Vignette #2
Instructions
Answer each question in a substantive manner using evidence-based
resources to support your work. Provide a reference list for all references
used as citations. Upload your completed document
...
Vignette #2
Instructions
Answer each question in a substantive manner using evidence-based
resources to support your work. Provide a reference list for all references
used as citations. Upload your completed document under Professor’s Grade
for Vignette 2.
Patient Case
Claire Green, a 6-year-old patient presents to the clinic with a chief
complaint of wetting the bed. This has been going on for a month. The
parent has been setting an alarm every night so that she can go to the
restroom, however, she is still having accidents. The parent stated that she
has been potty trained beginning around 2 years of age and had intermittent
accidents which stopped at 4 years of age. The patient denies fever, no
dysuria or urgency.
Vital Signs
Heart rate: 90 bpm
Respiratory rate: 22
Blood pressure: 94/56
Temperature: 99.2° F
Pulse ox: 97%
Assessment Findings
Patient appears non-toxic, well-appearing. Moist mucus membranes, tonsils
are 1+ bilaterally and non-erythematous. Lung sounds are clear, respirations
are unlabored. Heart rate is regular, a 1-2/6 systolic murmur is heard on the
left sternal border, 5th intercostal space, capillary refill is less than 3
seconds. Bowel sounds are present and regular, palpable stool burden in all
abdominal quadrants, and slight tenderness in all quadrants with deep
palpation. Tanner stage 1, labia and vaginal opening are normal appearing,
rectal opening with a few tiny fissures. No rashes or skin lesions. Full range
of motion of all extremities. Age-appropriate behavior.
1. Using the history and exam findings, create a problem list.
2. Based on this history, what are 3 priority differential diagnoses? For each
diagnosis, what additional subjective and objective information (e.g. physical
exam, diagnostics) would you prioritize and why.
3. What are 2 possible causes of primary nocturnal enuresis?
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