Create the plan of care for this patient
Michelle brings Rey in for complaint of fever and rash. The fever began 3 days ago and is of normal levels in the morning then gets as high as 103 to 104 degrees in the afternoons. Rey has also had clear rhinorrhea and in the last 24 hours he has developed a red, diffuse rash to the torso and abdomen that does not itch. Mother reports he is drinking well and had a good wet diaper this morning, but is not really eating much and is not playing.
She is very concerned about the level of the fever and the fact that after 3 days he is not improving.
Physical Examination Rey:
V/S: Ht: 83cm, HC: 48cm, Wt: 11.5 kg, B/P: 82/50, T: 101, HR: 125 BMP/reg., Resp: 28, reg, non-labored, SpO2: 99%
General: somewhat lethargic and cries some throughout exam. SKIN: Diffuse eretyamtous rash in wheel like eruptions over the torso, but no blistering. HEENT: Head normocephalic atraumiatic. Conjuctiva clear, non-icteric, but mildly injected PERRL. Unable to complete fundoscopic exam. Tympanic membranes intact with scant clear fluid posteriorly bil and mild injection. EAC unremarkable. Pinna/tragus w/o tenderness. Nares patent, mucosa pale, sl. edema in inferior and medial turbinates bil, moderate clear rhinorrhea. Pharynx with mild slight erythema, tonsils 2/4 bil. Oral exam unremarkable. Neck supple w/mild anterior cervical lymphadenopathy bil. Thyroid small, firm, equal bil. CARDIOPULMONARY: Heart RRR w/o murmur. Lungs CTA throughout. Respirations even and unlabored. Abdomen rounded normoactive bowel sounds throughout, soft, non-tender, no masses or organomegaly.
Labs: WBC 7.2, Lymph 40.1%, Monocytes 6.4%, Granulocytes 53.5%, Hgb 12.7%, Hct 43, Differential: Nuetrophils 50, Lymphocytes 30, Monocytes 5.
After reviewing the physical exam.
1- What are your differential diagnoses including the Primary diagnosis (ICD 10 codes)?
2- What are your priority actions in developing a plan of care for this child?
3- What further diagnostic work-up should always occur with any child who presents with fever for longer than four days duration or higher than 104 without a clear
Sample Solution
