NSG 6435 Pediatric Week 5 discussion | NSG6435 Pediatric Module 5 discussion - South University ( Grade))

NSG 6435 Pediatric Week 5 discussion - South University How would you evaluate and manage a pediatric patient who has a painful swelling of the hands and feet, fatigue, or fussiness? Which diagnostic studies would you recommend for this patient and why? Sickle cell anemia (SCA) disease is an inherited form of anemia, which effects the shape of red blood cells and decreased healthy cells to carry adequate oxygen. Burns, Dunn, Brady, Starr, Blosser (2016) states that SCA involve the synthesizing of hemoglobin S instead of hemoglobin A. SCA is a complex, chronic disorders characterized by the development of sickled shape cell, which can result in unpredictable acute complications that can lead to life threatening. Most states routine screening of newborn heel stick blood is done to detect genetic and metabolic disorders, such as sickle cell disease, sickle cell trait, and other hemoglobinopathies (Burns et al., 2016). These mandated neonatal screenings detect sickle cell disease more than any other genetic disease (Burns et al., 2016). According to the Center of Disease Control and Prevention (CDC) (2015) SCA is diagnosed at a rate of approximately one in every five hundred births and in Hispanics at a rate of one in every thirty-six thousand births. A child that presents with the complaints of painful swelling of the hands and feet, fatigue, or fussiness, the health care provider should inquire about common childhood illnesses such as respiratory infections, ear infections, diarrhea, vomiting, dehydration, individual, and family history. Diagnostic studies that are beneficial in the diagnosis of a child presenting with Dactylitis, fatigue, and/ or fussiness are CBC (detect anemia), reticulocyte count, C-reactive protein (indication of infection), liver function test ( identify presence of altered liver function, and jaundice), LDH ( identify lysis of WBC or RBC), hemoglobin electrophoresis ( determine presence of abnormal HGB cells), blood smear (detect abnormal cells), blood culture and sensitivity ( rule out infection), ESR ( indication of acute infection), ANA ( rules out systemic lupus), and X-rays of hands and feet (rule out fracture/trauma). The anemia associated with SCA is usually normocytic or macrocytic, and a peripheral blood smear typically shows the sickled cells as well as numerous target cells (Hay et al., 2014). Hay et al. (2014) recommends the avoidance of solubility testing because of increased risk of false positive in infancy and its inability to distinguish between sickle cell disease and sickle cell trait in older children.