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The case study presented has been a distress situation accompanied by complexities of medical issues. The patient needs to be handled with sensitivity and care. I would consider the physical examination of the patient along with the psychological wellbeing as the part of her recovery plan in her management. The girl is overwhelmed with the loss of her father and lack of attention from the mother who is coping with her own grief. She also has medical conditions which do require hospitalization and immediate corrective action.
My assessment of her medical situation is that she is suffering badly on account of her tonsils which are triggered by stress. This is the cause of her frequent absence from school. The rapid weight gain is also the sign of distress and stress which requires her psychological assessment.
The girl needs hospitalization and management of the hospital staff as she needs to undergo tonsillectomy for the control of her sleep apnea which is a serious problem in her case history and requires immediate action. Sleep Apnea is a condition which is characterized by momentary stopping of the breathing. It is a serious illness. Apnea means in medical terms stopping to breath. The obstruction of large tonsil and adenoids cause this condition in children.
In her case she has large tonsils hence removal of this surgically will have curative results on her health. She needs to undergo tonsillectomy, and also needs firm management of her weight which has been an issue of concern.
The goals of the hospital management will be to first determine her readiness physically and mentally for the tonsillectomy. The doctor will need to know certain facts regarding the patient before proceeding through the surgery. “
- Is there a family history of bleeding problems? Does your child bleed excessively from small cuts, or does he bruise easily?
- Has your child used any blood-thinning medications within 3 weeks of surgery? (Examples are: aspirin, bufferin, motrin, advil, ibuprofen.)
- Is your child under a doctor’s care for any reason? Does your child take ANY medications (prescription, nonprescription, herbal… anything)?
- Has your child ever been hospitalized?
- Has your child ever had general anesthesia?
- Has anyone in your family (blood relative to your child) ever had a bad reaction to a general anesthetic?”(Hoffman, para.5)
The hospital will require certain investigations like checking of the blood pressure, present infection, the calculation of the BMI and determination of the obesity factors before proceeding with the surgery. The child will need to have blood tests done which will include complete blood count, electrolytes, clotting factors along with physical exam and medical history.(Wetmore,pg.380). Since the patient has significant degree of OSA (Obstructive Sleep Apnea) the patient will require overnight hospitalization and management of the physical and psychological factors which impact her physical illness.
The determination of the BMI reveals that she is 135 cm in height and 40 kg in weight which classifies her as progressing on road to being overweight. She is not obese, as inorder to be classified as obese her BMI needed to be above 30, but her BMI is only 22, which reflects that it is still under manageable control. Her rapid weight gain since her fathers death needs to be considered seriously as this can lead to obesity if it is left unattended. At the hospital she needs surgical procedure for her tonsillectomy and as well as firm and progressive management of her weight issue which has strong tendency given her background to take the form of obesity. It is also important to involve her mother and family in the management of her weight related problem before it manifests itself as full blown obesity.
Tonsillectomy is the most important step which is needed medically in the management of her medical problem. This will help cure her obstructive sleep apnea as well as her sickness which has resulted in her long absence from school. She has large tonsil and she has been reported to suffer from obstructive sleep apnea along with rapid weight gain in the past one year. In her case surgical removal of the tonsil is recommended as the other alternatives like steroid treatment and CPAP may not tolerated by her and her tonsils are very large. (Hoffman, para2.).
Her situation demands surgical removal of the tonsils to control her recurrent school absence as well to control her sleep apnea. OSA (Obstructive Sleep Apnea) can harm the child in many ways, if left untreated severe OSA can lead to delayed growth and eventual heart and lung failure, and less severe complications include excessive daytime sleepiness, poor school performance, hyperactivity and developmental delay. (Hoffman, para.3).
Since she is in fragile mental state it is important to keep her under observation in the hospital to make sure that the risks of the tonsillectomy which are bleeding, dehydration, breathing problems, infection, pain, voice change, swallowing and speaking problems and lack of snoring etc. are monitored and explained with apt support by the hospital staff. Since the patient concerned is suffering from severe OSA(obstructive sleep apnea) she needs to be closely monitored in the hospital for one night after surgery, occasionally longer hospitalization is also required.
The diet plan for her admission will require that she does not eat anything for several hours before the surgery. The medicine prescribed by the doctor should be given with very little water. Ten days before the surgery the child should stop taking aspirin, ibuprofen which cause thinning of the blood. The diet plan should include non acidic and non carbonated drinks, broth, atrocious diet which includes juice, soda, jello and lots of fluids.
The patient ranks under 95 percentile as far as her weight is concerned, it should be monitored with sensible food management and encouragement to participate in physical activity once she recovers from her surgery. The desired weight loss would be half a pound a week. She should be encouraged to watch her calorie intake with the expenditure of energy. She is overweight and should take measures to balance her calorie and energy ratio to make sure that she does not fall in the trap of obesity. Childhood obesity needs to be managed effectively with the involvement of parents, health care providers as well as the schools. This is the challenge of the modern age.
Work Cited
Hoffman, Douglas. Tonsillectomy and Adenoitectomy for Obstructive Sleep Apnea. Web.
Tonsillectomy. MedicinePlus. Web.
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 380.
Overweight, Obesity and Weight Management. IFIC. 2006. Web.
Dalton, Sharon. Overweight and Weight Management. The Health professionals guide to Understanding and Practice. Jones and Bartlet Publishers. 1997.
Obesity. NHS. 2009. Web.
The Sleep Apnea Trust. Web.
Childhood Obesity Facts. Buzzle. Web.
Poskitt, Elizabeth & Edmunds Laural. Management of Childhood Obesity. 2008. Web.
Wang, Guijing & Dietz, William H. Economic Burden of Obesity in Youths Aged 6 to 17 years: 1979-1999. Pediatric. Web.
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