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Week 7 Reflective Discussion
Recently in clinical I had a family come in for their follow-up appointments for medications refills. The family included mother, stepdad, 14-year-old male and 11-year-old female. While everyone was getting checked in, I pulled the 14-year-old back to the exam room after intake and started asking about school. His medical history included (ODD), oppositional defiant disorder, ADHD, and autism. I was a new provider for him, so I realized that I had to grab his attention and trust quickly. We started talking about video games and he began to talk to me more about school. He became upset very quickly about school because he was having to move away from his friends. He then told me that his parents had lost their home and that they were having to sneak into the gym to take showers and did not have a bed to sleep in. I noticed when the rest of the family came into the exam room that he shut down and stopped talking. Red flags everywhere. I then began to assess the little girl and noticed immediately that she had lice and a major fungal infection on her head. Both children were dirty and malodorous. The teen had dark black spots on his upper torso. They were flat and unraised. At first, I thought it was dirt, but it would not come off, I ask him about it, and he said that he noticed the spots months ago and wasnâ€™t sure what caused them. They had never been documented in his record.
I then turned my attention to the parents. I asked some questions about the little girlâ€™s head. The fungal infection was bright red and open, I thought maybe from scratching, but the mother told me that she had been treating the fungus with clear nail polish and nail polish remover. The mother said that she has been trying for months to get rid of the lice and was unsuccessful. I asked about school, and the type of heat in their home and of course if the water was city or well water, and if there were any pets. The mother changed the subject and started telling me about how she was about to have breast implants because the girls were sagging. Completely changed the subject and would not discuss the home conditions for the children.
After my assessment, I went to my preceptor and told her of my findings and she told me that she had been seeing this family for a while now and she often worried about the children, and then she informed me that there were two more children in the home. It was a concerning situation.
For the little girl I decided to prescribe griseofulvin 10ml/kg (4.6mg/pound) and she weighed 72 pounds. I decided to give her 125mg per day.(drugs.com, 2021) This would need to be taken for 8 weeks and taken with milk to help with stomach upset. I did not prescribe an antifungal shampoo, because of the open wounds on her head, however I told her to use baby shampoo until it cleared up. I was also hesitant to prescribe lice shampoo, so I told the mother to get coconut oil, cover all the hair well and apply a shower cap for 8 hours, rinse and use a nit comb to get the eggs out. (Healthline, 2020) I also referred her for a dermatology consult as well for the teen, due to the black spots on his skin.
Finally, I made a call to the Department of Childrenâ€™s Services and made an anonymous complaint with them. (Tennessee Department of Children’s Services [DCS], 2021) I spoke with someone who took all the information and gave all the details that I could. The next day, I got a call from a DCS case worker and turns out the family was in fact living in their van, the children were found to have no food and no running water and were in truancy at school. The children were taken for temporary placement with family elsewhere and I am not sure what happened with the parents.
From this experience I learned to always trust your gut and if something doesnâ€™t seem right, it most likely is not. I also from previous experiences did not have faith in DCS, however, they redeemed my respect in this case. I also learned to look for other signs of neglect and abuse, because not always will the patient be able to just come out and tell you that something isnâ€™t right. While it was a very sad situation, I felt good in knowing that I was able to help these kids and look forward to advocating for all of my patients in the future.
FridayMar 4 at 7:53pm
Describe the experience, your thoughts and feelings, your evaluation of the situation, your analysis of the experience, conclusions and learning from the experience, and your action plan resulting from the experienceLast week during my clinical, my preceptor and I were in the walk-in clinic for the day. This was an excellent opportunity to see some acutely ill patients and minor procedures. The first patient who walked in had left great toe pain for two weeks. He was checked in and brought back to a room. As I entered the room, I could see that his toe was red with a scab at the tip and bloody drainage that was actively dripping from his foot. He said that a year ago, he scraped his toe on some concrete, and it had healed some but not entirely. Then, about two weeks ago, he was working outside and noticed his toe was painful with what looked like a blood blister. There was no history of diabetes or neuropathy, only that he confessed there was a callus that he tried to remove with his wife’s nail file. After cleaning the area in the clinic with Hibiclens, we proceeded to lance a small area to see if any pus would drain for a successful wound culture. However, once my preceptor lifted a piece of dead skin, a small object was just beneath it. This could be a piece of concrete that has been lodged in his toe for over a year now.
After the procedure, I went back into the room to tell him the plan he was picking at the area with dirty fingernails. I refrained from scolding him like my initial reaction was and instead took the time to explain to him how bacteria enter our body and what we can do to prevent infections by hand hygiene. I discussed in length that cellulitis occurs when bacteria, such as streptococcus or staphylococcus enter a wound (Mayo Clinic, 2022). Also, an even more severe infection can occur, such as methicillin-resistant Staphylococcus aureus (Mayo Clinic, 2022).
My overall analysis of this situation is that no one had told him why it is crucial to avoid infection such as his. He was not aware of the danger of bacteria or staph entering through a wound into the blood system. It was unfortunate that he developed such a severe infection; however, hopefully, in the future, he will seek medical care earlier rather than later and know how to care for wounds a little better.