Riley
Primary Diagnosis
Vomiting, unspecified (ICD-10: R11.10)
This disorder is usually characterized by frequent ejecting of food or drinks in the stomach through the mouth and is defined as one of the possible reasons why patients lose their weight and have gastrointestinal tract problems (Hay, Levin, Deterding, & Abzurg, 2014, p. 85). It is one of the main reasons why parents are ready to address doctors and ask about the possible health problems of their children. The patient is a 24-month-old male, who had several episodes of vomiting during the last three days. Vomiting was also accompanied by diarrhea and fever (101 degrees). Riley’s behavior is lethargic during the exam. He also does not want to walk independently but prefers to stay in his mother’s hands.
Diarrhea, unspecified (ICD-10: R19.7)
This condition is characterized by frequent watery bowel movements and feces. The statistics show that about 2 million children younger than 5 years suffer from diarrhea three or even more times per year (Farthing et al., 2013, p. 15). Riley had several episodes of diarrhea during the last three days. He neither eats well nor plays a lot. He prefers to stay in his mother’s arms.
Differential Diagnosis
Noninfective gastroenteritis and colitis, unspecified (ICD-10: K52.9)
This disorder occurs because of inflammation in the person’s colon. Though the cases of gastroenteritis have been considerably declined when the rotavirus vaccine was introduced (Payne et al., 2013, p. 1121), some children may suffer from this disorder. Gastroenteritis is usually characterized by the combination of such symptoms as abnormal cramps, cases of vomiting and diarrhea, and middle fever. Riley has proved all that symptoms during the last three days. The only case is the inability to explain if he had abnormal cramps or not. Still, the fact that he does not want to play and eat may be served as one of the possible outcomes of his cramps.
Acute tubule-interstitial nephritis (ICD-10:)
This disease is based on problems with kidneys and is called pyelonephritis. It is defined as one of the most serious infectious diseases in children (Morello, La Scola, Alberici, & Montini, 2015, p. 2), and parents have to address the doctor as soon as they observe the first possible signs of this disease. There is a list of classic symptoms that have to be taken into consideration: fever, vomiting or nausea, and costovertebral angle pain (McCoy, 2014, p. 172). The boy is not able to explain the kind of pain he has. Still, it is necessary to take additional diagnostic tests to check the condition of his kidneys.
Plan for One Primary Diagnosis of Riley (Vomiting)
Diagnostic tests
Vomiting is usually regarded as a symptom, not as a disease. Therefore, certain tests should be taken to clarify what child’s vomiting is a signal to. The initial diagnostic evaluation should include blood tests (to check full blood count, the presence/absence of iron, calcium, and sugar), urinalysis, and stool tests (check its microscopy and culture). Sometimes, if vomiting leads to a child’s dehydration, it is suggested to check the level of serum bicarbonate level to clarify the required therapy (Churgay & Aftab, 2012, p. 1062).
Medications
Ondansetron (also known as Zofran) (Hay, Levin, Deterding, & Abzug, 2014, p. 599): Rx.: 3.2 mg. Sig.: orally every 8 hours. Disp.: #10, Refill: unnecessary.
Referrals
If additional severe or alarm symptoms such as the change in vision, fever, or dehydration occur, a referral to a trained specialist (according to the nature of symptoms) is required (Prunty & Prunty, 2013, p. 26).
Conservative measures
The mother should provide the child with help and support to avoid or, at least, reduce, the number of vomiting cases. The possible suggestions are to place the child in a prone position, to choose an upright position after every feeding, and to control the volume of food and fluids offered. Proper diets and rest are also required.
Patient education
The patient (in this case, the mother of the patient) has to be educated about the importance of hygiene, healthy food for a little child (no fast food or Coca-Cola), and physical exercises that help the child to gain control over his body. Besides, the child has to drink a lot of water or tea to avoid the case of dehydration.
Follow-up plan
The patient should visit a therapist in one week and inform about the changes. If the cases of vomiting repeat or additional symptoms occur, an immediate referral to a therapist or even to the ER is obligatory.
Lily
Primary Diagnosis
Dysmenorrhea (ICD-10: N94.6)
This disease is observed in many women of different ages regardless of their age and sexual life (Kannan, Chapple, Miller, Claydon, & Baxter, 2015, p. 81) and is characterized by painful menses and discomfort in the area of the lower abdomen. It may have different symptoms including cramping pain, dull ache, and even fever. The patient is a 16-year-old female, who experienced her parents’ divorce, change of school, and place of living. Still, her stress is not the only reason for her problems with her periods. She has a fever (101 degrees), vomiting, nausea, and diarrhea. Besides, she complains of her headache and myalgia. Her urine analysis shows the presence of scant microscopic blood (the result of her current menses). No glucose, WBCs, protein, or nitrites prove the absence of infection in the organism.
Bacterial foodborne intoxication, unspecified (ICD-10: A05.9)
This disease is defined as food poisoning, the result of eating some contaminated products that lead to the organism’s impossibility to control the presence of such food or drinks (Kirk et at., 2015, par. 3). Lily’s main symptoms are vomiting, diarrhea, and fever (100-101 degrees). Though her vomiting stopped in two days, she continues suffering from pain in the lower abdomen and has flat with hyperactive bowel sounds throughout.
Differential Diagnosis
Endometriosis (ICD-10: N80)
This disease is characterized by abnormal tissue inside of the uterus. Mu, Rich-Edwards, Rimm, Spiegelman, and Missmer (2015) introduce it as “a chronic and estrogen-dependent gynecologic disorder that affects approximately 10% of women of reproductive age in the United States” (p. 257). The possible symptoms are painful periods, diarrhea, nausea, fatigue, and even fever. During the examination, the patient could not lie on the table and use a supine position but preferred a kind of fetal position to reduce the level of pain (that was 5 on the scale from 1 to 10).
Premenstrual tension syndrome (ICD-10: N94.3)
It is the condition several women go through just before their menses begin. It is hard to predict the outcomes of PTS or choose an appropriate treatment in time because several things depend on the physical condition of the patient. As a rule, PTS is closely connected to dysmenorrhea, and its severity depends on female personal habits and styles of life (Ju, Jones, & Mishra, 2014, p. 103). The girl has several symptoms of this disease such as nausea, vomiting, and diarrhea just before her menses. During the periods, she suffers from abnormal pain and discomfort.
Plan for One Primary Diagnosis of Lily (Dysmenorrhea)
Diagnostic tests
Pelvic examination is offered to underline the possible abnormalities in the reproductive organs of the patient. Though Osayande & Mehulic (2014) admit that primary dysmenorrhea does not require this kind of examination (p. 343), it is still suggested to check if her organs are normal and prove the absence of cervical erosion or other gynecological disorders. Ultrasound is also possible to check the conditions of the patient’s uterus, ovaries, cervix, etc.
Medications
Ibuprofen. Rx: 200-400 mg two times per day (Patel, Patel, Acharya, Nakum, & Tripathi, 2015, p.119); Disp: 16; Ref.: not required. Zoloft (Sertraline): Rx.: 50 mg per day; Disp: 30; Ref.: 2 (Hay, Levin, Deterding, & Abzurg, 2014, p. 201).
Referrals
Lily has to be sent to a gynecologist for further consultation. As a rule, the doctor should offer to take pain relievers during the menstruation period and appoint a visit for the next two days after menses are over.
Conservative measures
It is suggested to take rest as frequently as possible to avoid any possible overwork. Besides, it is possible to address herbal medicine to decrease the level of pain that is associated with menses. For example, ginger, mint tea, chamomile tea, or even tea with raspberry leaves can be used three times per day to kill pain almost the same way ibuprofen does (Kashani, Mohammadi, Heidari, & Akhondzadeh, 2015, p. 3).
Patient education
The girl should be educated about the peculiarities of the female organism and the possible changes when the time of menses comes. It is not to get ready for this period physically and avoid any kind of work. It is more important to accept this fact mentally and emotionally and realize that these four or more days could not be avoided or neglected. Still, pain is not an ordinary symptom, and painful menses should be treated with the help of a professional. Besides, more information about the importance of protection during a sexual life in the form of condoms should be given to the girl (Hay, Levin, Deterding, & Abzurg, 2014, p. 131).
Follow-up plan
Communication with a gynecologist is required once per month to control the changes during the menstruation period.
References
Churgay, C.A. & Aftab, Z. Gastroenteritis in children: Part I. Diagnosis. American Family Physician, 85(11): 1059-1062.
Farthing, M., Salam, M. A., Lindberg, G., Dite, P., Khalif, I., Salazar-Lindo, E.,… & Krabshuis, J. (2013). Acute diarrhea in adults and children: A global perspective. Journal of clinical gastroenterology, 47(1), 12-20.
Hay, W., Levin, M., Deterding, R., & Abzug, M. (2014). Current diagnosis and treatment: Pediatrics. New York, NY: McGraw Hill.
Ju, H., Jones, M., & Mishra, G. D. (2014). Premenstrual syndrome and dysmenorrhea: Symptom trajectories over 13 years in young adults. Maturitas, 78(2), 99-105.
Kannan, P., Chapple, C. M., Miller, D., Claydon, L. S., & Baxter, G. D. (2015). Menstrual pain and quality of life in women with primary dysmenorrhea: Rationale, design, and interventions of a randomized controlled trial of effects of a treadmill-based exercise intervention. Contemporary clinical trials, 42, 81-89.
Kashani, L., Mohammadi, M., Heidari, M., & Akhondzadeh, S. (2015). Herbal medicine in the treatment of primary dysmenorrhea. Journal of Medicinal Plants, 1(53), 1-5.
Kirk, M. D., Pires, S. M., Black, R. E., Caipo, M., Crump, J. A., Devleesschauwer, B.,… & Hall, A. J. (2015). World Health Organization estimates of the global and regional disease burden of 22 foodborne bacterial, protozoal, and viral diseases, 2010: A data synthesis.PLoS Med, 12(12). Web.
McCoy, C. A. (2014). Emergency nursing review questions: March 2014. Journal of Emergency Nursing, 40(2), 172-173.
Morello, W., La Scola, C., Alberici, I., & Montini, G. (2015). Acute pyelonephritis in children. Pediatric Nephrology, 1-13.
Mu, F., Rich-Edwards, J., Rimm, E. B., Spiegelman, D., & Missmer, S. A. (2016). Endometriosis and risk of coronary heart disease. Circulation: Cardiovascular Quality and Outcomes, 9(3), 257-264.
Osayande, A. S., & Mehulic, S. (2014). Diagnosis and initial management of dysmenorrhea. American Family Physician, 89(5), 341-6.
Patel, J. C., Patel, P. B., Acharya, H., Nakum, K., & Tripathi, C. B. (2015). Efficacy and safety of lornoxicam vs ibuprofen in primary dysmenorrhea: A randomized, double-blind, double dummy, active-controlled, cross over study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 188, 118-123.
Payne, D. C., VinjĂ©, J., Szilagyi, P. G., Edwards, K. M., Staat, M. A., Weinberg, G. A.,… & Wikswo, M. (2013). Norovirus and medically attended gastroenteritis in US children. New England Journal of Medicine, 368(12), 1121-1130.
Prunty, J.J. & Prunty, L.M. (2013). An outpatient approach to nausea and vomiting. US Pharmacist, 38(12), 24-28.