Health Simulation Activity
Jaundice
Questioning is the basis of all learning.
Overview
Information to create a role play, problem solving, simulation for learners to participate in a health activity as a medical intern. The information is presented as: narrative with background information and dialog between a Practicing Physician, intern, and patient. Hints and answers for the questions are provided below the narrative so the narrative may be printed and read as a read aloud with discussion or provided to groups of learners to create a role play presentation to apply and review body functions.
Anatomy and body function concepts include:
- Skin, eyes, finger nails coloration
- Blood, red blood cells, hemoglobin
- Pathogens, white blood cells, or toxins
- Liver function
- Gastrointestinal tract, bile ducts
- Kidney function, bladder, urine
- Jaundice, bilirubin
Role play
A man and women are waiting in the examination room with their one year old child balanced on one knee as a Doctor and intern walk into the room.
The Dr. looks at the exterior physical appearance of the young child and asks the intern.
Doctor: "What do you notice?"
The intern knew this question would be coming and began observing the child by first noticing the child's curly dark hair, tan skin, dark eyes with the whites (sclera) being bright yellow.
After seeing the yellow glow of the sclera (white part) in the eye the intern immediate thought and answer ... (Hints and answers: 1.)
Intern, ...
The Dr. reaches for the child's hand and looks closer at both sides of the hand and spends more time looking at the finger nails.
The intern thought the Dr. was .... (Hints and answers: 2)
When the Dr. confirmed that there was a yellow tint in the skin and under the finger nails she asks the parents ... (Hints and answers: 3)
Doctor, ...
Parents,"Yesterday."
Doctor, "Has it happened before?"
Parent,"When he was born he was yellow for a few days and then it went away."
Doctor, "Has he been eating and drinking?"
Parent, "Yes."
The intern knew the jaundice was caused by something and began to search his memory for the cause of jaundice ...
(Hints and answers: 4)
... and
What might be going on to increase the bilirubin levels? ...
(Hints and answers: 5)
The Doctor continues to examine the child.
Listens to the heart and found it had a rapid beat and the lungs sounded clear of fluid.
The intern thought the reason the Doctor examined these was to ... (Hints and answers: 6)
Next the Doctor uses her fingers to probe the upper right side of the patient's abdomen to ... (Hints and answers: 7)
The child didn't show any signs of discomfort.
Doctor, Did the child's diapers show any unusual coloration?
Parents, Yes, there was a dark-orange color in his diapers.
The intern connects the orange urine as resulting from ... (Hints and answers: 8)
Next the Doctor looks closer at the child's eyes behind the eyelids, the eyelids themselves, lips, and behind and around the finger nails and decides they were paler than what they should be. Suggesting ... (Hints and answers: 9)
This examination suggests to try and verify or rule out anemia by ... (Hints and answers: 10) and
To investigate a cause of anemia by using the possible causes: malaria, inherited genetic condition, iron deficiency, vitamin B-12 deficiency, folate deficiency, bleeding, cancers that affect the bone marrow (such as leukemia), kidney disease, liver disease, hypothyroidism thalassemia — a genetic disorder that causes low levels of hemoglobin and red blood cells,
And asks questions such as ... (Hints and answers: 11)
Questioning results in negative answers to all questions except recent diet changes, which is answered with him eating fava beans two days ago.
Favism can be caused by eating broad beans. Beans that cause hemolysis (destruction of red blood cells) in people with Glucose-6-phosphate dehydrogenase deficiency (G6PD). However, not all people with G6PD deficiency have favism. It is more likely in infants and children. It is an X-linked recessive genetic condition that that can trigger hemolysis (spontaneous destruction of red blood cells) and result in jaundice as a response to certain foods, illness, or medication. It is most common in people of Mediterranean and African origin. Only know treatment is to avoid known triggers. Source
Immediate treatment with ... (Hints and answers: 12)
Test results. Blood test show the hemoglobin was extremely low, about one-third a normal level for his age. Later tests revealed Glucose-6-phosphate dehydrogenase deficiency (G6PD).
Hints and suggestions
- Jaundice
- Confirming the yellow tint by looking closer at the skin and finger nails for a yellow tint.
- When did the yellow appear?
- Jaundice is caused by too much bilirubin (a substance that results from breaking down red blood cells) that tints the skin and nails yellow. Jaundice in newborns needs to be monitored, because if bilirubin levels get too high (hyperbilirubinemia) it must be treated and lowered or it can cause brain damage (kernicterus) and other serious problems.
- To generate possible causes think about red blood cells. Where they are produced, their function, how they travel, and other organs that interact with them (filter blood ...). Some possibilities:
- Hemoglobin in the red blood cells could be malfunctioning, raising the bilirubin levels.
- Red blood cells might be being destroyed by white blood cells, pathogens, or toxins, raising the bilirubin levels.
- Liver might not be functioning well, which would increase bilirubin levels in the bloodstream since the liver wasn't removing bilirubin from the blood.
- Bile ducts might not be functioning which would decrease bilirubin from being excreted into the gastrointestinal tract and instead back up into the bloodstream.
- See if the condition was threatening life necessary functions.
- See if she could feel the liver or if the child showed signs of discomfort. If she could it would suggest the liver was enlarged, inflamed, or his bile ducts were blocked.
- Urine is produced in the kidney. Suggesting the color as a result of something in the blood stream that is passing through the kidney. Which could be hemoglobin from destroyed red blood cells passing through the kidney's filters and into the urine. While the coloring could be caused by liver or bile disease the physical exam of the area around the liver suggested it was not a bile or liver related problem.
- Anemia. Caused by a reduction of red blood cells, which would decrease the intensity of the red color. Anemia could also increase the heart rate because ... (the heart needs to pump faster to supply sufficient oxygen and remove carbon dioxide.)
- Verification of anemia with a blood test to find hemoglobin levels
- Has he been exposed to mosquitoes that might have given him malaria? Is there a history of anemia in the family? Have they feed any new food to their son lately?
- To begin treatment with a blood transfusions. Before a blood transfusion can be given, what must be determined or considered?
( Blood types and antigens )
Source
Adapted from: Yellow for Caution by Jonathan Reisman Discover Magazine May 2016.
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