Medical Diagnosis of Bradley Ford - Case Study Example

Name : xxxxxxxxxxxxxxxxxxxx Identification number : xxxxxxxxxxxxxxxxxxxx Institution : xxxxxxxxxxxxxxxxxxxx Course : xxxxxxxxxxxxxxxxxxxx Tutor : xxxxxxxxxxxxxxxxxxxx @2009 Hello writter, My teacher has sent me the following comments wwhen she draft read my assignment. Please include a proper introduction as to what exactly you are going to be be discussing in the case study ? Please also include the proper conclusion of the case study. Therefore writter could you please do those changes for me ... our teachers are really pedantic about intros and conclusions. Cheers. Bradley Ford case study Introduction This case study involves Bradley Ford who is aged three years. He lives in an Indigenous community on the edge of a large town with his mother Doris aged 18, his father Ron aged 19, and four aunties and their families, a total of thirteen people. Their house has three bedrooms and three dogs. Bradley was breast fed until he was 10 months old and was at that stage, meeting all his milestones. However, he has been bought to the health clinic by an Auntie and Doris, because he’s "really small and has the runs". This is first visit for Bradley Ford to the clinic since he moved with his parents to the community five months ago. On examination, Bradley was found to be infected Scabies, the abdomen is distended and tender to palpate, the area around his anus is red from scratching, he has signs of recent vomiting on his tee shirt, and is mildly dehydrated. His auntie says that he has vomited "some spaghetti" and asks if it could be worms. Bradley and Doris have obvious nits in their hair. His weight, height and the more obvious psychomotor skills all suggest that Bradley falls below the 10th centile for his age group. His observations are: Temperature 37.4 degrees; Pulse 90, Respirations 32, Blood pressure 113/70. Diagnosis n the process of the identification of the most appropriate approach of the relevant medical diagnosis in the case of Bradley Ford, it is important to appreciate the fact that the signs as well a the symptoms of scabies in their early stages of infection are a reflection of alternative diseases of the skin. These cover the range of dermatitis, syphilis, allergic reactions, as well as the rest of the ectoparasites including lice together with the fleas. The first step in the diagnosis should therefore be based on the identification of the burrows (Apgar 2000). This is however associate with a degree of difficulty as a result of their scarcity, another issue of the difficulty is the fact of their being obscured by the presence of the marks of scratches. In the event of the absence of the burrows within the primary regions that are associated with infection the whole surface of the skin in the body of the patient requires examination. In the case of Bradley it was clear that he was infected with Scabies the abdomen was distended and tender to palpate, the area around his anus was red from scratching. This is a clear indication that the patient was suffering from scabies. There was therefore no need for the examination of the entire body since the already available symptoms are an indication of the presence of scabies (Green 1989). For the purpose of the full clarification of the symptoms to be a representation of the presence of scabies, a second medical diagnosis may be conducted. This involves the rubbing of the areas that have been suspected to indicate the symptoms with the fountain pen ink. The alternative to the ink is the application of the topical solution of tetracycline which should glow when exposed to a special type of light. This is followed by the off of the surface using a pad of alcohol. The positive case of scabies will be manifested by the presence of a pattern that is either zigzag or the shape of a letter S in the region of the burrow (Pruksachatkunakorn, Damrongsak & Sinthupuan 2002). The third type of diagnosis is meant for confirmation of the presence of scabies in the instance that the burrow has been suspected. It is based on the microscopy of the scrapings of the surface that are put on some slides containing glycerol, some mineral oil or they are immersed in some oil and then they are covered using a cover slip. There is a need to keep off any possible potassium hydroxide to eliminate any chances of the dissolution of the fecal pellets. The realization of the positive results of the availability of scabies is based on the presence of mite, the ova or the fecal pellets (Green 1989). This might seem to be practically simple but the real detection of the presence of scabies is associated with a degree of difficulty. The available suspicious lesions to the level of the superficial dermis should be thoroughly scrapped for the best results to be achieved. The result of this exercise is some minor bleeding in the affected spots. Even in the instance of negative results of this exercise, the possibility of the presence of scabies may not be ruled out entirely. It therefore implies that, the most effective diagnosis involves the determination of the history of the patient accompanied by the physical findings and the response to the topical treatments. It is important for the provider health care to apply the medical history of Bradley Ford. The best available statistics in the case of Bradley Ford indicates that he is "really small and has the runs". This is the first visit for Bradley Ford to the clinic since he moved with his parents to the community five months ago. This information is to a degree not sufficiently reliable. There is therefore a need for the application of some physical examination. The available physical signs indicate that Bradley Ford’s abdomen is distended and tender to palpate, the area around his anus is red from scratching, and he has signs of recent vomiting on his tee shirt, and is mildly dehydrated There are related actions of nursing that are important in the determination of the definitive medical diagnosis in the case of Bradley. This may include conducting of a simple test aimed at checking the presence of the mites or their eggs. This is achieved by applying a drop of oil on the lesion of the skin followed by scraping the lesion’s surface with the use of a scalpel. The resulting scraping is examined through the use of a microscope to determine the presence or the absence of the eggs. This facilitates for the treatment of the scabies through he application of permethrin cream or the lindane lotion at the part of the skin that is infected. There are alternative medication involving the use of crotamiton as well as sulphur ointments. Antihistamines, like the diphenhydramine, could also be applied for the purpose of relieving of itching (Pruksachatkunakorn, Damrongsak & Sinthupuan 2002). There is a need for the nurse to estimate Bradley’s level of dehydration in an effort of the determination of what needs to be done to combat it initially. This is followed by the provision of the education about dehydration to the family. There is an indication of diarrhea diseases and vomiting causing the loss of substantial amount of water from the body. This is indicated by the area around his anus which is red from scratching accompanied by diarrhea; he has signs of recent vomiting on his tee shirt, and is mildly dehydrated. The greater percent of the body is composed of water the loss of which is the cause of dehydration. Further estimation of the dehydration affecting Bradley is indicated by the abdomen which is distended and tender to palpate. The preliminary steps in addressing the situation of dehydration is the encouragement of taking large volumes of water to replace the already lost water in the process of dehydration and the provision of milk of magnesia. The stabilization of the body against dehydration is an avenue towards the effectiveness of the treatment and a quick recovery. The recognition of the symptoms responsible for dehydration is an important step towards the assistance of the victims with the needs that they require in the most efficient manner. The family needs to be educated on the need of the provision of clean water for drinking occasionally to Bradley. This is achieved through the use of boiled water which should be kept in a safe place (Chakrabarti 1985). In the situation that Bradley is to be sent home with his family after care there is a need for some follow up appointments to make sure that the health status of the patient becomes stable. The follow up appointments that would be initiated include a need a need to treat the secondary infections brought about by a diversity of bacteria. This situation occurs occasionally resulting to the weakening of the defense system of the body. These are also accompanied by the presence of the inflammation of the skin and should be treated. There is a need to monitor and take measure against a new symptom that may be seen to become worse. Another important step is the diagnosis of the dogs at the home of Bradley. Due to the seriousness associated with the rate of spread of the disease as a result of the contribution of dogs, the possibility of infection in the dogs should not be under estimated. The sarcoptic mange that is found in dogs is treatable through the application of a number of diverse medications. These range from ivermectin, amitraz, selamectin, moxidectin, or even milbemycin (Chakrabarti 1985). There is a need for the application of the community services as well as support aimed at assisting Doris together with Ron for the purpose of assisting them in the maintenance of the healthiest family. The success of this exercise should be based on the realization of the fact that there is no known available vaccine that is effective against scabies. In addition, there exist no exact causative factors associated with risk. This therefore implies that the majority of the strategies should have a focus on the prevention of the reoccurrence of re-infection. There is a nee for the treatment of the entire family who have a close contact with Bradley Ford at the time that Bradley was being treated inn a simultaneous manner which may be asymptomatic. There is also a need to maintain a clean environment to eliminate any chances of the occurrence of the re-infection. This is achieved through washing followed by hot ironing all he personal effects such as the clothes, the beddings as well as the towels which are suspected to have come in to contact with the infestation of scabies prior to the treatment. The process of cleaning of the environment should entail the following procedures: Treating all the furniture in addition to the beddings Vacuuming of the floors, the carpets as well as the rugs. The disinfestations of the floor together with the surfaces of the bathroom through mopping. Conducting a daily wash of the clothes that were worn in the recent past, the towels in addition to the beddings by the use of hot water. They are then dried in a dryer that is hot together with steam ironing them. The information concerning the high contagious nature of scabies should be made available to the members of this family. This is specifically because the three bed roomed house that the entire family occupies has more than the required carrying capacity. The house is occupied by his mother Doris aged 18; his father Ron aged 19, and four aunties and their families, a total of thirteen people. The mod of the spread of the disease includes scotching, picking of the mites in the fingernails in addition to the personal contact of the skin. There is also a possibility of the spread of the disease through spreading in to the rest of the objects that are used by the whole family including keyboards, the beddings, furniture, among other things that are in a position of hosting the mites The understanding of the fact that scabies is in a position of being transmitted in a simple way throughout the whole household is an important factor of intervention for the checking further spread of the disease. This involves the skin contact of the person who is already infected. The clothing also plays a vital role in the spread of the disease as is the beddings together with the towels. This is the situation that requires intensive washing of these items and the application of permethrin sprays in case of the items that are difficult in being washed. The sharing of the things that contribute to the spread of the disease should also be discouraged. The congestions in the residential house in the case of the family of Bradley Ford is another contributing factor or the proliferation of the disease (Pruksachatkunakorn, Damrongsak & Sinthupuan 2002) It is also notable that in the house, there are three dogs that may bring about the spread of the Sarcoptic mange associated with the puppies having scabies. The dogs are in a position of affecting Bradley Ford in a transient manner. The mites that are in a position of causing scabies in the dogs reproduce on the bodies of the humans and they are in a position of multiplication in a very short time. They are therefore additional causative agents of the spread of the disease. There is a high level of susceptibility in humans to the dogs that host the mites with results of the disease increasing to an epidemic proportion. Sarcoptic mange has been commonly diagnosed in dogs resulting to the increase of the extent of itching to severity accompanied with secondary infection of the skin (Scheinfeld 2004). Another important measure aimed at checking the spread of the disease is to avoid a situation where Bradley may play in pools containing dirty water which are swarmed with mosquitoes. Bradley should also be restricted from wearing dirty clothes for long time to avoid the spread of scabies. There should also be some efforts to separate Bradley from t rest of the members of the family until the time that the disease has been effectively managed. Conclusion There is a dire need for the understanding of the serious consequences that may be brought about by a situation of infection with scabies. There are high chances of avoidance of the situation of inflicting the serious disease. There are also some associated misdemeanors that are consequential to contracting scabies. The parents of Bradley have a duty to comprehend all the circumstances surrounding the disease. This argument is based on the fact of the possibility of the management of the disease. Based on the scenario of the environment surrounding the patient under discussion, there is a possibility of implementation of the relevant measures of precaution to ascertain a situation of control of reoccurrence of the disease. Bibliography Apgar, B, 2000, "Efficacy and Safety of Therapy for Human Scabies Infestation". American Family Physician.Chakrabarti, A, 1985, "Some epidemiological aspects of animal scabies in human population". Int Zoonoses 12 (1): 39.Green, M, 1989, "Epidemiology of scabies". Epidemiol Rev 11: 126–50.Pruksachatkunakorn, C, Damrongsak, M & Sinthupuan, S, 2002,"Sulfur for Scabies Outbreaks in Orphanages", Pediatric Dermatology, 19 (5): 448–53.Scheinfeld, N, 2004, "Control of scabies in the institutional settings, a review for medications, models of treatment, and implementation". Dermatol, 5 (1): 31–7. . Read More