in a tiny percentage of the population (Ögren et al., 2020). For children who can take oral hydration but are vomiting, professionally prepared oral hydration might be an option. Start with little amounts of liquid and gradually increase the amount of liquid as the youngster is able to handle. A trip to the emergency room is necessary if a child is critically dehydrated and needs intravenous fluids and hemodynamic monitoring (Malbrain et al., 2020). Proper handwashing is the first step in preventing gastroenteritis. Teaching children, mothers, and their caregivers how to wash their hands properly is critical, as is making sure they are aware of the dangers of food contamination that has been improperly stored.
To conclude, acute diarrhea in children should be treated as quickly as possible in order to avoid dehydration. The initial treatment for mild dehydration is oral rehydration. Children should be taught proper hygiene, for which cleaning hands properly prevent gastroenteritis.
Fields, L. (2016). 7 Serious Symptoms in Babies and Toddlers. WebMD. Retrieved 12 January 2022, from https://www.webmd.com/children/features/serious-symptoms-babies-toddlers
Malbrain, M. L., Langer, T., Annane, D., Gattinoni, L., Elbers, P., Hahn, R. G., … & Van Regenmortel, N. (2020). Intravenous fluid therapy in the perioperative and critical care setting: executive summary of the International Fluid Academy (IFA). Annals of Intensive Care, 10(1), 1-19.
Munde, C. (2019). Hydriatic Treatment of Scarlet Fever in its Different Forms. Good Press.
Ögren, J., Dienus, O., & Matussek, A. (2020). Optimization of routine microscopic and molecular detection of parasitic protozoa in SAF-fixed faecal samples in Sweden. Infectious Diseases, 52(2), 87-96.