Discussion: diagnosis and management of hematologic and metabolic

In clinical settings, pediatric patients often present with hematologic and metabolic disorders such as anemia and diabetes. Many of these disorders are manageable with drug therapy and lifestyle changes, but they can pose serious complications for patients if left untreated. In your role as the advanced practice nurse, you must identify patients at risk of hematologic and metabolic disorders and provide the appropriate education for them and their families. Consider potential treatment, management, and education strategies for the patients in the following case studies.

Case Study 1

You see a 1-week-old Asian infant for a weight check. The infant is back to his birth weight and is breastfeeding for 10 minutes every 2 hours with one 3-hour stretch a day. He is alert, has bowel movements with each feeding, and wets 8–10 diapers a day. His blood type is A+ and his mother’s blood type is A+. Coombs’ testing at birth was negative. You note slight scleral and skin jaundice.

Case Study 2

Jimmy is a 3-year-old “picky” eater according to his mother. He refuses to eat anything but waffles for breakfast and macaroni and cheese or chicken nuggets for lunch and dinner. He will eat apples and bananas but refuses all vegetables except corn. After a normal physical examination, you obtained blood testing that revealed the hemoglobin is 11.4 mg/dl and his hematocrit is 30% (both obtained by venipuncture). The CBC revealed microcytic hypochromic RBCs.

Case Study 3

Melissa is a 13-year-old who presents to your office for a well-child check. Physical examination reveals a thin child who is short of stature. Breast Tanner stage is II and pubic hair development is Tanner I. Neurologic, skin, heart, lung, abdominal, and HEENT examinations are normal.

To prepare:

• Review “Endocrine and Metabolic Disorders” and “Hematologic Disorders” in the Burns et al. text.
• Review and select one of the three provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
• Consider strategies for educating patients and families on the treatment and management of the hematologic or metabolic disorder.

By Day 3

Post an explanation of the differential diagnosis for the patient in the case study you selected. Explain which is the most likely diagnosis for the patient and why. Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis. Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments. Finally, explain strategies for educating patients and families on the treatment and management of the hematologic or metabolic disorder.