PEDIATRIC CLINICAL DAY #2

Well, today went much better at the pediatric office than last week. I didn’t feel like a total idiot. At least the developmental stages were easier because I reviewed as much as I could last week. I bought a little reference book and a larger book with everything you always wanted to know about peds but were afraid to ask. We actually had some interesting patients today.

I examined a four day old who was there for a routine exam after leaving the hospital. He had acne neonatorum which is common with newborns and infants. I have already seen several neonates with this in the office. It usually resolves within six months to a year. Poor kid is probably going to get acne again when he becomes an adolescent. He is fair skinned. His father has red hair and his mother has dark blonde. The parents were very young. The parents wanted to schedule the circumcision today but the P.A. in the office said he could do it today if they wanted. I don’t know if any of you have seen a circumcision, but it is an interesting thing to see. The first time I saw one was in my undergraduate nursing program. I could have sworn when I watched that one I had referred penile pain. Anyway, they decided they would have it done today. The consent was signed and everything was ready to go. Mom was starting to cry a little and had to be consoled by her husband. There is a plastic board that has an indentation shaped as a child in the middle of it. The arms and legs have Velcro straps to hold the child in place. The P.A. injected lidocaine into the base of the penis twice. The baby was screaming. Mom was looking at the wall. Dad was looking at mom and his baby. A couple of snips and cuts with a scalpel and the foreskin was off. There was hardly any bleeding. The parents have to keep Vaseline on it for 10-14 days. It should be completely healed in that time.

About an hour later the P.A. received a phone call from the father. He told him the baby’s penis was bleeding and had saturated the diaper. They were told to hold pressure and go to the E.D. This was the first time this had ever happened to the P.A. and he has done quite a few. He was a little upset.

I found out today that the welfare system in our state does not cover circumcisions. I find that totally ridiculous because the information I have read about the benefits of circumcisions is a lower incidence of UTI’s, infections, and cancer. So instead of covering this procedure while the patient is still a neonate, they would rather cover the medications or possible circumcision due to medical problems at a later age when there are higher risks. I also remember when I was in my undergraduate nursing program a 19-year-old who had to have a circumcision due to recurring infections and other problems related to poor hygiene. I was in the PACU. He lost a lot of blood post-op while in the PACU and had quite a few problems before even getting to the floor.

I also saw a 9-month-old little girl who developed a rash yesterday. She had a fever of 101 on Thursday and had it off and on until yesterday (Sunday). That is when the rash appeared. It appeared first on her face then went to her torso. What made her rash look worse was she had a significant case of eczema on her back. Her back was dark pink and blotchy. The rash on her face and torso was rose-pink maculopapular spots. Otherwise this was one cute happy baby. She smiled the entire time I looked in her ears and throat. I have found out this really seems to really piss them off. Her diagnosis was Roseola Infantum. This was the first time I had ever seen this. I guess you go by the symptoms and she was a textbook case. It is viral and will go away on its own. Just the signs and symptoms need to be treated, such as fever, and she will be fine.  

Overall the day went well. I saw a couple of kids with thrush, one with herpangina, and one with Dacryostenosis (aka blocked tear duct). I am still having a difficult time looking in infant’s ears, but I know that will come with experience and practice. Holding the head was much easier this week too. I go for two days next week. Every day will get better and I will become more comfortable. I have some more reading to do and hopefully then I will be ready.