Assignment:Cole Wilson I human Case Study Management Plan Essay

Assignment:Cole Wilson I human Case Study Management Plan Essay

Assignment:Cole Wilson I human Case Study Management Plan Essay

Human Case Study Management Plan

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The management plan is for a four-year-old male patient who presents with his father for leaking stool in underwear that commenced three weeks ago. The father indicated that the minor has had abdominal pain for the last two days without any improvement. He also reports that the pain is a 2-4/10 or mild to moderated pain. The patient is currently not taking any over-the-counter or prescription for the symptoms. The patient has a bowel movement every four to five days, with the last one experienced five days ago. The father also states that the patient strains when defecating, and the stool is small and looks hard, like little pebbles. He eats three meals a day and is a picky eater. The diet consists of mild, fried foods, chicken nuggets, and pizza. The patient also refuses to eat any vegetables or drink water. The father denies that the patient has any fever, vomiting, nausea, or blood in the stool.


Primary Diagnosis

Encopresis (ICD 10 code: F98.1): This is a condition also known as fecal incontinence. It is characterized by the involuntary passing of stool into inappropriate places as underwear among children of at least four years. It may be an indication of severe psychological distress for minors and their families. Some of the symptoms include recurrent bladder infections, enuresis, abdominal pain, lack of appetite, long periods of time between bowel movements, avoidance of bowel movements, passing of large stools which clogs, constipation with hard and dry stool and leakage of stool on underwear (Friman, 2020). The patient showed most of these systems making this a primary diagnosis.

The Guideline Used In Developing the Primary Diagnosis

 Guidelines are applied to help healthcare professionals to come up with an appropriate diagnosis so that an appropriate management plan can be formulated. Therefore, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). According to this guideline, for an individual to be diagnosed with this condition, they have to be at least four years (Yilanli & Gokarakonda, 2020). In addition, the encopretic events should be experienced for at least three months.

Differential Diagnosis

  1. Constipation (ICD Code: K59.00): This is a condition where an individual experiences infrequent or uncomfortable bowel movements. It occurs when the bowel movements lead to the passage of small amounts of hard, dry stool. Symptoms include abdominal pain, fleeing sluggish, feeling bloated, bowel movements fewer than three times a week, and painful and difficult bowel movements (Vriesman et al.,2020). The patient showed some of these symptoms making this a differential diagnosis.
  2. Celiac Disease (ICD 10 Code: K90.0): This is a condition where the body reacts to eating gluten. The body reacts through the small intestine, whose linings are damaged hence preventing it from absorbing nutrients. Some of the symptoms include constipation, vomiting, nausea, abdominal pain, bloating, weight loss, fatigue, and diarrhea (Caio et al.,2019). The patient only experience a few symptoms making this diagnosis less likely
  3. Hypothyroidism (ICD 10 Code: E03.9): This is a condition that results when the thyroid gland fails to make enough thyroid hormone. It is also called underactive thyroid. Some of the symptoms include tiredness, constipation, dry skin, weight gain, hoarse voice, muscle weakness, and thinning hair (Chiovato et al.,2019). The patient only experienced constipation among these symptoms making this diagnosis less likely.
  4. Hirschsprung’s Disease (ICD 10 Code: Q 43.1): This is a birth defect where a child presents with missing nerve cells in the muscles of part or all of the large intestine. The condition leads to complications with passing stools due to blockage. Some of the symptoms include vomiting, swollen stomach, diarrhea, delayed passage of meconium, and constipation (Uylas et al.,2021). This condition is usually associated with newborns hence less likely in this patient’s case.


  1. PEG 3350 powder, 4 and 0.8 g/kg/d
  2. Bisacodyl (suppositories): 5 mg once a day (Vriesman et al.,2020)
  • Infliximab: 5 mg/ kg
  1. Levothyroxine: 5 – 7 µg/kg/day 
  2. Acetaminophen after the surgical procedure: oral suspension (5 ml)

The medications listed can be used in the management of the discussed conditions. However, the patient needs to be concerned about various side effects, which may also need to be managed for better outcomes. For the PEG 3350 powder, the patient may experience side effects such as vomiting, swelling of the stomach, stomach pain, and bloating. For Bysacodyl, the patient may need to be concerned about vomiting, blood in poo, dizziness, stomach pain, diarrhea, and nausea (Vriesman et al.,2020). The patient should also be aware of Infliximab side effects such as redness of the parts like arms, neck, and face, muscle stiffness, ingestion, heartburn, feeling of warmth, difficulty moving, and belching. Levothyroxine can also lead to various side effects, such as swelling of the lower legs, ankles, feet, and hands, nausea, stomach pain, flushing, rash, itching, hives, wheezing, and breath shortness (Flinterman et al.,2020). Lastly, acetaminophen can lead to effects such as difficulty breathing, hoarseness, swelling face, itching, hives, rash, or blistering skin.

The patient also needs to receive education as part of the treatment and management. For example, the patient should get further tests to rule out some of the conditions. For example, thyroid-stimulating hormone tests should be done to confirm or rule out hypothyroidism, and a biopsy of the small intestine and blood tests can be done to confirm celiac disease. Abdominal X-ray can be done to find out the amount of stool in the large intestine to evaluate encopresis. Abdominal X-ray using a contrast die can also be used to assess Hirschsprung’s disease (Uylas et al.,2021). These further tests are necessary to help make the diagnosis more precise. As a form of education, the patient’s father should ensure that the patient uses the medications as prescribed. As indicated earlier, the father needs to know about the potential side effects of using the prescribed medications. In the case where adverse effects of the medications are observed, then the father should immediately stop the medication and take the child back to the hospital. The patient should visit the hospital after four to six weeks for a follow-up.

Problem Statement

            The patient is a minor. Therefore, it can be difficult for him to articulate every symptom. However, the father has concisely stated the symptoms. These symptoms make the child uncomfortable and embarrassed as he passed stool on his underwear. Therefore, the patient needs to be given appropriate medication and a comprehensive management plan to help relieve the symptoms and treat him.

The Social Determinants to Consider

Social determinants of health are closely associated with people’s and population’s health outcomes. Therefore, it is important to take them into account when coming up with care plans. As such, the social determinants of health to consider include the safety of the home environment, the ability to seek and access care, and the level of education of the parents. This is a minor, and therefore, the home environment should be made safe for him. The ability to seek and access care should also be considered as part of the pan. The father’s level of education may also determine if he can help the patient follow the medication regimen appropriately (Nubeam & Lloyd, 2021). As part of the health promotion, the father needs to ensure that the patient takes enough water, consumes a balanced diet, performs physical exercise, and has enough sleep and rest.


Caio, G., Volta, U., Sapone, A., Leffler, D. A., De Giorgio, R., Catassi, C., & Fasano, A. (2019). Celiac disease: a comprehensive current review. BMC Medicine, 17, 1-20. Doi: 10.1186/s12916-019-1380-z

Chiovato, L., Magri, F., & Carlé, A. (2019). Hypothyroidism in context: Where we’ve been and where we’re going. Advances in therapy, 36, 47-58. 10.1007/s12325-019-01080-8

Flinterman, L. E., Kuiper, J. G., Korevaar, J. C., van Dijk, L., Hek, K., Houben, E., … & Fliers, E. (2020). Impact of a forced dose-equivalent levothyroxine brand switch on plasma thyrotropin: a cohort study. Thyroid, 30(6), 821-828.

Friman, P. C. (2020). Evidence-based therapies for enuresis and encopresis. Handbook of evidence-based therapies for children and adolescents: Bridging science and practice, 267-280. 10.1007/978-3-030-44226-2_18

Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annu Rev Public Health, 42(1), 159-73.

Uylas, U., Gunes, O., & Kayaalp, C. (2021). Hirschsprung’s disease complicated by sigmoid volvulus: a systematic review. Balkan Medical Journal, 38(1), 1.

Vriesman, M. H., Koppen, I. J., Camilleri, M., Di Lorenzo, C., & Benninga, M. A. (2020). Management of functional constipation in children and adults. Nature Reviews Gastroenterology & Hepatology, 17(1), 21-39.

Yilanli, M., & Gokarakonda, S. B. (2020). Encopresis.


Case Study: 4 year old male presents with his father for leaking stool in underwear that started 3 weeks ago. Father states he has had abdominal pain for the last two without any improvement. Father reports his pain is a 2-4/10 or mild to moderate pain. Pt is currently not taking any OTC or prescription medication for his symptoms. He has a bowel movement every 4-5 days with his last bowel movement being 5 days ago. His father states he do strain when defecating and stool is small and looks hard like little pebbles. He eats three meals a day and is a picky eater. His father states his diet consists of unhealthy food such as pizza, chicken nuggets, fried foods, and milk. He refuses to drink water or eat any vegetables. Father denies pt having any fevers, blood in stool, or nausea and vomiting.

Diagnosis: Encopresis

Differential Diagnosis:


Celiac Disease


Congenital a ganglion ICD mega colon (Hirshsprung’s Disease)

Instruction (Include this in management plan)

Management Plan Template– must include these headings

Primary Diagnosis with ICD-10 code, rationale and resources. Include CPT codes, and any procedural codes, including nurse lab draws, vaccinations given, biopsies, etc…10 pts.

Guidelines used to develop this primary diagnosis. 5 pts

Differential diagnoses with rationale and resources. 3-5 Ddx required, unless well visit. 5 pts

Medications including OTC, dosage and education, additional ancillary tests needed, referrals and follow up – 10 pts

Problem Statement – 5 pts

Social Determinants of Health to consider, Health Promotion and Pt risk factors – 5 pts

Must use 3 scholarly references the course text may NOT be used as a reference. The references must be professional and not general patient education websites.

Worth 40 points

Pt is currently not taking any medication and has no allergies.

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