???Group 1: RxMen

Angustia ★ Ayes ★ Chan ★ Co Garcia ★ Macapinlac ★Tumibay

★Vega

O Purpose of the presentationO Impact of illness to the patient and

familyO Coping mechanismO Family dynamicsO Social resources

General DataO APO 4 mos./MaleO FilipinoO Roman CatholicO Residing in San Miguel, Pasig CityO Informant: Mother, Father, and

Paternal GrandparentsO Reliability: 70%

O Admitted at PCGH on December 3, 2010

Chief ComplaintO Fever (2 days)

History of Present Illness

O 3 weeks PTA O intermittent cough, productive of whitish phlegm

O No associated signs and symptoms

O consult at a private clinicO Ambroxol

(unrecalled dosage) No relief

O Amoxicillin 6.75 mg No relief

History of Present Illness

O 2 weeks PTA O persistence of symptomsO consult at a private clinic

O CarbocisteineO Co-trimoxazole

(unrecalled dosage)O Phenylpropanolamine

(Disudrin) 0.5 ml QID O Phenylephrine HCl,

chlorphenamine (Neozep) 0.5 ml QID

O No relief

History of Present Illness

O 2 days PTA O persistence of symptoms

O (+) undocumented fever

O (+) Difficulty of breathing

O No consult done O Parents self-

medicated patient with Paracetamol drops 8.45 mg/kg/dose

History of Present IllnessO Morning PTA O persistence of symptoms

O (+) rhinorrhea, productive of yellowish-green mucous

O (+) vomiting milk and phlegm (about 4 oz)

O Consult at health centerO Cephalexin 32.43

mg/kg/dayO Paracetamol 8.45

mg/kg/doseO Increase in feverO (+) cyanosis of distal

extremitiesPCGH ER

Review of SystemsO Constitutional: no weight loss, no

weakness O Integument: (+) rashes (diaper), no

changes in colorO Respiratory: no hemoptysisO Gastrointestinal: no changes in

bowel movementO Genitourinary: no frequency

Past Medical HistoryO no previous hospitalizationO no previous operationsO no history of trauma

Family Medical HistoryO Liver disease, Tuberculosis -

Maternal sideO Breast cancer - Paternal sideO (-) AsthmaO (-) DMO (-) Hypertension, cardiac disease

Developmental HistoryO patient is a 4 mo., male

O (+) grasps object placed in handO (+) moves head toward soundO (+) reaches for objects O (+) chewsO (+) roll overO (-) chest up, arm support

Immunization HistoryO BCG - 1 doseO OPV - 1 doseO Hepa B - 1 doseO No HiB

Birth HistoryO Born Full Term to a 17 year old

G1P1, delivered via Normal Spontaneous Delivery with birth weight 3.6 kg, at a lying-in clinic, attended by midwife, (-) perinatal/neonatal complications

Nutritional HistoryO Breast fed for 2 weeks then shifted

to milk formula (8 oz. per feeding x 4 feedings a day)

O No known food allergy

Genogram (12/30/10)I

II

III

49 43

20 18

4 mos.

21 16 15 14 13 11

4648

24 18

Personal Social historyO Only ChildO Mother - 18 y/o not employedO Father - 20 y/o

factory workerO Parents not marriedO Families are not on good terms

Environmental history O Patient does not stay permanently in

one household. He is shuttled from the mother’s household to the father’s household and vice versa

O Lives in a 1 story wooden house near the streets with 2 bedrooms.

O The house is well ventilated and well lighted.

Environmental history O Their water supply comes from

Manila Waters.

O Drinking water of the patient was previously Wilkins, but now the water comes from a refill station

O Garbage is collected every day.

Physical ExaminationO General Survey:

O Conscious, alert, in mild respiratory distress, well-nourished

O Vital signs: O HR 165HR 165, RR 38, Temp 40.5Temp 40.5ooCC

O Anthropometrics:O Length 59 cm (<3rd percentile)O weight 7.4 kg (50-85th percentile for age,

>97th percentile for length)O HC 40.5 cm (15th percentile), CC 44.3

cm, AC 46.4 cm

Physical ExaminationO Skin:

O normal skin color, good turgor (CRT<2 sec), flushed skinO (+) diaper rash, inguinal area extending to buttocks, (-)

lesions, flushed skinO HEENT and neck:

O flat, open anterior fontanel; closed posterior fontanel O Normal hair distribution, (-) masses/depressions O anicteric sclerae, pink palpebral conjunctivae, pupils 3-4mm

ERTLO (-) ear deformities, (-) discharge, (+) intact tympanic

membrane, (+) cone of lightO (-) nasal deformities, (+) rhinorrhea, yellow-green

discharge slightly driedO (-) Tonsillopharyngeal congestion, (-) cervical

lymphadenopathy, supple neck, flat neck veins

Physical ExaminationO Heart:

O adynamic precordium, apex beat at 5th ICS LMCL, tachycardic, regular rhythm

O (-) murmurs, good S1/S2O Lungs:

O (-) scars or masses, (+) intercostal/subcostal retractions

O symmetric chest expansion, resonant on percussion, (+) rhonchi lower lung fields, (+) crackles on bilateral lower lung fields

Physical ExaminationO Abdomen:

O globular abdomen, (-) masses or scarsO Normoactive bowel soundsO tympanitic abdomenO (-) tenderness, (-) organomegaly

O Genital exam:O grossly male, (-) deformitiesO Descended testes

Physical ExaminationO Extremities:

O full and equal pulses, (-) edema, (-) cyanosis

Neurologic ExaminationO Cranial Nerves:

O CN I - not testedO CN II – 3-4 mm equally reactive to lightO CN III, IV, VI – intact EOMsO CN V – reacts to facial sensory stimulationO CN VII – no facial asymmetry, able to

smile and cryO CN VIII – responds to sound and verbal

stimuliO CN IX, X – able to feed, good suckO CN XI – able to turn head from side to sideO CN XII – tongue midline

Neurologic ExaminationO Sensory: responds to stimuli (light

touch)O Motor: good muscle tone and strength O Reflexes

O (+) BabinskiO (+) palmar graspO (-) rooting O (-) moroO (-) tonic neck

Salient FeaturesO 4 mo./M O fever (2 days) associated with cough

and colds, difficulty of breathing, peripheral cyanosis, and vomiting

O medications given afforded no reliefO on PE, (+) tachycardia, (+) intercostal

retractions, (+) rhinorrhea, (+) rhonchi on lower lung fields, (+) crackles on lower lung fields

Admitting DiagnosisO Pediatric Community Acquired

Pneumonia, Category CO (+) fever, difficulty of breathing,

cyanosis, cough and coldsO PLUS findings on PE: (+) tachycardia,

(+) intercostal/subcostal retractions,(+) rhinorrhea, (+) rhonchi, (+) crackles