Pediatric Case Studies

Case Studies

• Infant with VSD:

  • A hole in the septum between the right and left ventricles increases pulmonary blood flow, requiring the pulmonary artery to work harder.
  • Assessment reveals heart failure, pulmonary hypertension, lung inflammation, and potentially low weight/extra heart sounds.
  • Management involves ACE inhibitors and Digoxin (at least 60mg/hr).
  • The case highlights mixing of extra blood.

• 8-year-old with Sickle Cell Anemia:

  • Autosomal genetic disorder where abnormal Hgb S replaces Hgb A.
  • Sickled red blood cells (RBCs) are more viscous, increasing occlusion risk and decreasing oxygen carrying capacity.
  • Sickling occurs under stress factors like fever, dehydration, acidosis, and hypoxia.
  • Diagnostic tests include CBC, sickle turbidity, and Hgb electrophoresis.
  • Sickle cell crisis involves decreased Hgb, increased WBCs, bilirubin, and reticulocytes. Blood smears are also done for diagnosis.
  • Annual Transcranial Doppler tests assess risk of stroke (CVA).
  • Vaso-occlusive crisis is the most common type, characterized by RBC clumping, reducing blood flow to organs.
    • Mild to moderate pain use acetaminophen or ibuprofen.
    • Severe pain requires opioid analgesics.
    • Heat packs can also help with joint pain relief
    • Three or more opioid doses indicates potential need for hospitalization
  • Possible complications: gallstones, stroke, eye problems, leg ulcers
  • Treatment includes medications such as hydroxyurea to prevent sickled RBC formation and pain medication treatment.

Other Cases

• 10-year-old with Asthma:

  • Narrowed/inflamed airways are a key symptom.
  • Risk factors include family history of asthma and allergies, exposure to smoke, and low/overweight.
  • Signs include dyspnea, cough, audible wheezing, accessory muscle use, tripod positioning.
  • Diagnostics include PFTs and peak flow meters.
  • Medications range from corticosteroids to albuterol to montelukast, and more intensive care may require theophylline, magnesium sulfate.

• 16-year-old with Cystic Fibrosis:

  • Characterized by thick mucus in the lungs.
  • Early signs include wheezing, rhonchi, and a dry, non-productive cough.
  • Increased signs include dyspnea, emphysema, and atelectasis. Advanced signs involve cyanosis, barrel chest, and clubbing.
  • Other indicators include large, greasy, bulky, and foul-smelling stools.
  • Assessment includes lung sounds, respiratory, development, PIV (Possibly intravenous?) sputum culture.
  • Education focuses on high calorie, high protein diets, enzyme supplements taken 30 minutes before meals.

• 3-year-old with Hirschsprung's Disease:

  • A disorder characterized by missing nerve cells that control bowel function in certain bowel sections.
  • Symptoms include constipation, abdominal distention, and observable peristaltic waves.
  • Diagnosed via rectal biopsy and X-rays.
  • Treatment typically involves surgery.

• 7-year-old with ALL:

  • WBCs become neoplastic (cancerous).
  • Early signs include low-grade fever, pallor, bruising (petechiae), enlarged liver/lymph nodes/joints,
  • Late signs manifest as pain, hematuria (blood in urine), mouth ulcers, and enlarged kidneys.
  • Diagnostics will assess blood counts, anemia, thrombocytopenia, neutropenia, leukemic blasts (immature WBCs) for the assessment of the blood condition.

• 4-week-old with Pyloric Stenosis:

  • A condition causing a thickened pyloric sphincter, therefore narrowing and obstructing the passage between the stomach and small intestine.
  • Typical symptoms include projectile vomiting and failed formula feedings, and it may lead to dehydration.
  • Diagnosing frequently involves ultrasound
  • Treatment focuses on correcting fluid and electrolyte imbalances.
  • Consider IV fluids before surgery, a NPO (nothing by mouth) status before surgery and slow feedings after.

• 12-month-old with Intussusception:

  • A condition where one segment of the bowel telescopes into another segment.
  • Symptoms often involve sudden, intense pain, with possible nausea and possible edema. 
  • Diagnosed via ultrasound.
  • Treatment commonly includes an air enema procedure or, if necessary, surgery.

• 5-year-old with Acute Renal Failure:

  • A sudden decrease in kidney function.
  • Risk factors include pre-renal issues (dehydration from diarrhea, vomiting, or shock), intrinsic (kidney damage—from glomerulonephritis or other causes), and post-renal (obstruction).
  • Signs of concern, possibly including Oliguria, abrupt diuresis or edema.
  • Diagnostics include lab tests to look for potassium, sodium and mineral imbalances, and possibly checking for cardiac arrhythmias.
  • Treatment involves managing the underlying cause and providing supportive care (IVs, medications to manage electrolyte imbalances).

• 12-year-old with a Leg Fracture:

  • Assessment includes pain, crepitus, deformity, edema, ecchymosis (bruising) and possible warmth or redness from irritation or infection in an affected area.
  • Neurovascular status monitoring is fundamental for assessing for blood flow in the leg.
  • Treatment should include reducing jewelry and accessories that might restrict blood flow in the area.

• 5-year-old with Rheumatic Fever:

  • Autoimmune inflammatory reaction typically occurring 2-4 weeks after a strep infection.
  • It targets the heart, blood vessels, and joints.
  • Assessment should monitor for inflammation, carditis (sign of heart inflammation), subcutaneous nodules, polyarthritis, rash, chorea.
  • Diagnostics include blood tests for strep antibodies.
  • Treatment and preventative measures are essential, including antibiotics.

• 14-year-old with Nephrotic Syndrome:

  • Characterized by excessive protein in the urine (proteinuria), causing low blood protein levels.
  • Primary cause is unknown, other secondary causes can include kidney damage due to metabolic, biochemical, physicochemical disturbances in the body, for example, lupus, diabetes, and or heart failure.
  • Signs include significant weight gain, edema, decreased activity, ascites.
  • Diagnostics involve urine tests, blood tests (looking for albumin and other lipids), and kidney biopsy if necessary.
  • Treatment focuses on reducing swelling and infection, possibly using medication like prednisone, furosemide, and 25% Albumin.

Growth Charts

• Includes age ranges for Heart Rate (HR), Respiratory Rate (RR), Systolic Blood Pressure (SBP), and possibly other relevant data.

This quiz focuses on two critical pediatric case studies: an infant with Ventricular Septal Defect (VSD) and an 8-year-old with Sickle Cell Anemia. Through these cases, explore the assessments, symptoms, management strategies, and diagnostic procedures involved. Understand the implications of these conditions and their treatments.