Question 1 (a)

To evaluate a pediatric patient with painful swellings on the feet and the hand or with fatigue and fussiness requires certain procedures to be performed. The first thing to do is to determine the pathophysiology, character of the swelling parts whether generalized or localized and the cause. This will guide evaluation as well as treatment of the condition (Polin & Ditmar, 2011). The other thing that a nurse should do is to identify conditions that may be life-threatening or may have serious medical impacts. These life-threatening conditions may include anaphylaxis, hereditary angioedema, restrictive pericarditis and renal diseases. The evaluation of a pediatric patient with painful swelling begins with evaluating the location of the swelling, duration of the symptoms, patient age, past family and medical history, extra concurrent signs or illness, allergies and the current medications and weight gain. To manage this condition, laboratory test would be required. Urinalysis findings, chemistry tests on serum, echocardiography, can confirm or suggest the cause of swelling (Farkas, Varga, Széplaki, Visy Harmat & Bowen, 2007). Sodium and fluid restriction therapy, intravenous albumin infusion or diuretic therapy can then be carried out to treat the condition.

Question 1 (b)

In the case of generalized edema or swelling, studies to recommend include the pleural effusion, ascites, labial/scrotal edema or evidence of broken skin due to swelling. Ascites is often associated with shifting dullness and abdominal distention and at times a wave of fluid on the abdomen percussion (Polin & Ditmar, 2011). Pleural effusion is consistent with decreased breath sounds and also with dullness. For localized swelling, the best thing to do is to localize the swelling area so that it can help deduce a region of lymphatic obstruction. Assessing the patient for fever and inflammation local signs is also important since cellulitis may manifest with the regional swelling. When the swelling is localized on the face, a pediatric patient must be assessed for concurrent airway involvement that could be life threatening.

Question 2 (a)

The major focus of physical examination should include measuring the pediatric patient’s growth parameters. It should include a full evaluation of cardiovascular system including the important signs. Findings of tachypnea, rales, gallop, hepatomegaly and tachycardia are observed in patients who may be having heart failure. The increased pressure of the blood may suggest chronic renal failure (Farkas, et al., 2007). Measurements of blood pressure should be interpreted regarding age, height and gender percentiles. The other physical examination that needs to be conducted is characterizing the edema as whether it is localized or generalized for the purpose of managing or treating it.

Question 2 (b)

Regarding pediatric patients with generalized swelling that includes patients with acute glomerulonephritis, renal failure, hepatic ascites, nephrotic syndromes and heart failure the recommended treatment is through sodium and fluid restriction therapy. This is tailored to provide patients with required amount of sodium for growth (Khanna, Sato, Smith, Bauman & Nerad, 2006). In the case of children with swelling and an expanded intravascular volume, diuretic therapy is recommended. It is useful in treating swelling those results from acute renal failure, renal dysfunction, and glomerulonephritis. In the case of pediatric patients with painful swelling secondary to low oncotic pressure, intravenous albumin infusion is recommended. It is also recommended for pediatric patients with the nephrotic syndrome, those patients with severe ascites and cirrhosis and those pediatric patients with protein malnutrition.

Question 3 (a)

With Sickle Cell Disease (SCD), the spleen does not work well and may fail to work at all. The spleen has a lot of sickle red blood cells. In this situation, the spleen may expand or get damaged thus becoming dysfunctional. Therefore, in the case when the spleen does not function well the victim, may face some infections that are life-threatening (Brousse, Elie, Benkerrou, Odièvre, Lesprit, Bernaudin & de Montalembert, 2012). These infections include sudden weaknesses, rapid breathing, belly pain, rapid heartbeat, pale lips and excessive thirst. Families must understand how to treat or manage sickle cell crisis. One of the methods is to take painkillers such as paracetamol, ensuring that one drinks plenty of water, use a warm or heated pad to massage gently the body part that is affected. It is also imperative to get involved in activities that will take the mind off the pain.

References

Brousse, V., Elie, C., Benkerrou, M., Odièvre, M. H., Lesprit, E., Bernaudin, F., & de Montalembert, M. (2012). Acute splenic sequestration crisis in sickle cell disease: cohort study of 190 paediatric patients. British journal of haematology, 156(5), 643-648.

Farkas, H., Varga, L., Széplaki, G., Visy, B., Harmat, G., & Bowen, T. (2007). Management of hereditary angioedema in pediatric patients. Pediatrics, 120(3), e713-e722.

Khanna, G., Sato, Y., Smith, R. J., Bauman, N. M., & Nerad, J. (2006). Causes of Facial Swelling in Pediatric Patients: Correlation of Clinical and Radiologic Findings 1. Radiographics, 26(1), 157-171.

Polin, R. A., & Ditmar, M. F. (2011). Pediatric secrets. Philadelphia: Mosby/Elsevier.

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