HS - MISC : Olive Chaney – Pediatrics. Case Study

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i-Human: Olive Chaney Assessment 1. Exanthema Subitum (Roseola). Olive’s symptoms of cough, runny nose, and a fever of 103 that resolved 2 days ago followed by the appearance of a rash that be... gan on her abdomen and spread to her arms and legs make this the leading diagnosis (Kaneshiro & Zieve, 2019; Trembly & Brady, 2019). The physical exam findings of a maculopapular pink rash to the abdomen and extremities further support this diagnosis (Kaneshiro & Zieve, 2019; Trembly & Brady, 2019). 2. Human Parvovirus 19 (Fifth Disease, Erythema Infectiosum). Olive’s symptoms of cough, runny nose, and fever accompanied by a rash make this diagnosis a consideration (Centers for Disease Control and Prevention, 2019). However, the rash in Fifth Disease is present on the face and has a characteristic “slapped cheek” appearance and may spread to the chest, back, buttocks, and extremities (Centers for Disease Control and Prevention, 2019). The physical exam findings of a maculopapular pink rash to the abdomen and extremities and absence of the classical slapped cheek appearance coupled with reports of the rash beginning on the abdomen, rule this diagnosis out. 3. Measles. Olive’s symptoms of cough, fever, runny nose, and rash make this diagnosis a consideration (Centers for Disease Control and Prevention, 2020a). However, the lack of physical examination findings of red and watery eyes, Koplik spots, and the pattern of Olive’s rash (spreading from abdomen to arms and legs versus from the head downward) rule this diagnosis out (Centers for Disease Control and Prevention, 2020a). Lastly, Olive is up-to-date on her immunizations making this diagnosis less likely. 4. Rubella. Olive’s symptoms of cough, fever, runny nose, and rash make this diagnosis a consideration (Centers for Disease Control and Prevention, 2020b). However, her high fever of 103 and the lack of physical examination findings of pink eye and swollen and enlarged lymph nodes coupled with the pattern of Olive’s rash (spreading from abdomen to arms and legs versus from the face to the rest of the body) rule this diagnosis out (Centers for Disease Control and Prevention, 2020b). Lastly, Olive is up-to-date on her immunizations making this diagnosis less likely. 5. Upper Respiratory Infection (URI). Olive’s symptoms of cough, fever, and runny nose make this diagnosis a consideration. However, the presentation of a rash following resolution of Olive’s fever is more characteristic of Roseola making this diagnosis less likely (Tesini, 2019). Final Diagnosis: Exanthema Subitum (Roseola) Plan Pharmacology • Children’s Tylenol (acetaminophen) 5 mL or 1 tablet (chewable) by mouth every 4 hours as needed for fever of 100.4°F or higher. Do not give more than 5 times in 24 hours (Johnson & Johnson Consumer Inc., 2019a; Johnson & Johnson Consumer Inc., 2019b). Non-Pharmacology • Maintain adequate hydration by encouraging clear liquids such as water, ginger ale or clear broth (Mayo Clinic Staff, 2020). • Pedialyte, Gatorade or Powerade may also be given for hydration (Mayo Clinic Staff, 2020). • Apply cool washcloths to the forehead for fever, if present (Mayo Clinic Staff, 2020). A lukewarm bath may also assist with fever, if present (Mayo Clinic Staff, 2020). • Remove extra layers of clothing and use light cotton clothing and bedding when fever is present (Harding, 2018). • Encourage rest as needed. • Apply moisturizing cream following a bath if the rash causes itching. If itching develops, avoid soaps and bubble bath to prevent drying of the skin (Seattle Children’s, 2021). [Show More]

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