NSG 6020 wk 2 discussion -5
NURSING NSG 6020 wk 2 discussion -5
iHuman Case of Emma Ryan, 2 year old with chief complaint of runny nose, cough, and fever.
Discussion Question 1
Based on your performance and the expert feedback in your HISTORY collection, describe two missed
questions and your understanding of why they were important to collect for this case history. Use
specific references from your text to explain.
During history collection, when going through patient’s symptoms with her mother, I failed to further
investigate an ear problem, because patient is a 2 year old, she was not able to communicate and
presented with discomfort during visit. I asked about ear pain or discomfort such as the child tugging at
her ear and mother replied that there were no signs of that, but I failed to ask if there were any signs of
discharge or bleeding of the ears. The collection of these signs are clinically important because that
could lead to a better understanding initially, prior to physical exam, as bleeding discharge from the ears
can indicate and external ear canal wound, skull fracture, or traumatic perforation of the tympanic
membrane (Goolsby, Jo, M., Grubbs, Laurie., 2014, p. 127). Discharge of the purulent type can also be a
sign of infection or a foreign body in the ear (Goolsby, Jo, M., Grubbs, Laurie., 2014, p. 127). Another
question that was missed during history collection was if patient had a flu shot. I stopped at asking if
when her last immunizations were given and if they were up to date, but failed evaluate mother’s
answers further and ask about the flu vaccine. This is very important to assess and document because
children are a target population in receiving flu vaccine due to the benefits of reducing rates of
pneumonia in children and reducing the incidence of influenza in the community and should be offered
to all children older than 6 months that have no contraindications (Seasonal influenza vaccine in
children, n.d).
Discussion Question 2
Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two
errors in your exam performance or documentation. Use specific references from your text to explain the
importance of these findings in correct assessment of this client.
During physical exam, I went through all the systems and was able to accomplish the exam with more
, NSG 6020 wk 2 discussion -5
ease than last week, however, I added a mental state on vital signs that was not necessary and in looking
back I understand why it was not necessary since patient is 2 years old, cannot verbally express what she
is feeling, and although I can observe that she is awake or alert and in discomfort, it is not necessary in
gathering the information needed. Another error in my exam performance that was not a required exam
was looking up nostrils, or internal examination. Initially I felt this may be important to check if there
were any abnormalities, however, this is an exam that is more appropriate for those experiencing
significant nasal symptoms, the internal examination of the nose is best accomplished after asking the
NURSING NSG 6020 wk 2 discussion -5
iHuman Case of Emma Ryan, 2 year old with chief complaint of runny nose, cough, and fever.
Discussion Question 1
Based on your performance and the expert feedback in your HISTORY collection, describe two missed
questions and your understanding of why they were important to collect for this case history. Use
specific references from your text to explain.
During history collection, when going through patient’s symptoms with her mother, I failed to further
investigate an ear problem, because patient is a 2 year old, she was not able to communicate and
presented with discomfort during visit. I asked about ear pain or discomfort such as the child tugging at
her ear and mother replied that there were no signs of that, but I failed to ask if there were any signs of
discharge or bleeding of the ears. The collection of these signs are clinically important because that
could lead to a better understanding initially, prior to physical exam, as bleeding discharge from the ears
can indicate and external ear canal wound, skull fracture, or traumatic perforation of the tympanic
membrane (Goolsby, Jo, M., Grubbs, Laurie., 2014, p. 127). Discharge of the purulent type can also be a
sign of infection or a foreign body in the ear (Goolsby, Jo, M., Grubbs, Laurie., 2014, p. 127). Another
question that was missed during history collection was if patient had a flu shot. I stopped at asking if
when her last immunizations were given and if they were up to date, but failed evaluate mother’s
answers further and ask about the flu vaccine. This is very important to assess and document because
children are a target population in receiving flu vaccine due to the benefits of reducing rates of
pneumonia in children and reducing the incidence of influenza in the community and should be offered
to all children older than 6 months that have no contraindications (Seasonal influenza vaccine in
children, n.d).
Discussion Question 2
Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two
errors in your exam performance or documentation. Use specific references from your text to explain the
importance of these findings in correct assessment of this client.
During physical exam, I went through all the systems and was able to accomplish the exam with more
, NSG 6020 wk 2 discussion -5
ease than last week, however, I added a mental state on vital signs that was not necessary and in looking
back I understand why it was not necessary since patient is 2 years old, cannot verbally express what she
is feeling, and although I can observe that she is awake or alert and in discomfort, it is not necessary in
gathering the information needed. Another error in my exam performance that was not a required exam
was looking up nostrils, or internal examination. Initially I felt this may be important to check if there
were any abnormalities, however, this is an exam that is more appropriate for those experiencing
significant nasal symptoms, the internal examination of the nose is best accomplished after asking the
