Case Study 5
In this context, focus is on the case of Trina, a 10-year-old native American female. The child has not reported any discomfort; it is the mother who is concerned. Trina has been avoiding vegetables and fruits. She is fairly active in sports which is why her mother wonders why her body does not desire fruits and vegetables as most people do. Her body weight is 110 with her BP is 122/79. This is slightly above the upper limit of 120/80mmHg. In her case, the FMH was negative for the myocardial infarctions. However, the parents were taking medication specifically for dyslipidemia. These details are used to come up with a diagnosis analysis below.
Based on what has been reported about the patient, additional questions would be what else Trina takes that accounts for the calories she burns when she is playing soccer. These could be too sugary limiting her consumption of fruits and vegetables. The case has indicated all elements of LOCATES as follows: the location (unknown), the onset (10-year-old female), character (soccer player), associated signs (negative myocardial infarction), timing (currently ongoing), exacerbating factors (worrying BP vitals) and severity (possibly obese)
I will want to know about the history of obesity in the family given the lack of interest in vegetables and fruits yet the body weight remains 110 despite the heavy soccer practice. I will want to know more about the cholesterol level in the body of Trina. This will help to identify if she is at the early stages of obesity as per Sakata (2018). My differential diagnosis of Trina is that she may have decreased concentration, dry skin fatigue and cold intolerance based on her vitals and further observation. These are part of the hypothyroidism primary and hypothyroidism central tests in the historical and physical examinations.
The three differentials that might help me reach to the conclusion of obesity in Trina are the Free T4: being less than 5 picomoles, TSH: being more than 5 mU/L and TSH being in low normal or appropriately.
The most likely diagnosis would be that Trina is at an early stage of Obesity and other lifestyle diseases not discernible yet. I would give this child multivitamins to trigger her appetite and encourage the parents to give the child more vegetables and fruits when they are hungry while cutting down on snacks and fast foods. The medication would be multivitamins and medicines that will normalize her BP vitals as recommended by Kummet (2018). These are diuretics 2mg intake a day and beta-blockers 3mg a day.
The parents need to be educated on how to deal with such a child in terms of their eating disorder. They should not be forced to eat but can be encouraged by adding fruits and vegetables in their foods. Trina being from a native American family may not face any socio-cultural barriers with her weight management. There are no immunizations for obesity. Based on her age, she should visit the clinic after a week (Murphy, 2016). The parents and the child should be told to reevaluate their foods to make more balanced with less sugar as additional anticipatory guidance.
Kummet, T. D. (2018). History of Present Illness. Southwest Journal of Pulmonary and Critical Care, 16, 110.
Murphy, K. (2016). History of Present Illness. Southwest Journal of Pulmonary and Critical Care, 12, 205.
Sakata, K. K. (2018). History of Present Illness. Southwest Journal of Pulmonary and Critical Care, 16, 237.
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Case Study 5 was first posted on October 27, 2019 at 1:37 am.
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