Right Thumb Pain Child Treatment - Case Study Example

Five Cases Studies with Minor Injuries Patient A. 4 years old male Patient comes accompanied by the motherand an older brother 7. The mother gives consent for examination and treatment (Greaves and Johnson 2002, p.74). Patient scheduled for examination and planning of care. The patient is alert and oriented, he however appears to be in pain. He has no problem walking and eating. P/C: Pain on the right thumb with an open wound (Talan et al. 1999, p. 88). HPC: The patient was well until few hours ago when he was bitten by a stray dog while playing with other children in the neighbourhood.

Has been having consistent thumping pain on the bite site with swelling of the entire hand. Weight: 19.6kg PMH: There is no reported history of major illness since childhood. Medications: The child is not on any medication. Allergies: There is no known history of allergies to food or drugs reported. Immunisations: the child is up to date for his age. SH: Lives with the parents, both employed and 4 siblings. Both parents are elementary school teachers in a nearby school and come home daily. The last born in the family; Known by the social worker.

Attending day care with other children. At home, he is left under the care of a house-help who is employed to take care of an ailing grandparent living with the family. Playful and loves pets, has two pet cats at home. He likes playing with other children and sometimes takes his two pets with him to play. O/E: The child is in pain, with an open wound on the dorsal side of the right thumb. The bite is 2 cm long and canine marks are also visible on the frontal side of the thumb. The hand is inflamed from the carpal tunnel distally (Benson et al. 2006, p. 471).

The patient however guards the whole hand and does not agree to be touched. Only the mother can touch. HEAD AND NECK: No abnormality detected. Hands: Both hands are strong, with normal range of motion and symmetry. The right hand is inflamed from wrist joint downwards and the patient guards the entire hand and reports pain. No other abnormal observation on assessment. Right Wrist and thumb: NAD Rt. Thumb: superficial wound on anterior aspect of proximal phalanx about 0.5cm in diameter. 1cm in depth (Dealey 2005, p.57). No bleeding noted, slight swelling around the bite wound, no erythema, no atrophy, no sign of infection, no bruising.

ROM: Active: Flexion- full range; with minimal pain on anterior aspect of distal phalanx Extension- full range; pain free movement Abduction- full range; pain free movement Adduction- full range; with minimal pain on anterior aspect of distal phalanx Medial Rotation- full range; with minimal pain on anterior aspect of distal phalanx Passive: Flexion- full range; with minimal pain on anterior aspect of distal phalanx Extension- full range; pain free movement Abduction- full range; pain free movement Adduction- full range; with minimal pain on anterior aspect of distal phalanx Medial Rotation-FROM with minimal pain on anterior aspect Resistive: Flexion-with minimal pain on anterior aspect of distal phalanx Extension- pain free movement Abduction- pain free movement Adduction-pain free movement Medial Rotation-with minimal pain on anterior aspect of distal phalanx OBS: From the Pain score chart, the patient reports a pain score of 8-10 (Davies et al. 2011, p.8).

Pulse rate 108 bpm. Blood pressure 116/83 mmHg. Respirations 22 breaths per minute. Plan: Vital signs observation. Anti-inflammatory analgesics injection stat. Treatment: Analgesics Ibuprofen 200mg PO BD for one week. Antiseptic wound cleaning and dressing daily. Elevation of affected arm (Greaves and Johnson 2002, p.43). Rabies Vaccine. Follow-up: Re-visit the clinic after 2 weeks. Advice: Help the child to keep off stray animals and keep an eye on the child when at home. Keep the wound clean and always dry.

Avoid any contamination. The child to stay at home, under observation for one week. Abbreviations PC- Presenting Complain HPC- History of Presenting Complain Kg- Kilogram PMH- Past Medical History Meds- Medication Nil- Nothing SH- Social History O/E- On Examination NAD- No Abnormality Detected ROM:- Range of Motion. References Angus, D.C. & van der Poll, T., 2013. Severe Sepsis and Septic Shock. New England Journal of Medicine, 369, pp.840–851. Available at: Benson, L.S. et al., 2006.

Dog and cat bites to the hand: Treatment and cost assessment. Journal of Hand Surgery, 31, pp.468–473. Dawood, M. (2012) The Emergency Practitioner’s Handbook: for all front line health professionals. London: Radcliffe Publishers Davies , F. Bruce, C.E. and Taylor-Robinson, K.J. (2011) A Pratical Handbook: Emergency Care of Minor Trauma in Children. Uk: Hodder Arnold an Hachette Uk Company Greaves, I. & Johnson, G. (2002) Practical Emergency Medicine. London: Arnold Publisher. Talan, D.A. et al., 1999. Bacteriologic analysis of infected dog and cat bites.

Emergency Medicine Animal Bite Infection Study Group. The New England journal of medicine, 340, pp.85–92. Patient B. Age: 51 years old male. Patient comes alone and gives own health and personal history. The patient also sign the consent form on his own and consents to examination and any necessary care. The patient comes walking with a level of difficulty. The patient is not sick-looking, communicates with ease and freely. PC: The patient complains of a swollen and painful ankle (Kaufman 2008, p. 2396). HPC: The patient has been running after a cow that had broken out of the shed when his left foot got stuck in a trench and he fell spraining his left ankle.

Attending the department for examination and care. PMH: patient admitted once at the age of 16 years with appendicitis (Dealey 2012, p. 199). Appendectomy done. No major illness since childhood. Weight: 76kg Medications: The patient has been on analgesics broad-spectrum antibiotics regimen that ended three days ago; provided at the clinic. No other medication currently. Allergies: The client has a specific protein food allergies, cannot eat eggs. There is no known drug allergies. Immunisation: Tetanus injection immediately after the cut (one week ago) scheduled for a repeat (booster) in three weeks’ time (Greaves and Johnson 2002, p.38). SH: the patient is married, living with the wife and two children.

He is a farmer while his wife owns a grocery shop. Does not smoke but occasionally takes alcohol. His hobbies include reading, listening to music and tending the flowers. O/E: Stable general outlook. Not sick-looking. NAD on examination of the head, Neck, back, chest. Hands. Left foot: The ankle joint is swollen. The patient reports painful joint and cannot walk well. ROM: ROM: Active: Flexion- Cannot flex the ankle due to pain on anterior aspect Extension- full range; with minimal pain on movement Abduction- painful Adduction- painful Medial Rotation- painful Passive: Flexion- full range; with pain on anterior aspect the ankle Extension- full range; painful Abduction- full range; painful Adduction- full range; painful Medial Rotation- painful Resistive: Flexion-with intense pain on anterior aspect of ankle Extension- painful Abduction- painful Adduction- painful Medial Rotation- painful Impression: Ankle sprain Plan: Analgesics Diclofenac %50mg PO given, Range of motion exerceise.

Treatment: Analgesics. Weekly visit for physiotherapy. Advised: Rest the foot for one work. Maintain active range of motion to ensure maintenance of functionality (Lippincot 2008, p. 20). To take precaution whilst working because the ankle healing may be affected by strenuous exercise take at least one week before going back to work if possible. Abbreviations PC- Presenting Complain HPC- History of Presenting Complain Kg- Kilogram PMH- Past Medical History SH- Social History O/E- On Examination NAD- No Abnormality Detected ROM:- Range of Motion References Angus, D.C. & van der Poll, T., 2013. Severe Sepsis and Septic Shock.

New England Journal of Medicine, 369, pp.840–851. Available at: Benson, L.S. et al., 2006. Dog and cat bites to the hand: Treatment and cost assessment. Journal of Hand Surgery, 31, pp.468–473. Dawood, M. (2012) The Emergency Practitioner’s Handbook: for all front line health professionals. London: Radcliffe Publishers Davies , F. Bruce, C.E. and Taylor-Robinson, K.J. (2011) A Pratical Handbook: Emergency Care of Minor Trauma in Children. Uk: Hodder Arnold an Hachette Uk Company Greaves, I.

& Johnson, G. (2002) Practical Emergency Medicine. London: Arnold Publisher. Kaufman, J.L., 2008. Management of acute cutaneous wounds. The New England journal of medicine, 359, pp.2395–2396; author reply 2396. Patient. C. Age: 38 years. Female The patient was brought to the unit on a stretcher after being involved in a motorcycle accident. The patient was in pain but alert and fully oriented. Bleeding had been arrested and the affected area bound with a white clean cloth by the well-wishers.

The patient signed the consent for examination and care and gave her own history (Greaves and Johnson 2002, p.74). PC: Painful shoulder joint. HPC: the patient was well until an hour ago when she was riding her motorcycle home from work. She was involved in an accident and landed on the lateral side of the right shoulder. She did not lose consciousness felt intense pain after the collision with the ground. PMH: Normal childhood and youth. No major illness. Weight: 71kg. Medication: Reportedly given anti-inflammatory analgesics (Diclofenac 50mg tab) by a friend on the way here.

Has not been on any other medication recently. Allergies: The patient is reactive to sulphur and sulphur-containing compounds. There is no known food allergy. Immunisation: Up to date for her age SH: The patient is a mother of two boys, the youngest being 7 years old. She is single and lives with the two boys and a younger sister. She is a business woman and travels to and from work daily on her motorcycle. She does not smoke or take alcohol. O/E: Looks stable and well oriented. She is however in pain but can walk in her own without support (Davies et al. 2011, p.6).

She gives her own history, Head and Neck: NAD Trunk: NAD Hands: slight bruising on the right palm. Patient was wearing riding gloves during the accident. Right shoulder: Anterior Aspect: Minimal swelling over the SC Joint, Clavicle, AC Joint and Trapezius muscle, slight bruising with no obvious deformity, no visible wound. Bony tenderness noted over the SC Joint, Clavicle, AC Joint. No bony tenderness over the Acromion Process, coracoid process, non - tender on deltoid muscle, pectoralis major and biceps muscle Nerves: Regimental Badge Sign Tested-full sensation noted on deltoid muscle- Axillary, Brachial Plexus, Median, Ulnar and Radial nerve-sensation intact and compare to the left arm.

Posterior Aspect: No bruising or obvious deformity, no erythema or wound, skin intact compare to left shoulder. Slight Tenderness over the trapezius muscle, non-tender over the scapula, acromion process, Supraspinatus muscle, Infraspinatus muscle and Latissimus Muscle. Active Movement: Retraction-reduced and painful over the shoulder Protraction-reduced and painful over the shoulder Elevation-reduced and painful over the shoulder Depression- Full range; pain free movement Abduction-reduced and painful on shoulder Adduction-reduced and painful on shoulder Internal Rotation-reduced and painful on shoulder External Rotation-reduced and painful on shoulder Right Elbow:NAD -Brachial and Radial pulse –present and strong compared to left arm -no altered sensation/well perfused-capillary refill