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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