The present case study is targeted at an eight year old girl who is suffering from depression, anxiety and stress. This has led to many medical issues in her life causing her to miss school and normal healthy life. Her case is complex with many related medical issues. It is very important to understand the patient and her needs with care and sensitivity. In order to manage this patient it is necessary to evaluate clinically her medical and physical state along with her psychological state. The recovery plan should include a team effort on the part of the doctors which would involve her physical and psychological well being.
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The girl is suffering from neglect, loss and sickness which make it an overwhelming situation for her. Her medical condition which reflects enlarged tonsils and symptoms of sleep apnea requires immediate hospitalization and surgery. In the light of her medical history it needs to be identified that she is suffering seriously on account of her enlarged tonsils and acute stress. Her refusal to go to school for the last two months is a serious concern; it should be seriously acknowledged. Her rapid weight gain since her father’s death in the last one year should be noted as a serious symptom of distress and stress. She should be evaluated physically for her medical symptoms as well psychologically for her mental health. She clearly needs hospitalization and skilful management of her physical and mental health.
The goal of her hospital treatment should be to examine her thoroughly clinically for her medical problems which are physical as well as psychological. She needs to be hospitalized, and be under the supervision of the hospital staff as she needs to undergo tonsillectomy for the correction of her enlarged tonsils which are causing her to miss school and also causing obstructive sleep apnea. Control of her sleep apnea is a critical matter in her case history and it requires immediate correction by hospitalization. Sleep apnea can cause lot of distress on the patient by impacting patients sleep at night. It is a condition in which breathing stops for few moments involuntarily.
It is serious concern in the case of this patient. Apnea is medical term describing a condition in which a patient stops breathing.(Hoffman, Para,5) This condition is caused in young children by the obstruction of large tonsil or adenoids. The patient has been reported to have large tonsil and this requires immediate hospitalization and removal of the tonsils by a procedure called tonsillectomy. The surgical removal of her tonsils will have positive effects on her health and physical condition.
She also needs to have a counselor or psychiatrist evaluate her mental state which is cause of her rapid weight gain. Emphasis should also be made in firm management of her weight as she ranks in the 95th percentile as far as her weight goes and has been determined as overweight. With her medical condition and psychological condition if she continues on this path she will soon be obese and will have to face medical problems related to obesity. It is important to evaluate her readiness for the implementation of the surgical procedure tonsillectomy.
The doctor will need to evaluate her physical as well as mental condition. The doctor will need to maintain a chart which reflects her medical and family history. Her physical condition for her readiness has to be evaluated by running certain tests which determines her medical fitness. The hospital will check her blood pressure; run some blood tests to determine if she has any present infection. Another very important consideration would be to evaluate her BMI and weight chart. The hospital will need to have complete examination of tests which would include blood tests with complete blood count along with information about electrolytes and clotting factors.(Wetmore,pg.380).
This information is needed to evaluate her medical and physical condition before implementing surgery. The hospital also needs to run complete examination of her weight related facts. Her height is 135 cm and weight is 40kg. The patient is an eight year old girl weighing 88 pounds and is 4 ft.5 inches tall. This calculates her BMI as 22 which is not bad, but for her age she ranks in 95th percentile with indication towards overweight. Her overweight indication suggests that she has body mass index which is above 95 percentile and the risk of becoming overweight is indicated. Her psychological state suggests that she is depressed and neglected which might as well indicate her leanings to become obese in short time span. Hence management of her weight is a critical factor. (Dalton, pg.155).
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The patient urgently needs to undergo tonsillectomy to correct her medical problem of sleep apnea and frequent sickness. Tonsillectomy will be effective in controlling and curing her condition of sleep apnea. Her sickness has been the cause of major change in her routine which has caused her to miss school for two months. Regular schooling and maintaining good health is important for her physical and psycho-social recovery. It will give her motivation to live life fully. She needs surgical removal of her tonsils which are very large. This will safeguard her from further medical complications which can result from sleep apnea like heart and lung failure.(Hoffman, Para.3).
She needs to be hospitalized overnight to ensure she does not suffer from any post operative problems like dehydration, bleeding, breathing problems or any kind of infection. (Wetmore,pp.380). Since she has been reported to suffer from severe obstructive sleep apnea, she also needs close monitoring after surgery which will require her to be in hospital for at least one night or more depending on her condition and rate of recovery.
Her diet needs to be closely monitored before surgery when she needs to be on empty stomach. She should take prescribed medicine with very little water. She should avoid eating hard and acidic food. Her diet should include non-acidic and non-carbonated drinks, lots of fluids and soft food like jello or broth. (Hoffman, para.6)
At first effort should be directed towards her recovery from tonsillectomy and careful watch over her intake which should help maintain her weight. Gradually she should be encouraged to have low calorie and high nutrition diet. She should be made aware of the fact that she needs to balance her calorie intake and energy expenditure. It would be recommended that she loses not more than one pound a week so that she does not fall in the trap of obesity which has been a medical challenge which has hit many modern families.
Dalton, Sharon. Overweight and Weight Management. The Health professionals guide to Understanding and Practice. Jones and Bartlet Publishers.1997. Print.
Hoffman, Douglas. “Tonsillectomy and Adenoitectomy for Obstructive Sleep Apnea.”. 2009. Web.
Iannelli, Vincent. “Weight Management Guide. An introduction to weight management for ovwerweight children.” Pediatrics. 2003. Web.
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Wetmore RF. “Tonsils and adenoids”. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa:Saunders Elsevier; 2007: chap.pp. 380.