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NR 602: PRIMARY CARE OF THE
CHILDBEARING & CHILDREARING FAMILY
PRACTICUM WEEK 3 I-HUMAN CASE STUDY –
COMPLETE GUIDE VERIFIED ANSWERS | A+
RATED | PEDIATRIC PRIMARY CARE
**Case Type:** Well-child / Acute complaint
**Age:** 18 months
**Sex:** Female
**Chief Complaint:** *“My daughter has had a fever and pulling at her
ears for the past 3 days.”*
**Setting:** Primary care outpatient clinic (Nurse Practitioner
practicum)
## SECTION 1 – CHIEF COMPLAINT & HISTORY OF PRESENT
ILLNESS (HPI)
### Chief Complaint (CC)
> *“My daughter has had a fever and keeps pulling at her ears for the
past 3 days.”*
### History of Present Illness (HPI) – Key Information to Elicit
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| Question | Expected Answer | Clinical Significance |
|----------|----------------|----------------------|
| **Child’s age** | 18 months | High-risk age for acute otitis media
(AOM) |
| **When did symptoms start?** | 3 days ago | Acute onset |
| **Fever: highest temperature?** | 102°F (38.9°C) measured rectally |
Fever supports infectious process |
| **Ear pulling: constant or intermittent?** | Intermittent, worse when
lying down and at night | Eustachian tube dysfunction worsens supine |
| **Is the child sleeping more than usual?** | Yes, sleeping more and
fussy when awake | Irritability + lethargy → possible pain/infection |
| **Is the child eating/drinking normally?** | Decreased appetite; taking
small amounts of liquid, refusing solids | Pain with chewing/swallowing
|
| **Any ear drainage?** | No drainage noted (parent denies) | No
tympanic membrane perforation (likely) |
| **Any recent upper respiratory symptoms?** | Yes – runny nose and
mild cough started 5 days ago | Viral URI → Eustachian tube
dysfunction → AOM |
| **Any vomiting or diarrhea?** | No | Reduces likelihood of
gastroenteritis |
| **Any known sick contacts?** | Older sibling (age 4) had cold last
week | Viral exposure |
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| **Daycare attendance?** | Yes – attends daycare 3 days/week |
Increased risk for viral/bacterial infections |
| **Any medication tried?** | Acetaminophen (Tylenol) – helps fever
temporarily, but child still fussy | Partial response; no antibiotics yet |
| **Any allergies to medications?** | No known drug allergies |
Important for prescribing |
| **Has the child had ear infections before?** | Yes – one prior episode
of AOM at age 12 months | Recurrent AOM risk |
---
## SECTION 2 – REVIEW OF SYSTEMS (ROS)
| System | Findings |
|--------|----------|
| **General** | Fussy, increased sleeping, decreased activity |
| **HEENT** | Runny nose (clear to white mucus); tugging at ears; no
discharge from ears; no eye redness |
| **Respiratory** | Mild cough (dry), no wheeze, no retractions |
| **Cardiovascular** | No cyanosis, no known murmur |
| **Gastrointestinal** | Decreased appetite; no vomiting, no diarrhea;
normal stool (formed) |
| **Genitourinary** | Normal wet diapers (4–5 per day) – no signs of
dehydration |
NR 602: PRIMARY CARE OF THE
CHILDBEARING & CHILDREARING FAMILY
PRACTICUM WEEK 3 I-HUMAN CASE STUDY –
COMPLETE GUIDE VERIFIED ANSWERS | A+
RATED | PEDIATRIC PRIMARY CARE
**Case Type:** Well-child / Acute complaint
**Age:** 18 months
**Sex:** Female
**Chief Complaint:** *“My daughter has had a fever and pulling at her
ears for the past 3 days.”*
**Setting:** Primary care outpatient clinic (Nurse Practitioner
practicum)
## SECTION 1 – CHIEF COMPLAINT & HISTORY OF PRESENT
ILLNESS (HPI)
### Chief Complaint (CC)
> *“My daughter has had a fever and keeps pulling at her ears for the
past 3 days.”*
### History of Present Illness (HPI) – Key Information to Elicit
,2|Page
| Question | Expected Answer | Clinical Significance |
|----------|----------------|----------------------|
| **Child’s age** | 18 months | High-risk age for acute otitis media
(AOM) |
| **When did symptoms start?** | 3 days ago | Acute onset |
| **Fever: highest temperature?** | 102°F (38.9°C) measured rectally |
Fever supports infectious process |
| **Ear pulling: constant or intermittent?** | Intermittent, worse when
lying down and at night | Eustachian tube dysfunction worsens supine |
| **Is the child sleeping more than usual?** | Yes, sleeping more and
fussy when awake | Irritability + lethargy → possible pain/infection |
| **Is the child eating/drinking normally?** | Decreased appetite; taking
small amounts of liquid, refusing solids | Pain with chewing/swallowing
|
| **Any ear drainage?** | No drainage noted (parent denies) | No
tympanic membrane perforation (likely) |
| **Any recent upper respiratory symptoms?** | Yes – runny nose and
mild cough started 5 days ago | Viral URI → Eustachian tube
dysfunction → AOM |
| **Any vomiting or diarrhea?** | No | Reduces likelihood of
gastroenteritis |
| **Any known sick contacts?** | Older sibling (age 4) had cold last
week | Viral exposure |
, 3|Page
| **Daycare attendance?** | Yes – attends daycare 3 days/week |
Increased risk for viral/bacterial infections |
| **Any medication tried?** | Acetaminophen (Tylenol) – helps fever
temporarily, but child still fussy | Partial response; no antibiotics yet |
| **Any allergies to medications?** | No known drug allergies |
Important for prescribing |
| **Has the child had ear infections before?** | Yes – one prior episode
of AOM at age 12 months | Recurrent AOM risk |
---
## SECTION 2 – REVIEW OF SYSTEMS (ROS)
| System | Findings |
|--------|----------|
| **General** | Fussy, increased sleeping, decreased activity |
| **HEENT** | Runny nose (clear to white mucus); tugging at ears; no
discharge from ears; no eye redness |
| **Respiratory** | Mild cough (dry), no wheeze, no retractions |
| **Cardiovascular** | No cyanosis, no known murmur |
| **Gastrointestinal** | Decreased appetite; no vomiting, no diarrhea;
normal stool (formed) |
| **Genitourinary** | Normal wet diapers (4–5 per day) – no signs of
dehydration |
