pediatric gi and gu eval from an fnp perspective to peers response

Please respond to at least 2 of your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.

Vivek’s Response

1. You are managing the primary healthcare needs of a newborn who was born with Hirschprung’s disease. What will you expect to see at the 1 month well child exam? What information will you obtain from the father who has brought the baby to the appointment? When will you have the baby return to clinic to see you?

Question 1 – Hirschprung’s Disease

Hirschprung’s disease is a rare but serious birth defect in which nerve cells responsible for peristalsis in colon are missing or unable to fire. This causes problems passing stool. If a newborn infant does not pass meconium within 24–48 hours after birth, Hirschprung’s disease should be suspected (Szylberg, & MarszaÅ‚ek, 2014). Other symptoms include distended abdomen, diarrhea, constipation, gas, and/or vomiting. Around 80% of patients in the first months of their lives demonstrate defecation problems and, additionally, dietary problems, delayed physical development, significant flatulence, and emesis; other patients do not show any symptoms until late childhood, when the clinical symptoms include chronic constipation, malnutrition, and physical development delay (Szylberg, & MarszaÅ‚ek, 2014). Without proper treatment at an early age a significant group of children may suffer from severe complications later in life such as acute enteritis or toxic megacolon.

Assuming this child was not treated by surgery, at 1 month of age I may find bowel obstruction, constipation, and/or enterocolitis (Bhatnagar, 2013). Signs may include distended abdomen, bilious vomiting, fever, dehydration, lethargy, and occasionally dilated peristaltic loops visible on the per abdominal examination. Whether surgery was completed or not, I would ask the father questions pertaining to the complications mentioned. I would ask about any continuing defecation issues, trouble feeding, stool characteristics, and infant behavior. If the infant had a colostomy, I would ask about stoma care at home. According to the American Academy of Pediatrics, most infants and children can experience some constipation following the surgery (Bhatnagar, 2018). So this is something to assess for. Signs of constipation may include fussiness, bloating, difficulty passing stools, and lac of stools. Laxative can help. Health management of a newborn requires different healthcare professional including the surgeon, gastro, and primary care. If the newborn has no had surgery, a visit with the surgeon should be completed within a couple weeks. During regular PCP visits, referrals can be made to accordingly. I would advise the father to immediately reports temperature of 101° F or higher, redness or fluid at the incision, or no bowel movements in a day. During regular PCP visits, referrals can be made to accordingly.

Reference

Bhatnagar, S. N. (2013). Hirschsprung’s Disease in Newborns. Journal of neonatal surgery, 2(4), 51.

Szylberg, L., & MarszaÅ‚ek, A. (2014). Diagnosis of Hirschsprung’s disease with particular emphasis on histopathology. A systematic review of current literature. Przeglad gastroenterologiczny, 9(5), 264–269. doi:10.5114/pg.2014.46160

Amanda’s Response:

You have just finished assessing a 5-year-old girl for complaint of dysuria who presents with a fever of 102, nausea, and right flank pain.

What is your clinical suspicion?

Acute pyelonephritis.

In order to make a proper diagnosis a thorough history and physical exam must be performed. Cystitis is an inflammatory condition of effecting the bladder. Cystitis includes symptoms of dysuria include; foul smelling urine, painful urination, urinary urgency/frequency, hematuria, and suprapubic pain (Bitsori, & Galanakis, 2012). Pyelonephritis is an infection of the pelvis and parenchyma of the kidney (Bitsori, & Galanakis, 2012). Symptoms of pyelonephritis include; abrupt onset of symptoms, fever, chills, and flank pain (Bitsori, & Galanakis, 2012).

What testing will you order to assess the condition?

In clinic urine dipstick: To assess for leukocytes, nitrates, blood, and protein.

IF the in clinic dipstick was > +125 leukocytes, I would send the specimen for culture to confirm organism growth.

What is your plan of care including treatment recommendations and their rationale?

After reviewing this patient’s symptoms, it appears she is able to take oral medications. She has not experienced any vomiting. Depending on the patient’s allergies – I would chose a seven day course of oral Bactrim or Augmentin for treatment. A 7 day course of antibiotic treatment is recommended for the treatment of pyelonephritis (Bitsori, & Galanakis, 2012). I would initiate treatment immediately and not delay treatment pending results of the urine culture. Prompt treatment of urinary infections is believed to reduce the risk of renal scarring (Saadeh, & Mattoo, 2011). Studies have shown increased infection resolution rates with Bactrim versus a Penicillin only medication (Van Niel, 2011). This is believed to be attributed to the increased rates of e coli (Van Niel, 2011). I would identify if this was a recurrent infection for the patient. If the patient had experienced repeated urinary infections I would obtain renal imaging. Renal imaging is helpful to identify abnormalities and risk factors that can be modified and decrease infection recurrence (Saadeh, & Mattoo, 2011). Parental education is imperative to the success of the treatment plan. I would educate this patient’s parents regarding the medication schedule and importance of completing the regimen. I would provide education regarding proper urinary hygiene i.e. proper wiping. I would provide a list of concerning symptoms to return to the clinic or go to the emergency room. I would recommend the parents encouraged fluid hydration to reduce the risk of dehydration. The parents may also administer acetaminophen for fever control and discomfort. I would schedule this patient a follow up appointment in 10 days for a repeat urine dipstick to ensure the infection had resolved.

References

Bitsori, M., & Galanakis, E. (2012). Pediatric urinary tract infections: Diagnosis and treatment. Expert Review of Anti-Infective Therapy, 10(10), 1153-64.

Saadeh, S. A., & Mattoo, T. K. (2011). Managing urinary tract infections. Pediatric Nephrology, 26(11), 1967-76.

Van Niel, C., (2011). Which antibiotics are prescribed for pediatric ambulatory UTI? Journal Watch.Pediatrics & Adolescent Medicine