NR 602 Week 5 Assignment
NR 602 Week 5 iHuman Virtual Patient Encounter Activity – Grady Harris
Case Attempt: GH is a 26 month old male patient with a past history of Down Syndrome who presents to clinic with mother who reports abdominal pain for the past two days. The mom stated pt fell off bed while at home with her boy friend. She states that the pt has been whining and refusing to eat and has a noticeable bruise to his abdomen. Physical examination revealed hypotension, tachycardia, tachypnea, hypoactive bowel sounds. He also has a faint circumferential macular discoloration at wrists consistent with aging ligature marks. Physical examination also revealed a firm distended abdomen with ecchymoses overlying the epigastrium area. Pertinent negatives include adventitious breath sounds and head trauma.
Case Attempt: GH, a 2 y/o A.A male with a hx of Down Syndrome, ASD, and ASD repair presents with stomach pain x 2 days, crying, withdrawn, bruise on his stomach, one episode of vomiting, rapid breathing, lack of appetite, and decreased urinary output which his urine is a dark-colored with a strong odor and decreased bowel movements. The mother denies head trauma but acknowledged that the child is not acting like himself. PEX reveals poor eye contact, skin is pale, cool, clammy, and mottled; pulse-160; strength: weak, resp. 50, bp: 68/40 bilaterally; hypotensive; circumferential macular discoloration @ wrist with aging ligature marks, ecchymosis 10cm overlying epigastrium- oval shaped, distended abd. with tenderness and rebound to palpation, 2cm umbilical hernia, neg. tympany and shuffling dullness. Has not received the last immunizations for his age.
NR 602 Week 5 iHuman Virtual Patient Encounter Activity – Tommy Acker
Case Attempt: T.A. is a 26-month-old male with a PMH pertinent for Downs syndrome, ASD (repaired), and CHF who presents with his mother reporting onset of abdominal pain 2 days ago with vomiting x1 yesterday. She also reports poor appetite/fluid intake, decreased diaper count with dark, foul-smelling urine, lack of BM x 2 days, and increased fussiness. Denies fever, dyspnea, and diarrhea. She endorses a recent fall from bed but denies head trauma and other injuries. Child appears lethargic and withdrawn. Exam reveals pale, mottled, cool/ clammy skin, hypotension, tachycardia, tachypnea, hypoactive bowel sounds, and indications of dehydration. Capillary refill is 3-4 seconds. Abdomen is firm, distended, and diffusely tender on palpation with rebound tenderness, involuntary guarding, and rebound tenderness. A 10cm oval epigastric ecchymosis area is appreciated. A reducible 2.0 cm umbilical hernia and diffuse diaper rash were noted. Evidence of faint circumferential macular discoloration at wrists, suspicious of aging ligature marks is of concern.
Case Attempt: TA is a 26-month-old M with Downs syndrome who presents with his mother with c/o abdominal pain after “falling out of bed” two days ago, one episode of emesis, and lethargy. PMH includes s/p ASD surgical repair with CHF. The mother also reports TA has been breathing more rapidly, sweating, has a poor appetite, and has diminished urine output with a dark color and strong odor. PE reveals pallor, listlessness, hypotension, tachycardia, tachypnea, grossly distended abdomen with epigastric bruising, firm to palpation with guarding, and rebound tenderness. A reducible 2cm umbilical hernia, diaper rash, and faint circumferential macular discolorations present at wrists consistent with aging ligature marks are also present on examination. A single mother raises TA with occasional help from her boyfriend and neighbors. TA is exposed to secondhand smoke. The birth father is not involved.
NR 602 Week 5 iHuman Virtual Patient Encounter Activity – Hassan Khan
Case Attempt: Hassan is a 24-month-old male brought into the office by his mother with complaints of abdominal pain x 2 days after falling off the bed during a nap while under the care of her boyfriend. He has a history of Downs syndrome, ASD repair with transient CHF, and global developmental delay. Physical exam reveals tachycardia, tachypnea, hypotension, and lethargy. Skin is cool, clammy, pale, slightly mottled, toe capillary refill 4 seconds, dental carries, and diffuse diaper rash. Bowel sounds are hypoactive, abdomen is distended, and firm with ecchymoses overlying the epigastrium; tenderness on palpitation, guarding and rebound tenderness. Wrists have faint circumferential macular discoloration consistent with aging ligature marks. Pt is afebrile, lungs sounds CTA, no head trauma. Mother states Hassan is often watched by her neighbor and boyfriend while she works.
Case Attempt: HK a 26-month-old male with past medical history of Down syndrome and s/p AV septal repair with transient CHF and global development delay presents to the clinic with mother who reports a 2-day history of abdominal pain. Per report, mother says her boyfriend admits the patient “fell from the bed during a nap” and has not been the same. Patient is often left in the care of neighbors or mom’s boyfriend while she is at works. Physical exam is positive for tachycardia, tachypnea, hypotension, and lethargy; skin is pale, cool, clammy, and slightly mottled, with toe capillary re…ll of 4 seconds, dental caries, and diffuse diaper rash. Hypoactive bowel sounds, abdominal distention, 昀椀rm, with ecchymoses overlying the epigastrium area; tenderness on palpation, guarding, and rebound tenderness. Faint circumferential macular discoloration at wrist consistent with aging ligature marks. Negatives include fever, lung sounds CTA or head trauma noted.
Case Attempt: H.K. is a 2-year-old male with a medical history significant for Down syndrome and atrial-septal defect that was repaired who was brought into the clinic by his mother for abdominal pain for 2 days with 1 episode of vomiting last night. Mother states that symptoms began after the patient fell from the bed while taking a nap. She states that he has been lethargic, has decreased wet diapers daily with dark and strong-smelling urine and no bowel movement for one day and has had a decrease in appetite. Upon assessment, the patient is listless and has poor eye contact. Skin is pale, cool, and slightly mottled. Diffuse diaper rash noted. Faint circumferential macular discoloration at wrists consistent with aging ligature marks. Ecchymoses overlying epigastrium measuring 10cm in diameter in an oval shape. Hypoactive BS x 3. Distended, firm abdomen. Diffuse tenderness on palpation with associated guarding. 2cm, reducible umbilical hernia. No medications have been given to the patient.