Diagnosis and Management of Musculoskeletal and Neurologic Disorders
The 18-month-old baby presented in case study two has a 3-day history of upper- respiratory-type symptoms that have progressively worsened over the last 8 hours. The pediatric patient also experienced a rapid exacerbation of fever up to 103.2°F in the morning. Other significant clinical manifestations include vomiting, negative abdominal exam, marked irritability with inconsolable crying, and refusal to take oral fluids. The clinical manifestations presented in the patient’s history of present illness (HPI) point to a complex etiology. However, high-grade fever presents the basis for considering differential diagnosis in the diagnostic workup.
Differential Diagnoses
High-grade fever and fussiness constitute the most remarkable findings based on the patient’s HPI. Burns et al. (2017) have identified fever as the most common symptom in pediatric practice that has multiple etiologies. Therefore, it is important to consider the etiology of fever in view of the patient’s medical history to make the most appropriate diagnosis. The achievement of this goal requires a determination of differential diagnoses since pediatric a broad range of mild conditions to severe viral and bacterial infections present as fever in pediatric settings. Thus, the differential diagnoses include bacterial pneumonia, meningitis, gastroenteritis, enterovirus, urinary tract infection (UTI), viral upper respiratory infection (URI), and bacteremia.
Primary Diagnosis
Bacterial pneumonia is the priority diagnosis for this patient because of the remarkable fever and respiratory symptoms. First, the patient’s upper-respiratory-type symptoms have progressively worsened over the last 8 hours. According to Lynch et al. (2010), an upper respiratory tract infection precedes pneumonia. Secondly, the patient is febrile, which is a distinguishing feature of bacterial pneumonia. High-grade fever is the most prevalent clinical manifestation of bacterial pneumonia. In contrast, low-grade fever is common in viral pneumonia or pneumonia emerging from atypical organisms (Burns et al., 2017). The other distinguishing clinical manifestations include poor feeding (which leads to dehydration in infants), vomiting, abdominal pain, fussiness, and lethargy (Lynch et al., 2010). Dehydration is particularly a significant clinical marker because the patient vomited after drinking a cup of juice, and he has refused PO fluids since then.
Treatment Strategies
The etiology of the infectious organism, as well as the age and status of patients, influence treatment decisions in pediatric pneumonia. Antibiotic therapy constitutes the first-line treatment strategy, but it should be targeted to the causative agent, history of exposure, age, possibility of resistance, and pertinent history. Antibiotics are the first-choice regimen in treating bacterial pneumonia in children. Amoxicillin (Amoxil, Trimox) is the first-line antibiotic, with an empirical dose of 90 mg/kg/day PO divided q12 hr for 10 days, not to exceed 4,000 mg/day. Ampicillin (Marcellin, Omnipen, Polycillin) is an alternative to Amoxicillin, and the recommended dose is 150-200 mg/kg/day IV/IM divided q6hr (Williams et al., 2017). Williams et al. (2011) have recommended using empiric antibiotics to minimize the risk of antimicrobial resistance.
Importantly, the patient should be followed-up at 24 to 72 hours after diagnosis to reevaluate the efficacy of the selected antibiotics (Bradley et al., 2011).
Patient Education
The strategies for educating parents will involve face-to-face discussions, including the use of brochures and posters. The assessment period will particularly provide an opportunity of highlighting the need to minimize risk through periodic vaccination, as well as exposure through proper hygiene practices (Bradley et al., 2011). The posters and brochures will contain crucial information regarding the causes, symptoms, treatment, and management of pneumonia.
References
Bradley, J. S., Byington, C. L., Shah, S. S. Alverson, B., Carter, E. R., Harrison, C., … Swanson, T. (2011). The management of community-acquired pneumonia in infants and children older than 3 months of age: Clinical practice guidelines by the Pediatric Infectious Diseases Society and The Infectious Diseases Society of America. Clinical Infectious Diseases, 53(7), e25-76. doi: 10.1093/cid/cir531.
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (Eds.). (2017). Pediatric primary care (6th ed.). St. Louis, Missouri: Elsevier.
Lynch, T., Bialy, L., Kellner, J. D., Osmond, M. H., Klassen, T. P., Durec, T., … Johnson, D. W. (2010). A systematic review on the diagnosis of pediatric bacterial pneumonia: When gold is bronze. PLoS One, 5(8), e11989. doi: 10.1371/journal.pone.0011989.
Williams, D. J., Hall, M., Gerber, J. S., Neuman, M. I., Hersh, A. L., Brogan, T. V., … Grijalva, G. (2017). Impact of a national guideline on antibiotic selection for hospitalized pneumonia. Pediatrics, 139(4), pii: e20163231. doi 10.1542/peds.2016-3231.
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Question 
Create a powerpoint presentation from the following diseases, two slides per disease:
Diagnosis and Management of Musculoskeletal and Neurologic Disorders
including definition, signs and symptoms, pharmacological treatment, risk factors, goal standard test, patient teaching, including photos, introduction, conclusion, and references. Attached see rubric
1. Osteoarthritis (OA)
2. Rheumatoid Arthritis
3. Carpal Tunnel Syndrome
4. Plantar Fasciitis
5. Fibromyalgia
6. Gout
7. Osteoporosis
8. Scoliosis
9. Lordosis
10. kyphosis