I just wrote out a medical plan for school and I am kind of realizing why I am having some panic. The reality is logan will be fine:) The reality is usually there is a warning and he would be home if he has any of these complications. The reality is that as long as they call me, I can take care of Mr. Logan:) Plus, I think once you know Logan his medical stuff isnt that scary:) The reality is God has Logan in his hands :) The hard part is I dont want to overwhelm them, but I think they need to have the knowledge. So here it is- any suggestions would be appreciated:) Medical Plan for Logan Bergacker If Concerned for any reason call parents Phone numbers: Tracy Bergacker- cell listed Aaron Bergacker- cell listed Diagnosis- Heart condition- Tricuspid Atresia Symptoms- shortness of breath, blue in color- finger nails, lips, inside mouth Check pulse ox, if below 73, administer oxygen, call parent (remember sometimes it takes a few minutes for pulse ox monitor to pick up properly, remember if Logan is walking or active, it can take a few minutes for his oxygen to return to his normal range) Above 73, watch, if still concerned contact parent. _________________________________________________________ Diagnosis- Asthma symptoms- cause aspiration or illness Symptoms- shortness of breath, wheezing, blue in color Check pulse ox- give albuterol inhaler, recheck pulse ox. If pulse ox below 73, administer o2, call parent. Above 73, watch, when breathing improves return to class _________________________________________________________ Diagnosis- Temperature control issues- overheating Symptoms- skin warm or hot to the touch, high heart rate, face flushed or red Cool down with ice pack, give water via g-tube. Check pulse ox- often oxygen drops when heart has to work harder. Administer 02 if needed. Contact parent if Logan doesn’t cool down quickly. Could be an actual fever- Logan can have high fevers with no other symptoms. _________________________________________________________ Diagnosis- Stomach pain – can be an excuse Symptoms- Logan says his stomach hurts, laying down Stomach pain usually means he needs to stool. Hopefully it will improve as we change diet back to gluten free. If the pain persists, give extra fluid, call parent _________________________________________________________ Diagnosis- Low/High blood sugar Symptoms- irritated, no energy, falls asleep. Highs are usually after he has had high sugar foods. Lows are very infrequent. Check blood sugar- if above 200, give extra water, call parent. If below ______, give apple juice via g-tube, recheck sugar in 20 minutes, call parent. _________________________________________________________ Diagnosis- Portal vein thrombosis- varices in esophagus, bleeding internally Symptoms- sluggish, no energy, black stool (I realize you may not see), vomiting blood (Logan has a Nissan, therefore vomiting would be rare) Call parent immediately, monitor vitals- oxygen, breathing Diagnoses, Medications, Surgeries for Logan Bergacker Cardiology- Dr. Vitullo- Ann & Robert Lurie Children’s Hospital of Chicago Tricuspid Atresia- Oxygen is between 75- 85 at rest. After physical movement allow time for oxygen to return to normal. Logan is encouraged to participate as much as possible. Allow him to self-monitor. Allow him to use a stroller/wheelchair for transport when necessary. (Normally for tricuspid atresia a 3rd surgery the fontan is done which improves oxygen- this is not an option for Logan at this time) Surgery- Open heart surgery- BT shunt, Open heart surgery- Glenn Medications- Lasix- 1ml- nightly Hepatology- Dr. Bass- Ann & Robert Lurie Children’s Hospital of Chicago Portal Vein Thrombosis- Logan has a blood clot in both his portal vein and splenic vein. This means that blood flow does not get to liver and spleen typically. Logan’s body has created collaterals (smaller vessels) to bypass the clots and still get some blood flow to his both liver and spleen. The complications we see- varices (enlarged blood vessels that could erupt) in his esophagus, stomach, and colon. The varices going into the stomach have been removed via suguira procedure, but this means there is little blood flow going into his stomach. The varices in his esophagus have been treated using sclerotherapy- basically injecting them with a chemical. He currently (8/15/14) has a couple grade 2 varices. The other complications are that Logan’s liver and spleen are enlarged and that his stomach is distended. Surgery- Suguira procedure, endoscopy’s Gastrointestinal- Dr. Bass- Ann & Robert Lurie Children’s Hospital of Chicago Reflux- Nissan (prevents Logan from vomiting) G-tube Inflamed stomach and intestines- cause can be lower blood flow to stomach. Just tested for celiac (8/16/14) frequent stomach pain. Iron deficiency Both loose stools and constipation are typical for Logan. He stools 6-10 times a day. Surgery- Nissan, g-tube placed Medications- Prevacid- morning, Pentasa- morning, probiotics- morning, Iron- 2ml- morning Pulmonology- Dr. Nevin- Ann & Robert Lurie Children’s Hospital of Chicago Aspiration of liquids- cause could be a combination of paralyzed vocal cord and neurological. Swallow studies show that drinking thickened liquids is safe. However, after years of respiratory infections with frequent hospitalizations, we did a trial via pulmonology of no liquid and Logan was healthiest he had ever been. The thinnest “liquid” Logan “drinks” is applesauce thickened with rice flour. It is about the thickness of pudding. If the class is doing ice-cream for a party, I am happy to make Logan “ice-cream” thickened with rice flour. Medications- pulmacourt nebulizer daily, albuterol- as needed ENT- Dr. Schroeder- Ann & Robert Lurie Children’s Hospital of Chicago Frequent ear infections- Logan just got his 10th set of ear tubes (8/15/14). His ear drum is retracted with pockets. We are going to be meeting with a surgeon to discuss possible reconstructive surgery. Surgery- Ear tubes Audiology- Rebecca Salt- Ann & Robert Lurie Children’s Hospital of Chicago Hearing loss- wears hearing aids. – left ear is small in size Ophthalmology- Dr. Rahmani- Ann & Robert Lurie Children’s Hospital of Chicago Optic dysplasia in right eye. The right eye does not function. Basically the optic nerve is split. So it is like a tv plugged in, but the cord is cut. Logan compensates well. He has minor vision loss in his left eye. Glasses are worn mostly for protection of the right eye. Allergy/Immunology- Dr. Fuleihan- Ann & Robert Lurie Children’s Hospital of Chicago Immune deficiency- Logan has had low T- cells. Logan gets sick easily. He does not carry the antibodies for vaccinations given. If any major illnesses are known in the classroom environment, please inform the parents. Encourage frequent hand washing like you do for all children. Allergy to milk and soy. Epi pen for milk allergy. GI issues with soy allergy. Medications- Epi-pen, Benadryl as needed Endocrinology- Dr. Miller- Ann & Robert Lurie Children’s Hospital of Chicago Osteopenia- Logan’s bone density is low. He can break his bones easily. Please watch him closely on the playground. Blood sugar regulation. Logan’s body doesn’t always regulate blood sugar appropriately. He can have both hyper and hypo glycemia Growth hormone deficiency Medications- Acarbose- ½ tablet (12.5 mg)- morning and night, Vitamin D, growth hormone injections- 0.6 Genetics- Dr. Burton- Ann & Robert Lurie Children’s Hospital of Chicago Kallman’s syndrome- effects reproductive organs and puberty- no current symptoms Inverted 12th chromosome Orthopedic- Dr. Bueche- Dupage Medical Group (M &M orthopedics) Dentist- Dr. Dave- Small Smiles Pediatrician- Dr. Kovar, Dr. Liberty, or Dr. Ciszek- Kids First in Plainfield Neurology- Dr. Ritacco- released- Ann & Robert Lurie Children’s Hospital of Chicago Abnormal MRI- according to neurologist, MRI is consistent with children with heart conditions. Temperature control- Logan can get both over-heated even in just a warm environment. Logan has a cooling vest for hot days. He is not consistent with temperature regulation. Therefore, one day he is fine at 90 degrees and another day, he overheats at 80 degrees. Just watch for symptoms. If he is having shortness of breath and is warm, he could just be overheating. He also falls asleep when he overheats. Breathing can be effected when he gets too hot. He also gets cold easily (looks blue, but not breathing related). Hematology- Dr. Bhat- released- Ann & Robert Lurie Children’s Hospital of Chicago Logan has had several blood clots- DVT in his leg, blood clot from picc line in his upper arm, plus the portal vein thrombosis. The symptoms of a blood clot are painful swelling. Logan does not have a diagnosed clotting disorder.
Posted on: Sat, 16 Aug 2014 22:14:31 +0000
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