WestCoast NURS662A 2022 November Discussions Latest (Full)

NURS662A Primary Care Pediatric Patient

Week 1 Discussion

For complete discussion board expectations, visit your syllabus as well as the grading rubric located under My Grades.

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Abeni17-year old.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

1. Abeni is a 17-year-old adolescent female who came to the United States from Nigeria two years ago with her parents. Her parents are struggling to find work, and Abeni has come to your free clinic because she has a mass on her thyroid. Her mother is accompanying her and she is very worried. Her mother does not speak English and Abeni has a heavy accent, but you can understand almost everything she says.

What key aspects of the child and family health assessment, history, and physical exam should the APRN focus on?

What tests should the APRN order for this visit and why?

What specific questions demonstrate that the APRN understands cultural humility and competence?

2. Nabil is a 3-year-old boy who has recently come to the United States as a refugee from Syria with his parents. He is in the clinic today for an initial health visit, screening, and assessment.

What specific health and psychosocial needs should the APRN address with Nabil and his family?

What key aspects of the family health assessment, history, and physical exam should the APRN focus on?

What specific questions demonstrate that the APRN understands cultural humility and competence?

3. John is a 16-year-old male who has come into the clinic for a complete physical exam. Two years ago, he was placed in foster care, but he has recently moved into his paternal grandfather’s home. During this visit, you will perform an adolescent health history.

What key elements specific to the adolescent history and physical exam should the APRN utilize?

What elements of the basic family assessment should the  APRN consider and why?

What strategies should the APRN utilize to develop trust and establish confidentiality during John’s history and physical exam?

 

NURS662A Primary Care Pediatric Patient

Week 2 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Abeni17-year old.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

1. Ms. Hernandez brought in her son Matthew for his 2-year-old well-child visit. The mother is concerned because although Matthew says “Ma” for mom and “ba” for bottle, he mostly gestures and points when he tries to communicate his needs.

What type of screening tool(s) should the APRN use to assess Matthew’s language and social delay and why?

What potential risk factors (e.g., prenatal, pregnancy, neonatal) could place Matthew at risk for language/social delay?

What type of anticipatory guidance should the APRN provide to support Matthew’s communication and language development?

2.  Mr. Jones has brought in his son Johnny for a 15-month-old well-child visit, and his biggest concern is that his son does not walk yet. You note that in his electronic medical record, he was born at 35 weeks’ gestation via emergency C-section and was discharged 2 weeks later.

What fine motor and gross motor skills should the APRN expect a 15-month-old toddler to perform? Should Matthew be able to perform those skills as well? Why or why not?

What type of screening test(s) should the APRN utilize to assess Matthew’s current motor skills?

What type of anticipatory guidance and support should the APRN provide to monitor and encourage Matthew’s continued physical development?

 3. Rebecca is 7 years old and has refused to go to school for the past 3 days. Rebecca’s mother has brought her in to be evaluated. You note on her medical record that Rebecca had to repeat the first grade.

What additional history does the APRN need to gain a better understanding of Rebecca’s school refusal?

What testing should the APRN perform/order and why?

What should the APRN consider as developmental red flags for Rebecca?

 

NURS662A Primary Care Pediatric Patient

Week 3 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Abeni17-year old.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

1. Mandy is a 10-year-old girl brought in by her mother for evaluation of a “high fever.” Her mother has been giving her acetaminophen every 4 hours and asks if she should also give her ibuprofen for her fever. On exam, you note that Mandy weighs 70 pounds and has an oral temperature of 101°F and a slight runny nose and moist cough. She is not in distress and appears non-toxic.

What more should the APRN know about Mandy’s symptoms and fever?

What type of anticipatory guidance should the APRN share with the mother on pharmacological and nonpharmacological management of fever? Include dosage and instructions for administration.

What symptoms or behaviors would exclude Mandy from attending school?

2.  Rebecca is a 13-year-old who is brought into the clinic today for a cough and runny nose for 2 days. You diagnose her with a mild upper respiratory infection. However, you are most concerned that her BMI is greater than 95%.

What information should the APRN include in her history to address Rebecca’s obesity?

What diagnostic tests should the APRN order?

What type of anticipatory guidance should the APRN offer Rebecca and her mother?

3. Robert is a 7-year-old boy who weighs 50 pounds. He is frequently teased because he soils his pants at school and he is known as the “stinky kid.” His mother states that he has been doing this for the past 8 months. She brought him into the clinic because she thinks he may have an intestinal infection. She also reports that once a week he has very large bowel movements that completely clog the toilet.

What more does the APRN need to know about Robert’s bowel problems?

What type of diagnostic testing should the APRN order?

What treatment plan should the APRN prescribe and what is the rationale for this treatment? Include dosages and administration instructions if appropriate.

 

NURS662A Primary Care Pediatric Patient

Week 4 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Abeni17-year old.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

1. Maria is a 7-month-old baby who was brought into the clinic by her grandmother. She has had a fever for 3 days, up to 102.5°F. So far today, Maria has not had a fever, but she now has a rash all over her body. She is taking her bottle well and has a slight runny nose. Her weight today is 18 pounds.

What else does the APRN need to know about baby Maria’s symptoms and current rash?

What labs might the APRN order?

What type of anticipatory guidance should the APRN give the grandmother? What dosage should the baby have received of Tylenol or Motrin? Include dosages and administration instructions.

2. A first-grade teacher has asked Ms. Jantz to bring in her 6-year-old son Brad to be evaluated. The mother states that her son’s teacher complains that he is easily distracted, plays with his school supplies while he is trying to teach, and frequently gets out of his seat without permission.

What more s know about Brad’s history?

What type of screening and/or diagnostic tests should the APRN order for Brad?

What strategies should the APRN recommend to help Brad to cope with his distractibility?

3.  Ms. So has brought in her 12-month-old daughter because she has had a runny nose for 2 days and has a “fever” of 99° F. After reviewing her immunization records, you note that she has not received any immunizations since her 4-month well-infant exam.

What are contraindications for vaccinating this toddler today?

What vaccinations should the APRN order for this toddler today?

What type of anticipatory guidance should the APRN provide for Ms. So regarding vaccine scheduling?

 

NURS662A Primary Care Pediatric Patient

Week 5 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Abeni17-year old.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

1. Brenda is 17-year-old who has come to the clinic because she has had a yellow-green discharge in her right eye for 3 days. Today when she woke up, her right eye was swollen, red, and tender. She denies fever.

What should you ask Brenda about her eye?

What type of exam(s) should you perform on Brenda’s eye?

What oral antibiotic and follow-up should you order for Brenda? Include rationale, dosage, and instructions.

2. Cindy is a 30-pound, 3-year-old who was brought into the clinic today by her father for bilateral ear pain and eye discharge for 2 days. She has a fever of 102°F and looks uncomfortable.

What single organism is most likely affecting both Cindy’s eyes and ears? Explain why this is so.

What is the first-line antibiotic choice for this condition? Provide dosage(s) and instructions.

What type of anticipatory guidance should the APRN provide?

3. Mr. and Mrs. Corrigan have brought in their 4-day-old infant boy for a newborn exam. The mother and father are concerned that their baby seems to be crying excessively and appears to be “hungry all the time.” The mother reports that she exclusively breastfeeds her infant. The infant is measured and weighed; you estimate that he has lost 5% of his birth weight.

What should the APRN tell the parents about the baby’s 5% weight loss and crying?

How many wet and soiled diapers should the baby have at 4 days old?

What more should the APRN know about the baby–mother dyad breastfeeding experience?

 

NURS662A Primary Care Pediatric Patient

Week 6 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Abeni17-year old.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

1. Joey is a 4-year-old male brought into the clinic because he ran into another classmate while playing in the preschool playground. His mother was called to pick him up, and she reports that his mouth was bleeding a lot and his front two teeth appear to be loose. His vital signs are within normal limits and his weight today is 40 pounds.

What additional information does the APRN need to appropriately treat Joey?

What type of treatment does Joey need for his loose teeth?

What should the APRN make sure to include in her physical examination?

What can he have for pain? Please include dosage and instructions you will provide.

2. Freddy is a 3-year-old brought into the clinic by her mother’s fiancé, Mac. According to Mac, Freddy was running around in his living room when he fell and hit his mouth against the coffee table. Freddy’s tongue is still bleeding a bit and his lower lip is very swollen.

What additional information does the NP need to know to appropriately treat Freddy?

What immediate treatment does Freddy need for his tongue laceration and swollen lip and how should the APRN determine if an immediate referral is needed?

What steps would the APRN take if he/she suspected abuse?

3. Tommy is a 3-year-old who has been waking up in the middle of the night screaming, once a week for the past month. His parents are concerned that there is something seriously wrong with him. After a couple of minutes of screaming, he goes back to sleep and does not seem to remember what happened the night before.

What else should the APRN know about Tommy’s episodes?

What should the APRN tell Tommy’s parents about his condition?

What advice should the APRN give his parents regarding how to handle these episodes?

 

NURS662A Primary Care Pediatric Patient

Week 7 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Abeni17-year old.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

1.  Lindsey is an 8-year-old female brought into the clinic today for an evaluation of a “bad cough” for 2 weeks. Her vital signs are the following: Temperature 98.6° F, HR: 80, RR: 24, BP 110/50, Pulse Ox: 95%. She is alert and does not appear to be in distress. On exam, you note that she has inspiratory and expiratory wheezes and mild tracheal retractions.

What more does the APRN need to know about this child?

What treatment(s) should the APRN provide in clinic today and why?

What diagnostic tests should the APRN order today and why?

2.  Sara is a 14-year-old brought into the clinic for an “annoying cough” for the past 4 weeks. The cough is worse at night, but is present during the day as well. Her mother reports no fever and no other symptoms, but states that Sara appears a little tired because she is not able to sleep well at night due to her coughing. No one else in the family has had a cough.

What more does the APRN need to know about Sara’s condition?

What should the APRN focus on during the physical examination?

What tests might the APRN order and/or anticipatory guidance regarding Sara’s condition?

3. Lucy has come in for her annual well-child visit. Lucy enjoys preschool, she has been a healthy child, and she is at the 50% for height and weight. On exam, you note a Grade III/VI, mid-systolic murmur, heard best in the left sternal border.

What additional information should the APRN know about Lucy?

What tests should the APRN order?

What should the APRN specifically include in the cardiac physical examination?

 

NURS662A Primary Care Pediatric Patient

Week 8 Discussion

Select one of the following case studies to address. In the subject line of your post, please identify which prompt you are responding to, for example, #1 Abeni17-year old.

Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals, and other team members needed to complete patient care.

Use at least one scholarly source other than your textbook to connect your response to national guidelines and evidence-based research in support of your ideas.

In your peer replies, please reply to at least one peer who chose a different case study.

1.  Mr. Johnson has brought in his 3-year-old daughter Clara to be seen for vomiting and diarrhea for 2 days. He states that last night she vomited 3 times. This morning she vomited her breakfast of pancakes and sausage.

What more does the APRN need to know about Clara’s symptoms?

What should the APRN look for in the physical examination?

What type of anticipatory guidance should the APRN give Clara’s father?

2.  Mark is a 5-year-old male who was brought into the clinic today for a well-child exam. His mother reports that she is concerned that Mark wets his bed at night 3 to 4 times per week. She is at her wit’s end and does not know what to do.

What more does the APRN need to know about Mark’s condition?

What are some of the possible causes for Mark’s condition?

What strategies should the APRN share with Mark’s mother to help him stay dry at night?

3.  Chelsie was brought into the clinic by her mother with a fever of 102.7°F and pain with urination for 2 days.

What else does the APRN need to know about Chelsie’s symptoms?

What tests should the APRN order today?

Under what circumstances would Chelsie need additional diagnostic testing?

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