Patient Assessment - Deep trouble - page 4

The aim of this "game" is to look at critical indicators in assessment. Some of the patients in the following scenario are in "deep trouble" but some may not be. Can you identify the ones in... Read More

  1. by   Whisper
    This is a great thread, one I am learning so much from just by reading, Some of the paeds cases threw me, as I have no training with paeds, and no completed adult training!!!, I would probably send kid B first, If they are already on treatment and it is not working, that seems more severe some how than the other child.

    Any chance of the answer canadian?

    Whisper
  2. by   gwenith
    Karen G One of the many reasons why I keep wanting to have everyone play the game without recourse to lab values is that sometimes you just don't have teh access to the information. It is about working out probabilities and plotting interventions based on those probabilities.

    Perhaps if Canadian doesn't come back to give us the answer we can copy the questions onto the paediatric forum and get one of the Paeds nurses to answer them for us!:chuckle

    I am going to let a couple more members have a go at answering case six before I give you the real inside information on him.
    Hint:- In real life this guy would be AMAZED at how disinterested we would be in his broken arm!!!
  3. by   Peeps Mcarthur
    lady presented c/o severe abdominal pain, 11 0n 1-10 scale! nothing made it better/worse. pain in left upper quadrant. apyrexial.............and she threw up over me. diagnosis?
    Appendicitis??
  4. by   Mkue
    You all are doing great, I'm learning alot from you
  5. by   gwenith
    lady presented c/o severe abdominal pain, 11 0n 1-10 scale! nothing made it better/worse. pain in left upper quadrant. apyrexial.............and she threw up over me. diagnosis?
    ____________________________________________

    Acute cholecystitis is usually right upper quadrant and this woudl be a favourite especially if she fit the fair, fat and forty type. Occasionally people are born with the organs reversed so it is just because it is right (oops I meant LEFT) sided doesn't rule it out entirely.

    Upper quadrant - couldn't rule out acute pancreatitis but my money would have to be on a gut obstruction. Esp if the vomiting was projectile enough to actually hit you ( I presume you like me can move at olympic speeds when it comes to body fluids heading your way):spin:
    Last edit by gwenith on Jun 14, '03
  6. by   Peeps Mcarthur
    After I went back to study, I thought about cholecystitis(gall bladder). I think most here would just call it a cystic duct because that is where the conditions etioligy is from. The formation of crystaline structers in the cytic duct.

    You can't digest fat and I guess it would be like passing a kidney stone but from your cystic duct to your hepatopancreatic ampula instead of your urethra.

    I think that would make me regurgitate too.
  7. by   karenG
    well- she acutually had acute pancreatitis. gave her IM maxalon to no effect and admitted her stat! she was a non drinker as well!! have to admit my differential diagnosis was obstruction because she had no bowel sounds. so I let the surgeons sort her out!!

    Karen
  8. by   gwenith
    Silent gut is not unknown in acute pancreatitis. A significant number of acute pancreatitis is idiopathic or associated with obstruction by infammation or stones. They can get VERY sick VERY fast. It is one of those strange disorders in that there is almost two distinct types. Med/surg nurses are used to seeing the chronic pancreatitis and wonder why ICU nurses go pale at the mention of an acute fulminating pancreatitis.
  9. by   Peeps Mcarthur
    Since I've not ever worked in an ER..........yet


    From Gwenith
    Esp if the vomiting was projectile enough to actually hit you
    Would that degree of severity of the vomitting cause you to consider bowel obstruction in any case? I mean, is it a hallmark of bowel obtruction?

    I had forgotten that the pancrease produces bile salts for digestion of fats as well. The fats didn't digest and the ph would be all out of whack too.

    The most obvious of my errors was that I wasn't thinking of Left upper quadrant when I described all the organs from the right upper quadrant now was I? I was thinking of the patient in an anatomical view and went right to the left..........................only in anatomy left is right.

    Crap.

    I need to do this for real soooooooooo bad.
  10. by   karenG
    hey Peeps......it could have been cholycystitis- think referred pain. but would be low on my list of differential diagnosis

    K
  11. by   kids
    Originally posted by canadian
    A: kiddie 4 yrs old 3day Hx malaise and cough, dehyrated, temp 38.8

    B: kiddie 4 years old on Tx for ALL temp 38.3 no other Sx.
    Kiddie A: His fever isn't terribly high (101.8 F) when was his last dose of an antipyretic? No mention of vomiting/diarhhea, dehydration likely due to poor intake rather than excess loss. No mention of rash. No mention of nasal drainage.

    Probably a viral syndrome...possibly OM, might want to do a strep but unlikely (fever <102, no c/o HA, ST or abd. pain)

    Kiddie B: Temp not to bad, 100.9 F. no complaints. On tx for ALL.
    DING DING DING... we have our admit...find the kid a bed away from sick people, he's neutropinic, get blood cultures and a line going...this kid could be in the toilet very quick.

    Oh...and get kiddie A a Pedialyte popcicle.

    The risks to Kiddie B in not being worked up first are greater than they are to kiddie A.
  12. by   mare-mare
    What is the answer to case 6???? I'm dying to know... I think he has some sort of cervical injury and is at risk for losing his airway to swelling soon...
  13. by   karenG
    Originally posted by kids-r-fun
    Kiddie A: His fever isn't terribly high (101.8 F) when was his last dose of an antipyretic? No mention of vomiting/diarhhea, dehydration likely due to poor intake rather than excess loss. No mention of rash. No mention of nasal drainage.

    Probably a viral syndrome...possibly OM, might want to do a strep but unlikely (fever <102, no c/o HA, ST or abd. pain)

    Kiddie B: Temp not to bad, 100.9 F. no complaints. On tx for ALL.
    DING DING DING... we have our admit...find the kid a bed away from sick people, he's neutropinic, get blood cultures and a line going...this kid could be in the toilet very quick.

    Oh...and get kiddie A a Pedialyte popcicle.

    The risks to Kiddie B in not being worked up first are greater than they are to kiddie A.
    oh I am so glad someone agreed with me!! was starting to think I was way off beam!!

    Karen

close