Question

Objective Data

• Merci was diagnosed with celiac disease at about 11 months of age. Approximately 4 months after she started on solid foods.
• She had a term birth at 39 4/7 weeks of gestation with an Apgar 9/10.
• She developed normally until she began to have gastrointestinal symptoms and refused feeding.
• Smaller stature
• Merci is 30months old
• Slim with a prominent distended belly
• Merci’s chest was auscultated
• Heart tone were regular and heart rate is 102
• No murmur, gallop, or heaves were noted.
• Lungs were clear in all fields anterior and posterior
• Visuable thin legs and buttock

Subjective Data

• The patient has Celiac Disease
• Mother concerns if the patient is gaining weight
• She enjoys playing put she gets tired easily, she is irritable, needs to rest after playing
• Her appetite is good only half of the time
• Painful belly gas everyday
• No bloody stool
• She wants to eat the same food what the family eats
• She often has stomach pain and sometimes vomits after eating bread
• She is night waking
• She is usually constipated but occasional diarrhea
• Four smelling stools
• Mother is concerning about type 1 diabetes because she has heard that celiac disease can cause dm 1

Order

• Symptoms are different from one celiac to another
• Lab studies were drawn to check for anemia and diabetes (CBC, Glucose)
• A 3 day stool fat collection was ordered.
• Controlling the disease is the most important help that we can give Merci.
• Mrs. Garcia was reminded that gluten is toxic to Merci’s bowel.
• It was suggested that the entire family help with Merci’s diet
• Foods that contain gluten were reviewed.
• Mrs. Garcia was referred to both a nutritionist and a gastroenterologist.

So. question.

• Include examples of pertinent positive and pertinent negative data associated with each.
• Provide rationales for your examples.

Answer 1

#. Pertinent positives, which are disease-specific and can be learned by rote, are used to “rule in” a particular diagnosis. Pertinent negatives, which require more analytical and creative thinking, are gleaned from the differential diagnosis and function to “rule out” other diagnostic possibilities.

#. Positive pertinent symptoms are :-

• Flatulence

• Constipation

• Bloating

• Indigestion

• Steatorrhea (fat in stool)

• Abdominal pain

• Short stature

These are the symptoms which are present in celiac disease

#. Negative pertinent symtoms :-

- weight gain

- Nausea and vomiting

- abdominal distension

These are the symptoms which indicates towards other disease other than celiac disease