A Typical Cold? by Brent J.F. Hill

Topics: Cystic fibrosis, Asthma, Blood Pages: 5 (1483 words) Published: April 23, 2014
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Part I—The Initial Physical Examination
Scenario
Mary and Bill adopted a three-year-old toddler named Sam two weeks ago. Sam is good-natured and very inquisitive. Typically, before the finalization of an adoption, children are required to undergo a routine examination by a physician. However, the required examination is not meant to be a complete health screening, and many conditions are not even checked. Therefore, Mary and Bill are bringing Sam to Trinity Medical Center for a standard physical examination by a pediatrician to assess his health status. Patient History

Very little information was known about Sam’s parents. However, it was known that they died in an automobile accident when Sam’s father suffered a massive heart attack. In the past two weeks Sam has done very well adjusting to his new environment. Moreover, he has had all the proper immunizations for his age. Sam’s adoptive parents, Mary and Bill, have noticed some greasy/oily stools in his diaper. In addition, they are concerned about his wheezing (when breathing). Physical Examination

Vital Signs
Age: 3 yrs., 1 month
Weight: 28 lbs. (lower 10%-tile)
Height: 3 ft. 1 inch
Pulse: 115 beats/minute
Respirations: 30 breaths/minute
Blood Pressure: 95/60 (systolic/diastolic) mmHg
General Appearance
Happy, energetic child
Head and Neck
Runny nose but his ears are clear of fluid
Lungs
Cracking sounds are present
Coughing and wheezing are noticeable
Cardiovascular
Normal
Abdominal
No swelling is present
Genitourinary
Not assessed
Extremities
Full mobility is present
Pulse found in arms and legs
Neurological
Normal reflexes
Physician Comments
Have a complete blood count and chest x-ray done. Also, schedule a follow-up appointment for tomorrow to review the lab results and chest x-ray. Part II—The Follow-up Visit
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Scenario
Today is Sam’s follow-up medical appointment. The weather is very hot and humid, which makes it almost unbearable to be outside. Sam’s parents parked their car in the parking lot of Trinity Medical Center and went into the air-conditioned comfort of the pediatric clinic. They were immediately seen by the pediatrician, and Mary expressed her concern over the color of Sam’s sputum. Mary was upset that she had forgotten to tell the pediatrician the other day about this fact. The sputum Sam had been coughing up was green and viscid. While talking with Mary and Bill about Sam’s sputum, the pediatrician looked over at Sam and noticed a white “frosting” on his face (the “frosting” is an indication of salty build-up on the drying edge of sweat). The pediatrician asked Mary and Bill if they had noticed this salty build-up before. “That must be why his skin tastes a bit salty when I kiss him on his check,” Mary replied. The pediatrician then went over the blood count and chest x-ray results (described below) with Mary and Bill. After describing the chest x-ray results to them, the pediatrician had a hypothesis about Sam’s chest x-ray results. To test her hypothesis the pediatrician ordered a sweat chloride test (the result is listed below). Blood Lab Results

White blood cell count: values within normal limits.
White blood cell differential: lymphocytes, monocytes, eosinophils, and basophils are within normal limits. There is a slight elevation in neutrophils. •Red blood cell count: values within normal limits

Hematocrit: values within normal limits
Platelet count: values within normal limits
Chest x-ray Results
Some hyperinflation and bronchial wall thickening is apparent. Sweat Chloride Test Results
Indeterminate
Part III—Your Explanation of Sam’s Condition
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Upon completing Part II, each member of your group is now the “expert” for a particular learning issue that is involved with Sam’s condition. Hopefully, this research has either reaffirmed...
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