Case Study Discussion: Module 10, Case Study 2 No unread replies.No replies. Ana

Case Study Discussion: Module 10, Case Study 2
No unread replies.No replies.
Analyze this case as you would a client in a clinical setting. You may use your class texts, your pathophysiology text, peer-reviewed journals, and any other reputable sources necessary to help you plan care for this client.
Read the following case study:
CC: 2.5-year-old boy with no bowel movement in 4–5 days
HPI: This child is brought in by his mother with a history of no stool passage in 4–5 days. He currently has no vomiting, no cough, and no fever and is otherwise without any accompanying symptoms or signs of illness. The mother said he has had this problem since infancy, and has required various methods to prompt stooling, including rectal stimulation, suppositories, and enemas. He usually stools every 3 to 4 days. There have been no acute dietary changes, and based on his history, he has been placed on mineral oil. He occasionally rubs his tummy to signal discomfort, but overall appears to be at his baseline. His mother has attributed this current bout to recently starting to attend a new daycare and attempts at potty training.
Past Medical History: Normal birth history; needed to stay an extra day because he did not poop until the third day. Recent UTI treated with antibiotics, negative imaging studies.
Medications: none
Immunizations: needs Hep A No. 2
Developmental History: beginning two-word phrases; runs well; likes to play with other children
Family History: maternal uncle with Crohn’s disease; paternal history unknown
Subjective: Father not involved; mother’s boyfriend smokes outside home, no pets, no ill contacts, daytime providers at daycare and a maternal aunt, has had difficulty toilet training, associated with temper tantrums
ROS: as above; no rashes, no changes in behavior or activity; no urinary complaints, no weight loss, and no recent illnesses
VS: T. 37, C HR 90, RR 26, BP 95/50, Weight 15 kg
Physical Exam:
General: alert and in no distress, appears comfortable
HEENT: mucous membranes moist, TMs and oropharynx are clear.
Neck: supple
Chest: clear to auscultation bilaterally, without crackles or wheezes
CV: normal pulses, cap refill < 2 seconds, RR&R normal S1 S2, no murmur Abdomen: mild distention, mild tenderness left lower quadrant with palpable 4 cm x 4 cm mass; normal bowel sounds, no visceromegaly appreciated GU: normal external male genitalia, Tanner stage 1 Neuro: Grossly non-focal exam Skin: no lesions, no signs of trauma, no clubbing or edema Post a response to the following by 11:59PM (EST) on Thursday: What are 3 differential diagnosis (with rationales) for this patient at this point? What elements of the physical exam would you further pursue? What further work up would you pursue to aid in diagnosis for this patient? Give your treatment plan with rationale. What guidelines would you use for this patient? Cite at least 1 relevant article within the last five 5 to support your claim.

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