A 2-Year-Old Boy Is Brought to the Emergency Department by His

question 553

Multiple Choice

A 2-year-old boy is brought to the emergency department by his grandmother due to abdominal pain and lethargy.  The grandmother reports that he was playing calmly last night when he suddenly began screaming and holding his abdomen.  The pain resolved after several minutes, but the patient has had 5 additional episodes of sudden-onset, severe pain since then.  Today, the grandmother notes that he has no interest in eating or drinking and has been "sleeping all day" but intermittently awakens in pain.  The patient has also had several episodes of nonbloody, nonbilious emesis and "fewer wet diapers than usual."  He has had no fever, diarrhea, or recent infections.  He is an otherwise healthy child with no prior hospitalizations or chronic medical conditions.  The patient takes no medications, and his immunizations are up to date.  Temperature is 37 C (98.6 F) , blood pressure is 90/56 mm Hg, pulse is 160/min, and respirations are 24/min.  During the examination, the boy is sleeping and arouses briefly.  The abdomen has hypoactive bowel sounds and diffuse mild tenderness to palpation.  He is circumcised, with both testes descended and with intact cremasteric reflexes.  Immediately after the examination, the child passes blood in his diaper, as shown in the image below. The medical team has determined the appropriate procedure.  The patient lives with his parents and his grandmother about an hour away from the hospital.  His grandmother drove him to the emergency department but is not his legal guardian.  She states, "His mom should be on the way; she probably just left the house."  However, despite multiple attempts, the medical team is unable to reach either of the patient's parents by telephone.  Which of the following is the most appropriate next step in management of this patient?

• A)Delay the procedure until informed consent is obtained from both the mother and the father
• B)Delay the procedure until informed consent is obtained from either the mother or the father
• C)Proceed with the procedure after the grandmother provides informed consent
• D)Proceed with the procedure after the patient provides informed consent
• E)Proceed with the procedure without informed consent

Recognize the adaptive and maladaptive aspects of cultural practices.

Define culture in terms of its organizational and functional aspects.

Identify instances of cultural and social phenomena such as vigilante groups and body modification.

Acknowledge the importance of culture for human survival and its learned aspect.

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Definitions:

Nonverbal

Communication without using spoken language, including gestures, facial expressions, body language, and other visual cues.

Transactional Model

A communication framework suggesting that interactions are simultaneous and reciprocal among communicators.

Stimulated

The state of being aroused, activated, or energized by external or internal factors.

Motivated

Having a driving desire or willingness to take action towards a goal or objective.