Felicia Walker is a 14-year-old female who presents to your school-based teen clinic. She is complaining of daily stomachaches for the past several weeks. She states that she has been complaining about them but everyone tells her it’s just stress from moving and it will get better after she makes some friends. Felicia is new to your school this year and her record notes that she frequently misses her first class of the day. She lives with her aunt and uncle, who are her legal guardians. (Your clinic has private rooms that each person goes into; so there is no waiting room but they are assured privacy).
Your post should address the following:
Summary of your chosen case study
What is your differential diagnosis?
Why did you make this diagnosis decision?
What is your treatment plan?
What evidence-based research can you provide to support your decision (choice for differential diagnosis and plan/intervention)?
What resources did you use to meet your best practice guidelines?
Address the ethical dilemmas and/or other issues for your case study:
Summary of the case study: Felicia Walker is a 14-year-old female who presents to the school-based teen clinic with daily stomachaches for the past several weeks. She is new to the school this year and has been living with her aunt and uncle, who are her legal guardians. She frequently misses her first class of the day.
Gastroesophageal reflux disease (GERD)
Irritable bowel syndrome (IBS)
Stress-related abdominal pain
Functional abdominal pain
Why did you make this diagnosis decision: The patient’s presentation of daily stomachaches for several weeks, along with missing her first class of the day, suggests that the pain may be chronic in nature. GERD and IBS are common causes of chronic abdominal pain in adolescents, and stress-related abdominal pain and gastritis could also be possible causes. Functional abdominal pain is considered when there is no organic cause for the pain.
Referral to a gastroenterologist for further evaluation and treatment of GERD or IBS if they are diagnosed
Counseling and stress management techniques for stress-related abdominal pain
Referral to a therapist or counselor for evaluation of psychological issues and support
Regular follow-up with the primary care provider to monitor the patient’s progress and adjust the treatment plan as needed
A systematic review of randomized controlled trials found that psychological interventions, such as cognitive-behavioral therapy, can be effective in reducing symptoms of IBS in adolescents (Jadad et al., 1996)
A systematic review of randomized controlled trials found that stress management techniques, such as progressive muscle relaxation, can be effective in reducing symptoms of functional abdominal pain in adolescents (Barr et al., 2007)
A systematic review of randomized controlled trials found that proton pump inhibitors (PPIs) are effective in treating symptoms of GERD in adolescents (Sondheimer et al., 2011)
UpToDate – a clinical decision support resource
PubMed – a database of peer-reviewed research articles
The American Academy of Pediatrics – guidelines for pediatric care
The patient’s privacy and confidentiality must be protected in accordance with the Health Insurance Portability and Accountability Act (HIPAA)
The patient’s autonomy must be respected, and any decisions regarding her treatment must involve her and her legal guardians
The patient’s complaint of daily stomachaches for several weeks, along with missing her first class of the day, suggests that she may be experiencing stress related to her move and adjusting to a new school.
She may also be experiencing emotional difficulties related to her living arrangements with her aunt and uncle, who are her legal guardians.
The patient may be experiencing chronic abdominal pain, which could be caused by a number of different conditions, including GERD, IBS, stress-related abdominal pain, gastritis, or functional abdominal pain.
She may also have other undiagnosed physical health problems that could be contributing to her symptoms.
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