Using your course and textbook readings and the South University Online Library, perform research on the following:
- Assessment, diagnostic testing, and management of infectious conditions in a pediatric patient
- Differential diagnoses for presentation of symptoms involving infectious diseases in pediatric patients
After completing your research, consider this scenario:
An eighteen-month-old child, well-known to your practice, presents with a seven-day history of fever ranging from 101 to 104.7 degrees Fahrenheit. On the fourth day of the fever, the emergency department had performed the following tests:
- A blood and urine culture
- A complete blood count
- A comprehensive metabolic panel
The culture reports were found to be negative.
Today, the vitals of the child are the following:
- Temperature: 101.5 degrees Fahrenheit
- Heart rate: 120 beats/minute
- Respiratory rate: 20 breaths/minute
- Blood pressure: 90/40
Physical examination of the child indicates the following positive findings:
- Injected conjunctiva
- Palmar redness
- Magenta-colored lips
- Red macula
- Excoriating rashes in the diaper area
On the basis of the above information, respond to the following:
- What will be your differential diagnoses for this patient?
- What specific physical exam findings support these differential diagnoses?
- Of the differential diagnoses you listed, which would be the most concerning?
- What additional diagnostic tests will you recommend? Why?
- What would be your focus for caregiver education?
Please use only evidence based guideline for treatment and caregiver education. Do not use any articel older than 5 years old, please use APA format to cite, and don’t forget to do in text citation for the treatment and education section.
Expert Solution Preview
Introduction:
The following is a discussion of the differential diagnoses, required diagnostic tests, and caregiver education recommendations for an eighteen-month-old child with a seven-day history of fever, various positive physical exam findings, and negative culture reports.
1. What will be your differential diagnoses for this patient?
The differential diagnoses for this patient include viral infections, bacterial infections, urinary tract infection, and Kawasaki disease. Viral infections that can cause fever and maculopapular rash include measles, rubella, and roseola. Bacterial infections such as meningococcemia, group A streptococcal infection, and staphylococcal toxic shock syndrome may have fever, conjunctivitis, rash, and shock. Urinary tract infection may present with fever, irritability, and dysuria. Finally, Kawasaki disease, an autoimmune disorder, usually presents between six months and five years of age with fever, conjunctival injection, rash, cervical lymphadenopathy, and strawberry tongue.
2. What specific physical exam findings support these differential diagnoses?
Positive physical exam findings that support the differential diagnoses previously mentioned include injected conjunctiva, palmar redness, magenta-colored lips, red macula, and excoriating rashes in the diaper area. Injected conjunctiva and palmar redness may indicate Kawasaki disease, while magenta-colored lips and red macula may suggest bacterial infections such as staphylococcal toxic shock syndrome. Excoriating rashes in the diaper area may indicate viral infections such as roseola or bacterial infections such as group A streptococcal infection.
3. Of the differential diagnoses you listed, which would be the most concerning?
The most concerning differential diagnoses is Kawasaki disease as it may lead to coronary artery aneurysm if not treated promptly. Group A streptococcal infection and staphylococcal toxic shock syndrome can be life-threatening and require prompt treatment. Urinary tract infections may lead to kidney injury if not treated promptly.
4. What additional diagnostic tests will you recommend? Why?
Additional diagnostic tests that may be recommended for this patient include echocardiography to assess for coronary artery aneurysm and blood cultures to rule out bacterial infections. Kawasaki disease is diagnosed clinically, but echocardiography is needed to assess disease progression and potential coronary artery aneurysm. Blood cultures will help rule out bacterial infections, which may be life-threatening.
5. What would be your focus for caregiver education?
Caregiver education will focus on disease prevention, signs and symptoms of each differential diagnosis, how to manage fever at home, and when to seek medical attention. Proper hand hygiene, timely vaccinations, and fever management techniques such as tepid sponge baths will be taught. Signs and symptoms of each differential diagnosis will be discussed, including when to seek medical attention. Caregivers will be informed about the importance of completing antibiotics courses prescribed by physicians and the need for regular follow-up visits.
