NURS 6541 Week 2: Infants, Toddlers and Preschoolers

NURS 6541 Week 2: Infants, Toddlers and Preschoolers

NURS 6541 Week 2: Infants, Toddlers and Preschoolers

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NURS 6541: Primary Care of Adolescents and Children | Week 2

While every child develops a little differently, most infants, toddlers, and preschoolers meet the same basic growth and development milestones. When milestones are not met, it is often a sign of an underlying health issue. Consider Maddie’s story. In early infancy, she successfully met each of the expected growth and development milestones and was even able to roll over by her 6th month. However, at 9 months, she suddenly stopped developing normally. She quit babbling and did not learn how to crawl until she was 15 months old. Maddie did not start walking until age 3, and at age 4, she was still being spoon-fed with baby food. In Maddie’s case, growth and development milestones were not met because of autism (Autism Society, 2011). As an advanced practice nurse, you must be able to identify signs of abnormal growth and development in patients like Maddie. Whether you facilitate treatment for these patients or refer them for specialized care, it is essential to offer support and guidance to these patients and their families. NURS 6541 Week 2: Infants, Toddlers and Preschoolers.

This week you examine normal and abnormal growth and development in infants, toddlers, and preschoolers. You also explore developmental red flags and assessment and management tools for these age groups. NURS 6541 Week 2: Infants, Toddlers and Preschoolers

Learning Objectives for NURS 6541 Week 2: Infants, Toddlers and Preschoolers

By the end of this week, students will:

• Assess patients for developmental red flags of abnormal development
• Analyze the stages of physical, social, and cognitive development for infants, toddlers, and preschoolers. NURS 6541 Week 2: Infants, Toddlers and Preschoolers
• Differentiate between normal and abnormal growth and development of infants, toddlers, and preschoolers
• Evaluate assessment and management tools, guidelines, and strategies for infants, toddlers, and preschoolers. NURS 6541 Week 2: Infants, Toddlers and Preschoolers.

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Discussion: Developmental Red Flags

Wellness visits are an important part of pediatric primary care. During these visits, patient growth and development are assessed. As an advanced practice nurse who performs these assessments, you must be able to distinguish between normal and abnormal growth and development to recognize red flags. While some patients may not meet milestones due to differences in rates of development, abnormal development might also be a red flag of an underlying problem. In this Discussion, you examine the following case studies and consider potential developmental red flags.

Discussion board posting assignments are assigned alphabetically by FIRST NAME to ensure all cases are covered and discussed.

• Case Study 1: A-F
• Case Study 2: G-M
• Case Study 3: N-Z

Case Study 1

A mother brings in her 16-month-old, Brittany, for treatment of an acute illness. During the history, the mother reports that her mother-in-law is concerned about the toddler’s development. Further questioning reveals the following:

• Brittany was a term infant born vaginally with no intrapartum complications. Birth weight was 8 pounds 1 ounce and current weight is 26 pounds 9 ounces.
• She was breastfed until 12 months of age and now drinks 24 ounces of whole milk and eats table foods daily.
• Physical milestones are as follows: Rolled front to back at 6 months, developed pincer grasp at 11 months, crawled at 8 months, and began cruising at 10 months. She does not walk independently.
• Social development includes mimicking adult behavior, four-word vocabulary (mama, dada, baba, and no), follows one-step commands, and quiets easily when comforted.

Case Study 2:

You see a 30-month-old named Brian for a well-child visit. His mother reports the following development:

• Physical: Walks independently, runs, able to climb stairs alternating feet, makes a tower of nine cubes, and is able to button his pants.
• Social: Follows one-step commands, uses one-word sentences, and has a vocabulary of approximately six words. He is resistant to nighttime and feeding routines, he has marked temper tantrums, and Mom states he does not calm when she tries to comfort him.

Case Study 3

Jose is a 36-month-old who presents for a preschool evaluation. His father reports the following development:

• Physical: Walks, runs, and jumps independently, walks up stairs alternating feet, pedals a three-wheeler, scribbles, copies circles and squares, and is able to balance on one foot for 2 to 3 seconds.
• Social: Recognizes three colors; speech is 75% understandable; uses three- to four-word sentences; talks about friends, favorite activities, and family; frequently engages in imitative play; has an imaginary friend; does stutter on occasion when excited or when intent on getting something said. Will typically repeat the first word in a sentence three to four times, but does not repeat syllables or consonants. This happens three to four times a week.

To prepare:

• Review this week’s media presentations, as well as “Developmental Management of Infants” and “Developmental Management of Toddlers and Preschoolers” in the Burns et al. text.
• Think about how physical, social, and cognitive development vary during infancy, toddlerhood, and the preschool years. Reflect on normal versus abnormal growth and development and consider the decision-making process of identifying and managing red flags of abnormal development.
• Select one of the three case studies provided. Reflect on the patient information included in the case study and consider any developmental red flags.
• Reflect on standardized screening tools, clinical guidelines, and management strategies that would be used to assess and manage the patient in your selected case study.

By Day 3

Post an explanation of the following:

1. Developmental red flags that presented on the stages of normal physical, social, and cognitive development for infants, toddlers, and preschoolers. Based on the red flags identified within the physical, social, and cognitive what additional questions should you ask? What additional examinations will you conduct?
2. Explain how you differentiated between normal and abnormal growth and development for this patient.
3. Identify which standardized screening tools, clinical guidelines, and management strategies you might use to assess and manage this patient and why.
4. Health, promotion and anticipatory guidance:
   1. Based on the child’s age, discuss which immunizations this child should have received by now?
   2. When are the next set of immunizations? Which ones should be given?
   3. When should this child return to clinic?

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in one or more of the ways listed below. Respond to colleagues who selected different case studies than you did.

• Explain any red flags that you think your colleagues may have missed.
• Explain whether you would have interpreted any of the red flags differently.
• Explain the next steps you would recommend for this patient in terms of treatment and management.
• Explain how the management plan might change if the patients in the case studies your colleagues selected were at a different age.

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NURS 6541 Week 2: Infants, Toddlers and Preschoolers

NURS 6541 Week 4 Assignment

Application – Protocol for Diagnosis, Management, and Follow-Up Care of Growth and Development and Psychosocial Issues

As pediatric patients grow from infancy to adolescence, there are many common growth and development and psychosocial issues that may potentially present. As an advanced practice nurse caring for these patients, you must be able to recognize red flags and select age-appropriate assessment and treatment options. In this Assignment, you prepare for your role in clinical settings as you design an age-specific protocol for the diagnosis, management, and follow-up care for a common growth and development or psychosocial issue.

To prepare:

• Reflect on the age group and the growth and development or psychosocial issue that you selected in Week 2. Attention-deficit/hyperactivity disorder  in preschool age children.

• Think about the epidemiology of the issue.

• Consider an age-appropriate protocol for the diagnosis, management, and follow-up care of the issue you selected.

• Think about how culture might impact the care of patients that present with this issue.

To complete:

Write a 2- to 3-page paper that addresses the following:

• Explain a growth and development or psychosocial issue that might present in the age group you selected.(Attention-deficit/hyperactivity disorder  in preschool age children). Include the epidemiology of the issue in your explanation.

• Explain an age-appropriate protocol for the diagnosis, management, and follow-up care of this issue.

• Explain how culture might impact the care of patients who present with the growth and development or psychosocial issue you selected.

Nurs 6541 Week 5 Assignment: Pharyngitis

Reflect on a patient who presented with an eye, ear, nose, or throat disorder during your Practicum experience. Describe your experience in assessing and managing the patient and his or her family. Include details of your “aha” moment in identifying the patient’s disorder. Then, explain how the experience connected your classroom studies to the real-world clinical setting. If you did not have an opportunity to evaluate a patient with this background during the last 6 weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.

My choice of topic (pharyngitis)

NURS 6541 Week 6 Discussion Diagnosis and Management of Ear, Nose and Throat Disorders

Discussion: Diagnosis and Management of Eye, Ear, Nose, and Throat Disorders

In clinical settings, eye, ear, nose, and throat (EENT) disorders account for the majority of pediatric visits. With the prevalence of these disorders, you must be familiar with their signs and symptoms as well as evidence-based practices for assessment and treatment. Although many pediatric patients present with common EENT disorders such as ear infections, allergies, and strep throat, some patients present with rare disorders requiring specialist care. In your role, making this distinction between when to treat and when to refer is essential. For this Discussion, examine the following case studies and consider potential diagnoses and management strategies.

Case Study 1

A mother presents with her 2-year-old child with complaints of ear pain and decreased sleep. Earlier this week, he had a runny nose and congestion with a mild cough that occurred mostly when lying down. His temperature is 100.7°F. You note the following physical findings: shotty anterior cervical adenopathy, mild nasal congestion, clear postnasal drainage, and lungs clear to auscultation. Ear examination reveals the following: right tympanic membrane is red, translucent, in a neutral position, with no pus or fluid noted; left tympanic membrane is full, reddish orange in appearance, and opaque with pus.

Case Study 2

Kaitlyn is a 4-year-old with a 2-day history of nasal congestion and cough in the early morning. Her mother reports thick, green nasal discharge. She is afebrile, and appetite and sleep are normal. Physical examination reveals: lungs clear to auscultation, tympanic membranes pearly gray without fluid in a neutral position, no cervical adenopathy, nasal turbinates are red, and clear rhinorrhea and postnasal drip.

Case Study 3

Marcus is an 8-year-old with a 36-hour complaint of headache (frontal), sore throat, fever to 102°F, and nausea. Mom says his appetite is decreased and his breath smells ?like a puppy dog?s.? Physical examination reveals: lungs clear to auscultation, tympanic membranes partially obscured by cerumen but in neutral position and transparent, enlarged tonsilar and anterior cervical lymph nodes, 2+ enlarged and red tonsils with exudate, strawberry tongue, and petechiae on the soft palate.

To prepare:

·        Review ?Eye Disorders? and ?Ear Disorders? in the Burns et al. text.

·        Review and select one of the three case studies. Analyze the patient information, including the parent?s perspective.

·        Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

·        Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.

·        Consider strategies for educating parents on the child?s disorder and reducing any concerns/fears presented in the case study.

Post at least 200 words ( no introduction or conclusion)

1.     an explanation of the differential diagnosis for the patient in the case study you selected.

2.      Explain which is the most likely diagnosis for the patient and why.

3.     Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis.

4.     Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments.

5.      Finally, explain strategies for educating parents on their child?s disorder and reducing any concerns/fears presented in the case study.

NURS 6541 Week 7 SOAP Note

HPI: 7-year old female fully immunized with complaints of bilateral ear pain for the past two days. The patient had rhinorrhea, nasal congestion, and cough for one week that seemed to have resolved 3 days ago. The patient was afebrile during this illness. Yesterday and today child was febrile as high as 102.5. The mother states that she has been alternating Tylenol and Motrin for pain control. The child has been more tired than usual all day today. Patient did not sleep well last night was up complaining of ear pain in both ears. No change in eating or elimination patterns. No sick contacts.

PMH:

NURS 6541 Week 8 Journal Hematologic and Metabolic Disorders

Hematologic and Metabolic Disorders

?In week 5 of clinical I had the opportunity to examine a patient with congenital adrenal hypothyroidism. This patient was a male and was 11 years old.

Assignment: Practicum ? Journal Entry

Reflect on a patient who presented with a hematologic or metabolic disorder during your Practicum experience. Describe your experience in assessing and managing the patient and his or her family. Include details of your ?aha? moment in identifying the patient?s disorder. Then, explain how the experience connected your classroom studies to the real-world clinical setting. If you did not have an opportunity to evaluate a patient with this background during the last 8 weeks, you may select a related case study from a reputable source or reflect on previous clinical experiences.

NURS 6541 Week 9 Journal Gastrointestinal Disorders

Gastrointestinal Disorders

?During this practicum, I had the opportunity to see a 7-year-old male patient previously diagnosed with encopresis. Now, the child was in the office for a 6 month..

Paper details:

To prepare:

•Review this week’s media presentations and Part 12 of the Buttaro et al. text in the Learning Resources.
•Select one of the three case studies listed above. Reflect on the provided patient information including history and physical exams.
•Think about a differential diagnosis. Consider the role the patient history and physical exam played in diagnosis.
•Reflect on potential treatment options based on your diagnosis.

In primary care settings, patients often present with abdominal pain. Although this is frequently a sign of a gastrointestinal (GI) disorder, abdominal pain could also be the result of other systemic disorders, making this type of pain difficult to assess. While abdominal pain is most common, many other GI symptoms also overlap multiple disorders, further increasing the difficulty in diagnosing and treating patients. This makes provider-patient communication essential. You must be able to formulate questions that will prompt the patient to provide the necessary information, as this will guide your assessment and diagnosis. For this Discussion,1. consider potential diagnoses for the patients in the following case studies

2.an explanation of the differential diagnosis for the patient in the case study that you selected.

3.Describe the role the patient history and physical exam played in the diagnosis. 4.Then, suggest potential treatment options based on your patient diagnosis.

Case Study 3:

A 52-year-old male presents to the office for a routine physical. The review of symptoms reveals anorexia, heartburn, and weight loss over the past 6 months. The heartburn is long standing, occurring most days during the week. He takes TUMS or Rolaids to relieve the discomfort. The patient describes occasional use of ibuprofen for back pain, but denies other medications including herbals. He has no known allergies. He was adopted so does not know his family history. Social history reveals that, although he stopped smoking ten years ago, he smoked for 20 years. He occasionally consumes alcohol on the weekends only. The only positive physical exam finding for this patient was slight epigastric tenderness. The remainder of his exam was negative and the rectal exam was negative for blood
Resources

Learning Resources

This page contains the Learning Resources for this week. Be sure to scroll down the page to see all of this week’s assigned Learning Resources. To access select media resources, please use the media players below.

Required Resources

Readings

• Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2013). Primary care: A collaborative practice (4th ed.). St. Louis, MO: Mosby. Part 12, “Evaluation and Management of Gastrointestinal Disorders” (pp. 612–722)

This part examines the pathophysiology and clinical presentation of several GI disorders. It also describes diagnostic criteria, differential diagnosis, and management methods for GI disorders.
Part 20, “Evaluation and Management of Infectious Disease” Chapter 234, “Infectious Diarrhea” (pp. 1263–1271)

This chapter describes characteristics of three types of infectious diarrhea and identifies the pathophysiology, clinical presentation, treatment options, and possible causes of the disorder.
www.waldenu.edu

This is example of format of paper

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Building a Health History

Since the first meeting with any patient sets the tone for a successful patient provider collaboration and partnership I would ensure the clinical atmosphere was physically unencumbered and with a comfortable atmosphere. My client is a 76-year-old African-American male with disabilities living in an urban setting. I would first introduce myself with an extended hand and ask my patient how he would like to be addressed (Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W., 2015). As an active listener and in consideration of my patient’s age, gender, and ethnicity, I would formulate my questions in a respectful, nonjudgmental, and open-ended manner. I would begin with the patient’s explanation as to the reason for his visit or his chief complaint. I would then gather the patient’s current and past medical history, family history, psychological history, social history, review of systems, and then physical examination (Sullivan, D. D., 2012).

Explanation of Techniques Utilized

It is important that there are no physical obstacles between the patient and me, for the purpose of good eye contact and so he will know that I am actively listening to his concerns. A comfortable and uncluttered atmosphere will help the patient to relax and feel at ease (Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W., 2015). The formulation of my questions would give my patient the latitude and room for explanation.

Risk Assessment Instruments Their Justify the Applicability

The risk assessment tools that I would utilize are the TACE assessment tool and the geriatric functional assessment tool (functional impairment, gait instability, cognitive impairment, and major depressive illness). The TACE questionnaire will give me an indication of what additional labs I will need to order and additional patient education to be completed (Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W., 2015). Since my patient is in the geriatric age group, he is at increased risk for physical and cognitive impairment. Approximately 75% of persons over the age of 75 have decreased functional impairment and are at greater risk for falls, injury, illness, hospitalization, and nursing home placement. Although cognitive impairment for age 65 and older is roughly, only about 3%, cognitive testing it should not be ruled out because this often goes undiagnosed and must be ruled out and patients with suspected cognitive impairment should be screened for delirium and depression (University of Michigan Medical School, 2003).

Provide At Least Five Targeted Questions

1.Do you live with
2.How often do you forget to take your medication
3.How has this problem effected your everyday life
4.How often do you leave your home weekly
5.Are there stairs in your home
6.How many times have you fallen in the last 12 months
7.Do you have close family or friends
8.What other concerns do you have

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to

physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.

University of Michigan Medical School. (2003). Geriatric functional assessment. Retrieved from

http://www.med.umich.edu/lrc/coursepages/m1/HGD/GeriatricFunctionalAssess.pdf

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NURS 6541 Week 10 SOAP

CHIEF COMPLAINT: Sore throat

SUBJECTIVE

OBJECTIVE

ASSESSMENT: (Primary diagnosis)

DIFFERENTIAL DIAGNOSIS:

PLAN:

REFLECTION NOTES:

Practicum – Journal Entry

Reflect on your Practicum experience and the patients you have seen and the disorders that you have diagnosed and treated. Review your Journal Entry that you submitted in Week 1.

By Day 7 of Week 10, write a Journal Entry that includes responses to the following:

Explain what most excited and/or concerned you throughout your pediatric clinical experience.

Discuss how your personal definition of family and family roles has changed or stayed the same.

How has your understanding of family and family roles influenced your assessment of children and their families?

Explain how your understanding of culture (both the culture of the provider and that of the child and his or her family) has changed and how it may have influenced the assessments you conducted during your practicum.

Assess how you did with accomplishing the goals and objectives you developed in Week 1 for the Practicum experience.

Based on your Practicum experience, refine your existing goals and/or develop new goals for your continued education and professional practice. Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice Found in the Week 1 Learning Resources.

Submission and Grading Information

To submit your completed Assignment for review and grading, do the following:

Please save your Assignment using the following naming convention: “WK10Assgn+lastname+first initial”.

Click the Week 1 Assignment link.

Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK10Assgn+last name+first initial.(extension)” and click Open. If you are submitting multiple files, repeat until all files are attached.

Click on the Submit button to complete your submission.