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 Few Imp cases

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Age : 36
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PostSubject: Few Imp cases   Fri Jul 10, 2009 5:08 pm

1. Enuresis

History:

When did it start?
How frequently does he wet the bed? How many times per
week?
When does this happen? Only at night or at daytime too?
Have you tried any interventions or drugs before?
Does he drink or eat much late-night?
Do you know the volume of the urine?
What is the color of his urine?
Do you notice any blood in the urine?
Does he have any urgency for urination?
Does he have any other urination problem?
Does he snore?
Does he wake up during the night?
Is there any major stress for him?
How does he behave in school?
Is there any environmental changes related to wetting?
Ask HLHUGS
Is there anybody on your family has the same problem?
Ask PHSAM
Birth history, regular check up, immunization.

Counseling and Closure

Bed-wetting is much more common than most people
believe, so there is no reason for you or your child to
feel embarrassed or guilty. (Enuresis often runs in
families.)

Bedwetting usually goes away on its own. Almost all kids
who wet the bed eventually stop. But until it does, it
can be embarrassing and uncomfortable for your child. So
it's important to provide emotional support and
reassurance during this process.

There are something may help: Reassure your child that
bedwetting is a normal part of growing up and that it's
not going to last forever.
It may comfort your child to hear about other family
members who also struggled with it when they were young.
Tell your kid not to drink anything after dinner
Remind your child to go to the bathroom before bedtime.
When your child wakes with wet sheets, have your child
help you change the sheets. Explain that this isn't
punishment, but it is a part of the process. It may even
help your child feel better knowing that he or she
helped out.

There could be other possibilities causing bedwetting,
like an infection of urinary system. Would you please
bring your child here? So I can give him a complete
physical exam and order urine test.

DD Work-ups
Monosymptomatic primary nocturnal enuresis Genital exam
Secondary enuresis UA
UTI Urine culture
Constipation First-morning urine specific gravity
Sleep apnea U/S- renal
Functional bladder disorder


2. Picky eater case

History taking:

1. How old is your son?
2. How long has he been a picky eater?
3. Why do you think you son is a picky eater?
4. Is his picky eating habit getting worse or getting
better ?
5. Has he ever eaten well when he got really hungry?
6. Does he watch TV before dinner?
7. Does he have any pain in his belly?
8. Does he have any problems with his bowel movement?
9. How many times a week does he have bowel movements?
10. How many children do you have?
11. How much time do parents spend time with him?
12. Who takes care of your child when you are working?
13. What kind of house do you live?
14. Has your family moved recently?

Ask HLHUGS. PHSAM, Birth history, daycare, regular
checkup and immunization shots

Well, Mrs. X, thank you very much for answering my
question. Is there anything else you would like to tell
me about?

Ok, I would like to give you my impression right now.
First let me summarize what you have just told me. ???..
Is that right?

Mrs. X, based on the information you told me, I think
your son may be experiencing a habitual eating disorder,
however, we also need to exclude some other
possibilities, such as lead-poisoning or iron-deficiency
anemia. For that reason, I would like to examine him
personally and order some tests on him before I make any
diagnosis or give any advises. Is it convenient for you
to bring him here? (Provide help if she can not bring
his son to the hospital)

Alright, then, I will see you once you get to the
hospital. Take care.

D/D: Work-ups
1. Habitual eating disorder 1. CBC and electrolytes
2. Lead poisoning 2. Serum lead level
3. Iron-deficiency anemia 3. Stool for OVA and parasites
4. Fiber-lack diet
5. Parasitic Infections




3. Hallucination Case

History:

1. Onset ( How long have you been having this problem)
2. Would you tell me more about it? What did you
hear/see?
3. Is it always there or does it come and go?
4. Frequency (how often..)
5. Course ( getting worse or better)
6. Do you have any idea what might be causing of it?
7. Is there any warning signs before you hear/see it?
8. Do you feel someone is controlling you?
9. Does it affect your daily activities?
10. How is your relationship with your friends and
family members?

Ask FACE SLIPS(Qs for depression), HLHUGS, PHSAM FOSS(my
own mnemonics for ROS and History, equal to those in FA
and UW)

always ask about social support.

PE: MMSE, Hearing and visional exam, quick neurological
exam, Heart and Chest

Counseling:

Need to interview family members and close friends for
more information
Quit recreational drugs, it may be one of the causes of
the hallucinations he experiences
Provide support groups and recommend staying at hospital
if he is confused or not stable.


D/D Work-ups
1. Schizophrenia 1. CT-head
2. Brief psychotic disorder 2. TSH
3. Drug-induced hallucination 3. CBC
4.Thyroid Disease 4. UA and toxicity
5. Electrolyte imbalance
6. Grief reaction/PTSD.
.
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