The combination of symptoms presented in the child is quite rare and does not connect with one disease option easily. One of the differential diagnoses I would outline, in this case, is Kawasaki disease. It is a rare disease that can produce all of the symptoms presented, including fever, rash, red feet and hands, red swollen lips, and eye redness (Scheinfeld, 2016). Another diagnosis that cannot be ruled out is measles. There is no indication as to whether or not the child has been vaccinated, and the symptoms of measles include fever, sore eyes, and rash (NHS, 2015). Measles is especially common in young children, which is why vaccinations are due at 13 months (NHS, 2015). Another diagnosis option is that a child has a common cold and has developed an allergic reaction to medication used for treatment.
Measles diagnosis can be supported by the physical examination if the rash on other areas of the body is found and if there are small grey-white spots on the inside of his or her cheeks (NHS, 2015). Kawasaki disease, or coronary artery vasculitis, may be a probable diagnosis if the child presents as highly irritable (Burns, Dunn, Brady, Starr, & Blosser, 2016). ‘Strawberry tongue’ can also be one of the distinguishable characteristics of the disease (Burns et al., 2016). Lastly, if the common cold diagnosis is relevant, the child will likely have sore or reddened throat (Burns et al., 2016).
Out of the differential diagnoses used, Kawasaki disease is the most concerning, as it may lead to complications and even death. Scheinfeld (2016) outlines that, if untreated, Kawasaki disease can lead to death from coronary artery aneurysm, although the share of lethal outcomes is very small. Moreover, as Burns et al. (2016) suggest, coronary complications from Kawasaki disease could persist into adult age. Measles and the common cold, on the other hand, are likely to pass without serious treatment (NHS, 2015).
In this case, the diagnostics should be mainly focused on ruling out or supporting Kawasaki disease, as this is the most concerning option that requires the urgent start of treatment to avoid complications. Burns et al. (2016) outline the typical methods for diagnosing Kawasaki disease. The first step of the algorithm is to perform tests for CRP and ESR (Burns et al., 2016). If the CPR is at or greater than 3.0 mg/dL and/or if the ESR is at or greater than 40 mm/hr, this suggests further diagnostic test (Burns et al., 2016).
The decrease in red blood cells and hemoglobin, hypoalbuminemia, and increased α2-globulin are other diagnostic findings that may support the diagnosis (Burns et al., 2016). An echocardiogram is also required to solidify the diagnosis and treatment (Burns et al., 2016). To rule out the possibility of allergic reaction, I would also order allergy tests to be performed.
Caregiver education will depend on the diagnosis confirmed. For instance, if the child has measles, it is crucial to educate the caregiver on the importance of vaccination, both for measles and for other diseases. If the allergic reaction is confirmed, it is crucial to provide education on identifying allergy symptoms in the future and ensuring allergen-free environment. In the case of Kawasaki disease, the caregiver should receive education on the possible complications of the disease, such as the recurrence of the disease, CHF, massive myocardial infarction, myocarditis, pericarditis, and so on (Burns et al., 2016). The caregiver should also receive comprehensive advice on the treatment and care for any of the diagnoses confirmed.
References
Burns, C., Dunn, A., Brady, M., Starr, N. B., & Blosser, C. (2016). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier Saunders.
NHS. (2015). Measles. Web.
Scheinfeld, N. S. (2016). Kawasaki disease. Web.