Tutorial 10: Case 2

Question 1

Mona walks in carrying her young child asking for something to help with her children sleeping at night. Mona asks: “Can you give me something to help my children, please? They haven’t been sleeping well at night lately.

A) Who is it for? How old are they?

B) What are the symptoms?

C) How long have you had these symptoms?

D) Action taken

E) Medications being taken?

F) Medical conditions

G) Allergies

Answer 1

A) My three children; they are 2,5 and 7 years old

B) They are constantly waking in the night and have mentioned about itchy bottoms

C) Over the last week or so

D) I tried giving them warm milk before bed, but it is not helping. Also tried applying clotrimazole cream but that didn’t help either.

E) Occasional paracetamol or ibrupofen if needed

F) None of them has any medical conditions

G) 3 year old is allergic

Question 2

Appropriate extended questions

1. Are there any other symptoms
2. Have you seen anything in their bowel motion? OR are there any threadlike objects in their stool or underwear
3. Have you recently travelled overseas or to remote areas
4. How many family members are there/ how many people in the household?
5. Any unexplained weight loss? OR any change to diet or eating habits/appetite
6. Has anything changed recently? Any activities?

Answer 2

1. They have complained about itchy bottoms and they are being a bit grumpy, not sleeping well.
2. I did notice some small white bits that looked a bit like cotton in my youngest child’s nappy today. I assumed it was something she ate. Otherwise, I believe all their stools have been normal.
3. No, not for at least six months when we went to Tasmania
4. Just myself, my husband and three children
5. No, not that I have noticed.
6. My 2-year-old started daycare a couple of months ago, I was expecting a few coughs and cold, though not itchy bottoms

Question 3

What is the diagnosis? Explain reasoning to patient.

Answer 3

Based on the signs and symptoms you have told me, I believe your children have threadworm. The itchy bottoms, lack of sleep, grumpiness, white bits in your child nappy have confirmed my diagnosis. It is most likely been spread from your 2-year-old as infestations are common in school children. Unfortunately, the whole family will have to undergo treatment even though you and your husband don’t have it.

Question 4

What product would you recommend for this patient? Provide IDARL.

Answer 4

Mebendazole (combantrin-1)

• Indication: Dosing/dosage form is good (convenient). It will kill the threadworm and relieve the symptoms your children are experiencing
• Dosage and directions: Take 1 chocolate square on empty stomach (all members of the family)
• Adverse effects: generally well tolerated, may cause, stomach upset.
• Duration of treatment, time to recovery, when to refer: Repeat after 2 weeks if theadworms are still present. Itchiness may continue after treatment. Will refer if there is secondary treatment failure. (secondary bacterial infection, unusual GI symptoms, recent travel abroad for out of roleplay)
• Lifestyle/self-care: Wash toys in hot water, keep nails short and clean, clean toilet regularly.

I will give you a self care-card for threadworm (pinworm) and a consumer medication information leaflet. Do you have any questions for me?