Pedia Case Presentation.pptx

2. General Data Name R.C Age/Gender 1 year and 4 months / Female Nationality Filipino Religion Iglesia ni Cristo Home Cavite

3. Diarrhea Chief complaint

4. History of Present Illness 4 days PTA: ○ 2 episodes of vomiting previously ingested milk ○ 1 episode of yellow watery stool ○ No fever, cough or colds 3 days PTA: ○ 2 episodes of vomiting previously ingested food and milk ○ 2 episodes of yellow watery stool ○ Consult was done at CGHMC ER ❏ Acute gastroenteritis, mild dehydration ❏ Discharged ❏ THM: Pedialyte, Zinc Sulfate drops 1ml OD, Erceflora 1 vial BID for 5 days

5. History of Present Illness On the Interim: ○ 5x mushy light green stools ○ Zinc sulfate and Erceflora given as due, Pedialyte was not Few hours PTA: ○ 4x loose bowel movement ○ Weak looking, irritable, incessant crying prompted consult to ER

6. Review of Systems General (+) weight loss (3 kg in 2 weeks) HEENT (-) eye redness, (-) eye discharge, (-) ear discharge, (-) ear pain Cardiac (-) cyanosis Respiratory (-) cough, (-) colds Genitourinary (-) hematuria Musculoskeletal (-) limitation in range of motion Neurologic (-) seizure Hematologic (-) easy bruising, (-) pallor, (-) bleeding

7. Past Medical History ➢ Patient had similar illness in the past ○ 3x watery stools ■ Hidrasec, with relief ■ Changing of milk brands ➢ No past hospitalization ➢ No past surgeries

8. Family History ✓ Hypertension: maternal ✓ Diabetes: maternal ✓ Hyperthyroidism: paternal ✓ Cancer: maternal ✓ PTB: aunt, resolved ✓ Asthma: mother ✓ Allergies: mother

9. Personal and Social History ● Patient lives with her mother, who is working as a clinical nurse, with 5 other people, her maternal grandfather and grandmother, uncle and 2 aunts. ● A nanny comes by to take care of her when her mom goes to work. They live in a bungalow house, adequately ventilated, drinks distilled water (Wilkins) only, her family’s drinking water comes from the water station. T ● The patient still needs to be fed by her mom. Garbage is collected every other day

10. Birth and Maternal History ➔ Live, full term, to a then 33 year old G2P1 mother at a local hospital. She had regular prenatal checkups with an OB GYN. Mother had UTI during her first trimester, taken unrecalled antibiotics which resolved. 2nd and 3rd trimesters were unremarkable. ➔ Cesarean delivery, birth weight of 2.94 kg, no fetomaternal complications

11. Growth & Developmental History

12. Nutritional History ● Never breastfed ● Formula milk: ○ Bear brand ○ Nestogen lactose free ○ Lactum ○ AL110 ● Complementary feeding ○ Started at 6 months ● Regular table food ○ Started at 9 months ● Picky eater ○ Normal: rice, potato, yolk, cerelac ○ Preference: simple pastries ○ Snacks: morning, afternoon 24 hour recall ● Breakfast ○ 1 slice of bread, 3 biscuits ● Lunch ○ Milk ● Dinner ○ Milk ● Milk ○ 5-8 bottles ● Water ○ 7 oz

13. Immunization History Administered ● BCG ○ Hospital ● Hepatitis B ○ 1st dose - Hospital ○ 2nd to 4th dose - Health Center ● DPT-Polio-Hib ○ 1st to 3rd dose - Health Center ● OPV ○ 1st to 3rd dose - Health Center ● PCV ○ 1st to 3rd dose - Health Center Not administered ● Rotavirus ● Measles ● MMR

14. Anthropometrics Weight: 9.3kg Height: 82cm BMI: 13.8 kg/m2

18. Anthropometrics Weight for age 0 Length for age 0 Weight for length Below -1 BMI for age Below -1 Interpretation: Normal

19. Physical Examination General Awake, weak looking, not in cardiorespiratory distress Vital Signs HR 132 RR 24 T 36.4 O2 sat 98% at RA Skin (-) pallor, (-) cyanosis, normal skin turgor, CRT <2secs HEENT Symmetrical facial features, slight sunken eyeballs, dry lips, moist oral mucosa, non hyperemic tonsils, (-) cervical lymphadenopathies Respiratory Symmetrical chest expansions, clear breath sounds, (-) wheezes, (-) retractions Cardiovascular Adynamic precordium, normal rate and regular rhythm, (-) murmurs Gastrointestinal Soft, non tender, non distended, hyperactive bowel sounds Extremities Pulses full and equal, (-) edema, (-) inflammation

20. Salient History Subjective Objective Pertinent Positive ● 5 days loose bowel movement (11x) ● 2x vomiting episodes: previously ingested food Pertinent Negatives ● Non bloody, nonmucoid, no melena ● Nonprojectile, non bilious, no hematemesis ● No abdominal pain ● No fever ● Slightly sunken eyeballs ● Dry lips ● Hyperactive bowel sounds

21. Primary Working Diagnosis Acute Gastroenteritis with moderate signs of dehydration

22. Differentials Salient Features Viral Gastroenteritis Amoebiasis Lactose Intolerance ● 1y/4mo old ● Loose bowel ● movement (11x): mushy light green ● Vomiting episodes (2x): previously ingested food ● Non bloody, non mucoid, no melena ● Weak-looking and irritable ● Weight loss ● (-) Abdominal pain ● (-) Fever ● (-) Rotavirus vaccine ● Rotavirus most common pathogen ● Watery Diarrhea, vomiting, fever ● Dehydration ● Weight loss ● Young age associated with increased risk for severe disease ● Most cases asymptomatic ● Incubation period of 2-4 weeks ● Colicky abdominal cramps or pain, diarrhea associated with tenesmus ● Vomiting and fever uncommon ● Commonly manifests at 3 y/o and up ● Abdominal pain, bloating, flatulence, nausea or diarrhea after milk ingestion ● Symptoms present 30 minutes to 2 hours after milk ingestion

23. Admitting Orders Diet As tolerated Laboratories CBC with platelet count Serum Electrolytes Fecalysis Urinalysis Stool culture/sensitivity Therapeutics Zinc sulfate oral drops 1 mL PO OD IV Fluids D5 0.3 NaCl 1L x 45cc/hr Monitoring VS q4. Input and output

24. Laboratories CBC WBC 9.7 Hgb 116 Hct 0.350 Plt 364 Segmenters 59 Lymphocytes 26 Monocytes 15 Serum Electrolytes Na 133 K 3.9 Cl 103 Fecalysis Color Light Brown Consistency Mucoid Parasitic Ova None E. Histolytica Cysts Negative RBC 1-2/hpf Pus cells 0-2/hpf Yeasts Few Fat Globules Few

25. Acute Gastroenteritis

26. Definition ★ Inflammation of the gastrointestinal tract ★ Illness of <14 days

27. ★ Virus ○ Rotavirus (most common), Calicivirus (norovirus, sapovirus) ★ Bacteria ○ Nontyphoidal Salmonella, Shigella, Campylobacter, Yersinia, E. Coli (STEC, EHEC, ETEC, EPEC, EIEC), C. Difficile, V. Cholera (O1, O139), Foodborne (B. Cereus, S. Aureus, C. Pefringens ★ Parasites ○ Giardia, Cryptosporidium, Cyclospora, Entamoeba Etiolology

28. Pathogenesis

29. ★ Diarrhea ○ Passage of 3 or more abnormally loose or liquid stool per day ★ Vomiting ★ Fever ★ Abdominal pain Clinical manifestation

30. ★ Fecalysis: bloody, chronic, fat malabsorption ★ Urinalysis: dehydration (sp >1.02) ★ Stool CS: bloody (bacterial) ★ CBC w/ plt: systemic infection ★ Serum electrolytes: Na, K, C Diagnostics

31. ★ DEHYDRATION Complication

32. ★ Rehydration and maintenance ORS ★ Continued breastfeeding and refeeding with with an age-appropriate, unrestricted diet as soon as dehydration is corrected ★ Micronutrient supplementation ○ Zinc supplement ○ Probiotics ★ Antimicrobial therapy – if indicated Management

34. ★ Exclusive Breastfeeding until 6 months of life ★ Vit A supplement ★ Rotavirus Immunization ★ Improvement of hygiene, sanitation and water supply Prevention

35. CREDITS: This presentation template was created by Slidesgo, and includes icons by Flaticon and infographics & images by Freepik Thanks! Do you have any questions? youremail@freepik.com +91 620 421 838 yourwebsite.com Please keep this slide for attribution

Pedia Case Presentation.pptx

Pedia Case Presentation.pptx

Recomendados

Mais conteúdo relacionado

Similar a Pedia Case Presentation.pptx

Similar a Pedia Case Presentation.pptx(20)

Último

Último(20)

Pedia Case Presentation.pptx

Notas do Editor