HEALTH ASSESSMENT

Physician’s Findings
DATE: May 18, 2022

Medical Diagnosis

Admitting Diagnosis: Clostridium difficile sepsis-induced thrombotic microangiopathy along-

side with DIC and consumption coagulopathy.

Final Diagnosis: Clostridium difficile sepsis-induced thrombotic microangiopathy alongside

with DIC and consumption coagulopathy.

Reasons for Seeking Care

• Sustained fever for 3 days
• Vomiting blood
• Presence of blood in urine
• Presence of blood in watery stool
• Large like bruise

History of Present Illness

A 14-month-old boy was presented with a severe, rapidly progressing, life-threatening disease
because of sudden onset of fever, hemathemesis, hematuria, and bloody diarrhoea alongside
fast spreading hematomas and general corporeal edema was admitted in intensive care unit. A
day before onset of the disease the child consumed a small portion of plant soil.
Previously he was a healthy child with no relevant medical history of similar disease or in family
history. No prodromal symptoms were noticed.
Functional Assessment

1. Health-Perception-Health Management Pattern

• Before admission, client was healthy with no relevant medical history of similar disease or in
family history.
• Client’s current health is too weak to perform daily activities. According to the watcher, the
client needs assistance to perform activities.

2. Nutritional-Metabolic Pattern
• Before admission, client was not picky eater. He eats fruits and vegetables, and drinks for-
mula milk.
Client have normal weight for his age, and drinks water at least 200ml a day.
• Client’s current appetite is not normal, and not eating when given food. He only sips small
amount of water.
D5LRS is provided to maintain normal body fluids and nutrition.

3. Elimination
• Client’s current excretory pattern is not normal. Client is suffering from anuria with blood in
urine.
• Client is also suffering from bloody diarrhea.
4. Activity-Exercise Pattern
• Before admission, client was physically active. He have playpen where he can play toys and
crawl or walk, according to his parents.
• Client’s current condition is weak to be physically active because of the present disease.

5. Sleep-Rest Pattern
• Before admission, client have sleeping schedule to have normal hours rest.
• Client’s present sleeping and rest pattern is not maintained, but encouraged with the help of
relaxation technique like minimizing light exposure, reading bedtime stories.

6. Cognitive-Perceptual Pattern
• Before admission, client was oriented to surroundings, sounds, and people around him. He
can response to stimuli verbally and physically.
• Client’s present cognitive and perceptual pattern is still normal. He is still oriented, but lack fo
response to stimuli verbally.

7. Self-Perception—Self-Concept Pattern
• Before admission, the client was able to express his feelings to his guardians and knows what
makes him feel better. He is more contented when he sees his parents around him.

8. Role and Relationship Pattern

• Client is only child of Mr. X and Mrs. X.

9. Sexuality and Reproduction

- N/a

10. Coping and stress tolerance

• The coping mechanism of client before admission is by playing, or asking for milk. Client will
sleep eventually when crying and feeling irritated.
11. Values and Belief
• The client’s family is religiously Roman Catholic. According to his parents, they will be the one
who will guide him with his choices and beliefs when growing up.

LABORATORY EXAMINATIONS

COMPLETE BLOOD COUNT NORMAL RANGE ACTUAL RESULT

(CBC)

White Blood Cells 6000-17000/µL 4000/µL

Red Blood Cells 4.1-5.3/µL 2.8/µL
Hemoglobin 11.3-14.1g/dL 7g/dL
Hematocrit 37%-41% 25%
Platelet Count 150,000-300,000/L 125,000

NORMAL RANGE ACTUAL RESULT

Crea 0.03-0.05mg/dL 0.01mg/dL

SGPT 8.8-10.8mg/dL 11.1mg/dL
CT 10-13 seconds 11 seconds
PT 12.1-14.5 seconds 13.2 seconds
CBG 100-180mmol/L 120mmol/L
Na 135-145mEq/L 138mEq/L
 NORMAL RANGE ACTUAL RESULT

Ca 4.8-5.3mg/dL 4.7mg/dL
K 3.5-5mEq/L 3.3mEq/L
Mg 3.8-6.5mg/dL 3.5mg/dL
aPTT 33.6-43.8 seconds 44.1 seconds

D-dimer 0.4-2.27mg/L 3.01mg/L

Antithrombin III 80%-130% 72%
C3 88-201mg/dL 76mg/dL
H Levels 9.5-14g/dL 8.0/dL
C1q 81-128 AU/ml 45 AU/ml
ADAMTS13 50%-160% 46%
IgG 3.1-13.8g/L 2.0g/L
IgA 0.30-1.20g/L 0.08g/L
IgM 0.50-2.20g/L 0.28g/L

EVALUATION AND MODIFICATION

The goal of our study is to describe and understand  the immediate management needed
for Disseminated Intravascular Coagulation. Assessment, nursing interventions and
management was done to identify the medical diagnosis of the patient that allows pro-
vision of appropriate delivery of care. The care given to the client took time to avoid fur-
ther complications. Gathering subjective data was challenging as this is a pediatric pa-
tient and some information was provided by the parents. Laboratory examinations were
conducted precisely, since the patient cannot communicate as to where the exact part
of the body was painful. Patient “Baby X,” initially presented with multiple organ failure
which began with sepsis including gastrointestinal, renal, cardiac and liver impairment.
Therefore multiple diagnostic testings and treatment was immediately performed. The
nursing goal outcomes and objective was provided and the goal of care was met. The
primary objective was to replenish and maintain adequate fluid volume with balanced
intake and output, reduce episodes of hemathemesis, maintain stable vital signs and
identify the origin of bleeding, fast spreading hematomas, anuria and general corporeal
edema. During the course of medical treatment, focused health monitoring was done.
The client is cranky during medication administration but it was given successfully. The
client tolerated the medications well without adverse reactions. During the hospital stay
and treatment the patient’s condition improved. The patient was free from infection af-
ter medication treatments, improved urine output, reduced hemathemesis and bloody
diarrhea, minimized general corporeal edema, increase in red blood cell count after
blood transfusion of packed RBC.  After successful treatment of sepsis, symptoms of DIC
soon decreased. Eculizumab treatment in sepsis-induced DIC with decreased ADAMTS13
activity was already successfully administered. A subsequent TMA to be likely appear
based on the clinical features and Eculizumab response. It's also backed up by a long-
term drop in haptoglobin and platelets, as well as small but consistent hemolysis, which
started early in the disease. Plasma exchange is likely to explain some of the rapid nor-
malization of LDH. Low C3 can also help with TMA. Reduced C3, HF, and AP activity may
encourage complement loss or activation, as well as continuing TMA; however, these
parameters could also be linked to infection-related consumption. Because a kidney
biopsy was only conducted 1 week after the commencement of Eculizumab treatment
due to technical difficulties, a definitive conclusion about the presence or absence of
TMA before treatment cannot be drawn. Rapid clinical and laboratory response (rise of
platelets and C3) after Eculizumab administration best fits such possibility. Infection with
C difficile supports all aforementioned diagnostic possibilities, (HUS, aHUS, secondary

TMA DIC). The challenges during the course of care given to “Baby X” was to evaluate
the modification on normalizing the output pattern, free from further infection and
complication, and giving appropriate nutrients and diet for his age and symptoms. Com-
plete health teaching and discharge plan was conducted and given to the parents for the
patient’s health progression and recovery. Plans and objectives of care were carried out
successfully, even after 2 years of follow up check-up there are no complications and
chronic renal failure was saved.