"Running head: WEEK 3 CASE STUDY 2 1Week 3 Case StudyNameInstitutionWEEK 3 CASE STUDY 2 2SubjectiveThe Chief Complaint (CC): fever for three days, rashes, abdomen irregularities,torsos, clear rhinorrhea HPI: The patient was admitted for the complaint of a fever that commenced three daysago but had worsened in the evening by the mother. The nasal drainage was clear as in thelast 24 Hours. A red diffuse rash towards torso and the abdomen is normal. It does not itch.The patient. A dry cough within the last hours. The Physical AssessmentV/S: Riley’s Height is 85 cm. The weight is 12 kg. The B/P is 90/54. T is 101, HR is125BMP/reg, and Resp. is 28, and the Sp02 is 99 percent. From an analytical perspective ofthe percentile growth, the patient’s 99 percent Sp02 is an indication of normal growth.The patient is also non-labored regarding the respiration. That means that the child isexperiencing a normal respirational characteristic. The non-labored respiration means that thepatient does not experience increased effort to breathe. As such, the muscles are relaxed andthere is minimal or no nasal flaring. General: The child is quite inactive and often cries especially throughout theexamination process.Skin: The skin is observed to diffuse erythematous rash in wheel-like eruptions overthe torso. However, there are no observable signs of blistering.The HEENT: The HEENT comprises of the Head, Eyes. Ears, Nose, and Throat.Head: First, the head is observed to be normocephalic atraumiatic. The eyes areconjunctiva clear and non-icteric. However, the eyes are characterized by a slightly injectedPERRL. WEEK 3 CASE STUDY 2 3Eyes: Further, with regards to the eyes, it was impossible to complete the fundoscopicexam. The Tympanic Membranes are intact with scant clear fluid showing posteriorly bil, andmild injection.Ear: Regarding the ears, the EAC was unremarkable, the pinna/tragus demonstratedw/o tenderness.Nose: Further, regarding the Nose, a series of observations are as highlighted. Naresare patent, the mucosa is mildly injected with sl. Edema to the inferior and medial turbinatesbil. Finally, they have a moderate clear rhinorrhea. Throat: Concerning the throat, the observations are that the there is a pharynx withmild, slight erythema and the tonsils 2/4 bil. The oral exam is unremarkable. The Neck issupple with mild anterior cervical lymphadenopathy bil. Further, the thyroid is seen to besmall, firm and has equal bil.Cardiopulmonary: The hearts has a w/o murmur. The lungs have the CTA throughout.The respiration rates and trends are even and unlabored. The abdomen is rounded and hasnormative bowel sounds throughout. It is also soft, non-tender. There are no signs oforganomegaly.Lab: The physical examination as far as the laboratory test is concerned.Following isan outline of the lab outcomes.WBC 7.2, Lymph 40.1%, Monocytes 6.4%, Granulocytes 53.5%, Hgb 12.7%, Hct 43, Differential: Neutrophils 50, Lymphocytes 30. From ananalytical perspective, each amongst these measurements has a significance in determiningthe health condition of the patient. First, the White Blood Cells count is within the optimalrange in which the immunity ought to be. Further, the monocytes are also in the optimalrange meaning that there is a normal production of the same by the marrow before they aretransformed into the histocytes. The granules are also within a normal percentage. The WEEK 3 CASE STUDY 2 4hemoglobin count, as stipulated, fall within the optimal range. In the context of HCT, theratio of the plasma to the red cells in the blood is within the optimal rangeThe red flags In line with the outcomes of the physical observation, there are a series of healthissues that could be perceived. For instance, the fact that the skin is characterized by thediffuse erythematous rashes and the wheal like eruptions over the torsos is a red flagregarding the child’s health status. The mildly injected PERRL is subject to further diagnosisas far as the eyes are concerned and the possible health issues that may be related.The clearrhinorrhea is also subject to questioning as far as the health status is concerned if there is acontinuation of nasal discharge. There is also the erythema situation and the tonsils 2/4.These are possible signs of a health issue that may have been ignored by the parents or thecaregiver when conducting assessing the history of the patient.Sections subject to examination for there to be a reliable outcome of the potentialdifferentials.According to the red flag areas that have been determined, the sections that aresubject to examination Skin and the HEENT. Primary DiagnosisErythema Infectiosum (Fifth Disease): (ICD-10-CM: Code B08.3)In this context, this disease is proposed in the context that it relates to one of theraised red flags that are caused by rashes as stipulated in the observations. It is related tofacial erythema where there are red papules on the cheeks (Eid & Chen, 2013). They arelikely to change rapidly regarding colors. For instance, a child suffering from this disease arelikely to have red papules, especially on the cheeks. Usually, these colors may start fadingaway after four days. The disease is affiliated with low grade-fever, malaise and the sore WEEK 3 CASE STUDY 2 5throat that preceded the rash but in very rare vases, therefore, there are eruptions that may beobserved in two to three weeks.Differential diagnosisTonsillitis: (ICD-9-CM: Code 463) The Tonsillitis is diagnosed through conducting a serious physical examination. Theinvestigation is conducted particularly on the throat. That involved engaging in a throatculture that involves gentle swabbing of the throat (Yamanaka, 2011). Usually, one isdetermined to have this illness if there are signs of stomachaches, sore throat and even painfulexperience when swallowing. Further, cases of having neck tenderness that results from theswollen lymph nodes. In this context, there is a likelihood that the patient suffers fromchronic tonsillitis considering the symptoms and the observations made.Rubella: (ICD-9-CM: Codes 056)Rubella is a rashes-oriented disease. It commences by some discrete macules or redspots that are situated on the face. They are said to spread easily when appropriate measuresare not taken. The appearance of these rashes tends to correspond with the appearance of therubella-specific antibody (Papania et.al, 2014). Usually, the exanthem is expected to last forapproximately 1-3 days. Further, the disease is characterized by the swelling of the lymphnodes. Therefore, the disease is highly related to the outcomes of the physical examinationconducted on Riley.RationaleThe choice of the primary diagnosis, Erythema Infectiosum, in influenced by the factthat the signs and symptoms, as well as, the laboratory results rhyme with the healthcondition. The diagnostics stipulate, especially in the context of the HEENT, stipulatesimilarity in the symptoms. For instance, the reddening of the cheeks is one amongst the WEEK 3 CASE STUDY 2 6signs that depict the commonality. The next most possible diagnosis would have beenRubella. However, considering that the country has had measures to control the health issue. MedicationsNonsteroidal anti-inflammatory drugs (NSAIDs and recommend fluid consumptionand rest. Referrals There are several referrals that can be made for the patient. First, the patient may bereferred for dermatologic and diagnosis care. Alternatively, the patient may be referred to aninternal medicine specialist. Priority diagnosis and observationsAccording to the red flag areas that have been determined, the sections that aresubject to examination Skin and the HEENT. However, in the context of priority, it isimperative to argue that strain during swallowing or itching due to the skin rashes could be,or priority before any diagnosis is made. These challenges give an insight of the possibleoutcomes that can be established through the diagnosis.Priority actions for developing a plan for a child who is illThe process of developing a plan for a child who is ill can be conducted in phases.These phases are organized regarding agency. The first action is to assess the physicalcharacteristics and changes on the body. Then, the parent is asked to narrate the history ofillness. These actions are essential in making the initial medications for the child.Additional historical and physical information on the patient that was not obtainedIn consideration of the fact that some parts of the examination like the fundoscopicexam, there are some facts that were not acquired. They include the hereditary history of thekid’s relatives. Further, it was impossible to assess whether the kid was feeling painelsewhere especially because the child is not in a position to respond. WEEK 3 CASE STUDY 2 7Further diagnostic workupFrom a historical perspective, there is the need to conduct a thorough investigation ofthe history of the child regarding the functional status. These include the presence of lethargyor irritability and affiliated symptoms, as well as, oral intake (Shulman et.al, 2012). Usually,the condition may have occurred because the duration of fever is a poor measure or predictorsome unpredictable bacteremia. From a physical perspective, a child who is beinginvestigated concerning the subtle fever that does not have a source ought to be well- appearing. Usually, there are febrile children who in most cases are acutely ill with symptomincluding the hypoventilation, poor perfusion, cyanosis and lethargy since they are septic (Eidet.al, 2013). They are argued to have bacterial infections unless they are proven otherwise.Priority differentials that exclude a child from the fever with-out a cause situationAll these diagnostics could be essential especially if the fever is not determinedregarding the cause. The differentials in this context include the immunization status and therelated findings of infection including the croup, bronchiolitis, and otitis media. Theselaboratory tests, therefore, are dependent on these differentials.WEEK 3 CASE STUDY 2 8ReferencesEid, A. J., & Chen, S. F. (2013). Human parvovirus B19 in solid organtransplantation. American Journal of Transplantation, 13(s4), 201-205. - ErythemaInfectiosumTalley, N. J., & O'Connor, S. (2013). Clinical examination: a systematic guide tophysical diagnosis. Elsevier Health Sciences.Papania, M. J., Wallace, G. S., Rota, P. A., Icenogle, J. P., Fiebelkorn, A. P.,Armstrong, G. L., ... & Hao, L. (2014). Elimination of endemic measles, rubella, andcongenital rubella syndrome from the Western hemisphere: the US experience. JAMApediatrics, 168(2), 148-155.Yamanaka, N. (2011). Moving towards a new era in the research of tonsils andmucosal barriers.Shulman, S. T., Bisno, A. L., Clegg, H. W., Gerber, M. A., Kaplan, E. L., Lee, G., ...& Van Beneden, C. (2012). Clinical practice guideline for the diagnosis and management ofgroup A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society ofAmerica. Clinical Infectious Diseases, 55(10), e86-e102.- fever "