NURSING 491: Tommy Acker Evaluation Assessment (Aspen University)

TA is a 26-month-old male with Down syndrome who has presented with his mother’s statement of “a tummy ache”. Mother has also noted that TA has been lethargic, whining and has a poor appetite for the last two days. She continues on stating that TA fell out of this bed while taking a nap. TA appears listless and pale during examination. TA has a history of atrioventricular septal defect (complete), status-post surgical repair; congestive heart failure, resolved following surgery; and, global developmental delay. TA’s temperature is 97.9 with a BP of 68/40, pulse of 160 bpm-regular, and his respiratory rate is 50 bpm SpO2: 93% on room air. Upon further evaluation, TA abdomen is grossly distended with significant epigastric bruising, in a distribution that is atypical for a fall. It is firm to palpation with diffuse tenderness, guarding and rebound tenderness. 2 cm umbilical hernia. No tympany or shifting dullness. Based on TA’s assessment some of the differential diagnosis include volvulus, systemic inflammatory response syndrome (SIRS), and possible incarcerated abdominal hernia and/or child abuse. Volvulus was ruled out because his CT did not demonstrate a herniation of a large portion of the stomach above the diaphragm, often with differential air-fluid levels (Tackett, 2014).