Differential Diagnoses

Systemic Inflammatory Response Syndrome (SYRS)

The presence of swelling, heat, and pain, or tumor, calor, and dolor imply that the child may suffer from SYRS. Seeing that the patient is experiencing severe abdominal distension, bacterial translocations, and, particularly, bacterial peritonitis, can be considered one of the key factors affecting the child’s current condition (Caserta et al., 2016). The presence of Down syndrome may have contributed to the progress of the systolic murmur since the disorder is viewed as the associated condition due to the presence of duplicated chromosomes (trisomies), which predetermine the development of the Ventricular Septal Defect (VSD) and, thus, lead to the emergence of systolic murmurs (Breslin et al., 2014).

Child Abuse: Acts of Commission

The atypical position of the epigastric bruising indicates that the child did not receive it from the fall. The circumferential marks on the child’s wrists and ankles may be the aftereffects of rope burns, which means that the child must have been tied up. The identified information is sufficient enough to diagnose child maltreatment (Huffhines et al., 2016).

Final Diagnosis: Blunt Abdominal Trauma

The protrusion in the abdominal area and vomiting combined with lassitude and loss of appetite are clear signs of blunt abdominal trauma (Arul, Sonka, Lundy, Rickard, & Jeffery, 2015). Since the child underwent post-Atrial-Septal Defect (ARD) repair and now suffers from postoperative congestive heart failure (CHF), rapid breathing can be attributed to POCHF. Abdominal pain, a protrusion in the abdominal area, epigastric bruising, and a 10-cm hernia, vomiting, lassitude, and loss of appetite, though, point to the presence of blunt abdominal trauma (Virmani, George, MacDonald, & Sheikh, 2013).

Laboratory and Ancillary Tests

Computer tomography and focused assessment with sonography must be viewed as the key tests to be taken. The outcomes of the CAT test will allow excluding the concomitant trauma from the diagnosis (Polat et al., ‎2014). As a result, the nature of the abdominal injury and its impact will be evaluated.

CBC and urinalysis must also be viewed as a necessity. CBC will provide the information about the patient’s blood cell count and help conduct an evaluation of the patient’s abdominal cavity. The assessment must be carried out every twelve hours. Urinalysis, in turn, will help detect the possible presence of an injury to the urinary tract (Olthof, Joosse, Van der Vlies, De Reijke, & Goslings, 2015).

Nasogastric-tube placement is the ancillary test that must be taken in the specified scenario. It will allow checking for diaphragm ruptures. Alternatively, an oral contrast study (1-2% ionic iodinated solution) will help determine the presence of any obstructions (Kozin, Remenschneider, Cunnane, & Deschler, 2014).

Treatment Plan

To address the patient’s needs, one will have to consider five primary steps for initial resuscitation and stabilization. These include the evaluation of the patient’s respiratory system, the introduction of a tool for monitoring changes in the patients’ cardiac condition, the provision of oxygen supplementation to prevent hypoxia, and the use of two bore intravenous lines (). Afterward, the assessment involving the use of the SAMPLE history and the active promotion of interdisciplinary collaboration between healthcare staff members must be conducted. Seeing that there are signs of possible child abuse, child protection services must be contacted.

Parent Education

The mother must be educated about the importance of proper child treatment. The legal repercussions of child abuse, as well as guidelines for meeting the needs of children with Down syndrome, must be provided to the mother. Detailed information about the use of tools for monitoring the patient’s state must also be administered to the mother. Finally, the mother must be instructed about the vaccination of the child.

Self-Assessment

The self-assessment process must include tests helping detect the presence of pain in the child. The mother’s ability to manage the child’s pain must also be evaluated. The mother has to be aware of the use of appropriate strategies for meeting the needs of a child with Down syndrome.

References

Arul, G. S., Sonka, B. J., Lundy, J. B., Rickard, R. F., & Jeffery, S. L. A. (2015). Management of complex abdominal wall defects associated with penetrating abdominal trauma. Journal of the Royal Army Medical Corps, 161(1), 46-52. Web.

Breslin, J., Spanò, G., Bootzin, R., Anand, P., Nadel, L., & Edgin, J. (2014). Obstructive sleep apnea syndrome and cognition in Down syndrome. Developmental Medicine & Child Neurology, 56(7), 657-664. Web.

Caserta, S., Kern, F., Cohen, J., Drage, S., Newbury, S. F., & Llewelyn, M. J. (2016). Circulating plasma microRNAs can differentiate human sepsis and systemic inflammatory response syndrome (SIRS). Scientific Reports, 6, 28006. Web.

Huffhines, L., Tunno, A. M., Cho, B., Hambrick, E. P., Campos, I., Lichty, B., & Jackson, Y. (2016). Case file coding of child maltreatment: Methods, challenges, and innovations in a longitudinal project of youth in foster care. Children and Youth Services Review, 67, 254-262. Web.

Kozin, E. D., Remenschneider, A. K., Cunnane, M. E., & Deschler, D. G. (2014). Otolaryngologist‐assisted fluoroscopic‐guided nasogastric tube placement in the postoperative laryngectomy patient. The Laryngoscope, 124(4), 916-920. Web.

Olthof, D. C., Joosse, P., Van der Vlies, C. H., De Reijke, T. M., & Goslings, J. C. (2015). Routine urinalysis in patients with a blunt abdominal trauma mechanism is not valuable to detect urogenital injury. Emergency Medical Journal, 32(2), 119-123. Web.

Polat, A. V., Aydın, R., Nural, M. S., Gul, S. B., Polat, A. K., & Aslan, K. (2014). Bowel and mesenteric injury in blunt trauma: Diagnostic efficiency and importance of experience in using multidetector computed tomography. Ulus Travma Acil Cerrahi Derg, 20(6), 417-422. Web.

Virmani, V., George, U., MacDonald, B., & Sheikh, A. (2013). Small-bowel and mesenteric injuries in blunt trauma of the abdomen. Canadian Association of Radiologists Journal, 64(2), 140-147. Web.