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Running head: SICKLE CELL DISEASE 1

Sickle Cell Disease

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SICKLE CELL DISEASE 2

Sickle Cell Disease

The evaluation and management of a pediatric patient who has painful swelling on the

hands and feet or with fatigue and fussiness may involve various processes. The evaluation and

management of a pediatric patient involves succinct evaluation of his or her history. Besides, it

involves an analysis of the pediatric skeleton. During the evaluation of a pediatric patient,

knowledge of congenital anomalies, skeletal maturation and developmental variation are

required. Besides, it involves an analysis of pain aspects including its location, how does the

swellings look like and are the swellings only on specific points. The evaluation should also be

aimed at determining the life threatening conditions that may be associated with the symptoms

which may include anaphylaxis, hereditary angioedema and renal diseases. The evaluation may

also involve the determination of the patient’s age, past medical history, any allergies and weight

gain. Also, evaluation should be able to determine whether symptoms the pediatric patient

possesses are attributed to trauma whether acute macro-trauma or repetitive micro-trauma.

Pediatric patients should be checked for any previous injuries, neurological disorder and any

chronic inflammatory diseases.

Some of the diagnostic studies I would recommend for the patient may include the

following: First, in the case of edema, I would recommend studies that involve pleural effusion,

ascites or evidence of broken skin due to the swelling. In most cases, ascites is associated with

changing dullness and abdominal expansion and in some scenarios, a column of fluid is seen in

the abdomen (Pollin & Ditmar, 2014). Pleural effusion has an association with decreased breath

sounds and dullness. In the case where there are localized swellings, it is advisable to localize the

swelling in order to be able to determine the region of lymphatic obstruction. Another diagnostic

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study that may be carried out is assessing the pediatric patient in case of fever and other signs of

inflammation as cellulitis may also arise due to the swellings.

The major area of focus of the physical examination may include the measurement of the

pediatric patient’s growth parameters and this should include a complete evaluation of the

cardiovascular system. Findings of conditions like rales, gallop, tachypnea and hepatomegaly

may be observed in patients who have heart failure. Measurements regarding blood pressure

should be examined and interpreted regarding age, height and gender analysis. Another physical

examination that may need to be carried out is characterization of edema to determine whether it

is localized or generalized to make its management easy.

The three differentials are as follows: Patients who have generalized swelling like those

with acute glomerulonephritis, renal failure and nephrotic syndromes are required to receive

treatment through sodium and fluid restriction therapy. The treatment is aimed at providing

patients with required amounts of sodium for growth purposes. The other differential is for

children with swelling and expanded intravascular volume who are to be given diuretic therapy

as treatment. Diuretic therapy helps in treating the swellings which results from acute renal

failure, glomerulonephritis. The last differential is for patients with painful swelling in addition

to low oncotic pressure. For this differential, intravenous albumin infusion is recommended.

The spleen of Sickle Cell Disease is deemed not to work well. The failure of the spleen

may lead to life-threatening infections and therefore appropriate care should be taken (Brousse,

2014). Some of these life-threatening infections may include the following: Sudden weakness,

rapid heartbeat and pale lips. Families of such patients should be able to understand how to treat

and manage sickle cell problems. The patient may be given painkillers and also ensuring he or

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she drinks plenty of water. It is also advisable for patients to engage in activities that can help

take the mind off the pain.

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References

Brousse, V., Ellie, C., Benkerrou, M., Odievre, M.H., Lesprit, E., Bernaudin, F., & de

Montalembert, M. (2014). Acute splenic sequestration crisis in sickle cell disease: cohort

study of 190 pediatric patients. British Journal of Haematology, 156(5), 643-648.

Pollin, R. A., & Ditmar, M.F. (2014). Pediatric Secrets. Philadelphia: Mosby/Elsevier.

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