Arizona State University NUR NUR 452 A 9 year-old boy presents to the office with a 4 day history of nose bleeds and frank blood in his stool. There has been no significant trauma. Mom…

Arizona State University NUR NUR 452 A 9 year-old boy presents to the office with a 4 day history of nose bleeds and frank blood in his stool. There has been no significant trauma. Mom…

A 9 year-old boy presents to the office with a 4 day history of nose

bleeds and frank blood in his stool. There has been no significant trauma. Mom states he has been known to pick his nose. The patient has no significant medical hx. He was born full term, never been hospitalized, is fully immunized.  Pt attends 4th grade and receives average grades. No behavior problems. “Good” eater, eats a varied diet that includes minimal fast foods or junk food.
FMHX: Mom denies significant problems in childhood for any family members. Denies autoimmune diseases in family members.
HR140, BP: 110/85, Resp 25 breaths/min, Temp 95.
Observation: Pale, but well-nourished male, appears well
HEENT: Head & ears atraumatic, Landmarks visualized on bilateral TMs, no hemotympanum, dried blood in both nares, no active bleeding at this time.
Resp: Regular rate and rhythm, no adventitious sounds
Cardiac: Tachycardia, normal rhythm, S1& S2, +2/5 holosystolic murmur
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