NUR 622
Adam Barnes Remediation
A.B. is a 5-year-old male, kindergarten child who is brought by mom with the complaint
of “my bottom itches”. The itching has been worsening over the last 2-4 weeks. The child is now
complaining it is worse at night and awakens him repeatedly. The child is not fully toilet trained
and has stooling accidents and wears pull ups. He does have a history of constipation. On
physical exam, his findings include: mild anal excoriations with minimal erythema and uneven
finger nails from his nail-biting habit. Additional risk factors include: recent change in body
soap and laundry detergent.
Important points to include when obtaining a history from this patient include asking
questions to both patient and mother. For example, asking about bowel movements, how many
per day, history of constipation/diarrhea, any straining with BMs, what treatments has helped,
any nausea or vomiting, any allergies/prescription medicines, any pain, any new
activities/exercises, and hand washing techniques.
Important points to include when performing a physical exam on this patient include
vitals (HR, BP, T, O2, RR), auscultating heart/lung sounds, inspecting skin, abdominal exam,
and rectal exam.
Differential diagnoses include encopresis, tinea cruris, dermatitis, and pinworms. Several
factors associated with pinworm infections are age, gender, behavior (biting or sucking fingers),
and poor personal hygiene practices, such as failing to wash hands after using the bathroom
(Taylor et al., 2018). Diagnostic testing that should be included for this patient is an anal tape test
to confirm diagnosis of pinworms (Wendt et al., 2019).
Adam Barnes Remediation
A.B. is a 5-year-old male, kindergarten child who is brought by mom with the complaint
of “my bottom itches”. The itching has been worsening over the last 2-4 weeks. The child is now
complaining it is worse at night and awakens him repeatedly. The child is not fully toilet trained
and has stooling accidents and wears pull ups. He does have a history of constipation. On
physical exam, his findings include: mild anal excoriations with minimal erythema and uneven
finger nails from his nail-biting habit. Additional risk factors include: recent change in body
soap and laundry detergent.
Important points to include when obtaining a history from this patient include asking
questions to both patient and mother. For example, asking about bowel movements, how many
per day, history of constipation/diarrhea, any straining with BMs, what treatments has helped,
any nausea or vomiting, any allergies/prescription medicines, any pain, any new
activities/exercises, and hand washing techniques.
Important points to include when performing a physical exam on this patient include
vitals (HR, BP, T, O2, RR), auscultating heart/lung sounds, inspecting skin, abdominal exam,
and rectal exam.
Differential diagnoses include encopresis, tinea cruris, dermatitis, and pinworms. Several
factors associated with pinworm infections are age, gender, behavior (biting or sucking fingers),
and poor personal hygiene practices, such as failing to wash hands after using the bathroom
(Taylor et al., 2018). Diagnostic testing that should be included for this patient is an anal tape test
to confirm diagnosis of pinworms (Wendt et al., 2019).
