Case study
Hello follows instruction please. APA format at least 6 references no older than 5
years old. Apply information from the Case Study below to answer the following
questions:
What do you believe is your best course of action for this appointment in the case
of T.A?
What clinical or historical findings will indicate the need for diagnostic studies and
why?
Discuss and define the following diagnostic test study and why do you think they
should be ordered in a drowning patient like T.A : Ammonia level, Urine culture,
CMP, valporic- acid, levetiracetam and chest x-ray.
Discuss and define these 3 differentials diagnosis in this case with sign and
symptoms and plan of care: status Epilepticus, and seizures generalized, and
aspiration pneumonia
Discuss and describe the diagnosis: Drowning
Case study
T. A is a 9 year-old developmentally disabled African-American male child with a
known history of long-standing tonic-clonic seizures secondary to perinatal anoxic
brain injury. As per his mother he started to have difficulty breathing and
wheezing after he felt face down in the poo while he was with his therapist. His
mother says Timothy has been "well" and participating in PT sessions. His "mild
asthma" is under control with medications according to his mother.
Name: T. A
Age: 9 years
Height: 4' 1"
Weight: 49 pounds
Chief complaint:
T.A is breathing real fast. He had a full seizure face down about 5 or so hours ago.
His therapist was right beside him and got him out of the pool quickly. Push the
water out of his lung in place him in a safe position. After he had recover and he
seems fine and I took him home. The lifeguard reminds me to keep close eyes on
him. In the pool in water; now I see him with difficulty breathing, wheezing. I gave
him inhaler it did not work.
History of Present illness:
T.A has been doing well, except today, he has not doing well since last check- up.
He is not able to express himself clearly. No complain of pain. Mother worried he
might have some fluid in his lung. After his mother got him home from the pool,
he seemed fine for a while. May be a few hours later, he started breathing fast
and wheezing. The event of not breathing started when he was getting his water
therapy. He must have breathing water with the seizures. According to his mother
she tries giving him inhaler, but it didn’t work. It is hard for him to breath and his
little chest is rumbling and wheezing. Good appetite. He goes to bed around 9 PM
or 10:00PM. No vomiting, drooling. He has difficulties swallowing since he was
born. He has peg tube since he was 2 years old. Lately he is been able to tolerate
very soft foods and thick liquid. But we have to becarefull and monitor him
constantly or he will put anything and everything in his mouth.
Past Medical History
T.A has been beset with seizures all of his young life. She was told he breathing
water while holding by the therapist face down in the water. She assuming he had
a seizure during this time, the lifeguard immediately took over and forced water
out of his lung. He suffered a perinatal anoxic brain injury, that has slows him He
has Microcolis down a quite a bit, but considering all his problem he is a happy
boy and we are happy to have him in our lives.
Medication:
Inhaler
Social History: Not been expose to second hand smoke. He doesn’t go to daycare.
His mother takes care of him at home. He is the only child, but he is attend
socialization activities twice a week and gets along well with other kids. His
grandmother from his father sides is helping out for baby sister. His father is a
cable man installation specialist
General Appearance: Expression:
Rhythmic head nodding, Skin: Warm, dry
Movement: Generalized spasticity
Odor: Chlorine, difficulty breathing and wheezing.
Hospitalization
As a baby yes frequently. He had the peg tube remove two years ago, but that
was a very quick stay and mostly for observation. Now between us and the home
health every visit, we have been able to keep him out of the hospital. I think PT
has been helping too.
Childhood sickness
The usual cough, tummy aches, colds, he had so many challenges, but he’s done
well in that regards, I guess.
Asthma pretty mild, eczema
Medication
Levetiracetam and Depakote for his seizures and albuterol for his asthma.
He took his last medication this morning before he went to the pool.
Preventive measures
His last physical was done a couple of month ago. Flu shot and regular
immunization.
History of Family
His father is 32 Alive and healthy
Mother is 31 alive diagnose with depression
Respiratory: Wheezing with difficulty of breathing
Lab result
Name Value Units Reference Range
White blood cells (WBCs) 11000 mm3 4,000-10,000
Red Blood Cell Count (RBC)
4.65 million/µl
4.5-5.9(♂), 4.0-5.2(♀), adults
Hemoglobin (Hgb) 13.7 g/dl 14-18(♂), 12-16(♀), adults
Hematocrit (Hct) 41.6 %
42-54(♂), 37-47(♀), adults
Mean corpuscular volume (MCV)
91
fl
82-103, adults
Mean corpuscular hemoglobin (MCH) 31
µm3 26-34, adults
Mean corpuscular hemoglobin concentration (MCHC)
adults
Platelets (thrombocytes) 340
Neutrophils 79
%
46-78, adult
Lymphocytes
17
%
Monocytes 2
%
3-10, adult
Eosinophils 1
%
0-6, adult
Basophils
%
0-3, adult
Segmented neutrophils 78
%
30-37,
k/dL 150-399, adults
Red cell distribution width (RDW)
1
33
13.3 %
11.5-14.5, adults
18-52, adult
%
36-72, adult
Band Cells 1
%
0-6, adult
Sodium (Na+)
132
mmol/L
135-145
Potassium (K+)
4.3
mmol/L
3.5 to 5.1
Calcium (Ca2+)
8.8
mg/dL
8.7-10.7(1 mo-adult), 8.7-11.9
Chloride (Cl-)
102
mmol/L
95-102(1mo-adult), 91-118(1d-1mo)
Carbon dioxide, total (CO2)
15y)
20
Glucose (BG/Glu) 104
mg/dL
Urea nitrogen (BUN)
8
mmol/L
22-29(15y-adult), 20-28(1y-
70-110(fasting), 70-200(non-fasting)
mg/dL
8-21(15y-adult), 5-18(1mo-15y)
Creatinine 0.8
mg/dL
Albumin
g/dL 3.5-5.0(adult), 2.9-5.5(0-3y)
4.2
0.6-1.3(♂), 0.5-1.1(♀)
Bilirubin, total
1.1
mg/dL
Protein, total
7.1
g/dL 6.0-8.2(8y-adult), 5.6-8.5(1mo-8y)
Alkaline phosphatase (ALP)
0.2-1.3(1 mo-adult), 0.6-11.1(1d-1mo)
82
units/L
30-125(adult), 80-250(1d-15y)
Aspartate transaminase (AST) 44
units/L
3-44
Alanine transaminase (ALT)
units/L
0-40
12
valproic acid (therapeutic range)
82
µg/mL
50-125
levetiracetam (therapeutic range)
20
µg/mL
12-46
Ammonia
24
µg/dL 10-80 (adult)
Name Value Units Reference Range
Color Amber
Interpreted by physician
Clarity
clear
Clear
Odor Normal
pH
5.0
Protein
slightly nutty
4.5-8
3
Specific gravity
mg/dL
0-8
1.016
1.002-1.030
Osmolarity > 400 mOsm/L
Leukocyte esterase
>400
Negative
negative
Nitrites
Negative
0
Ketones
Negative
negative
Bilirubin
Negative
negative
Blood (heme)
Negative
Urobilinogen
0.7
negative
EU/dL 0.2-1.0
Crystals
None
Interpreted by physician
Casts None hyaline casts/lpf
Glucose, urine
0-4
Negative
negative
White blood cells (WBCs) 0-1
hpf
0-5
Red blood cells (RBCs)
0-1
hpf
0-5
Red blood cell casts
None
SQEP None lpf
Bacteria
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