NR 602 WEEK 3 CASE STUDY PRESENTATION, SUMMARY, PEER, SICK CHILD

NR 602 WEEK 3 CASE STUDY PRESENTATION, SUMMARY, PEER, SICK CHILD PURPOSE The purpose of this assignment is for learners to: • Have the opportunity to integrate knowledge and skills learned throughout all core courses in the FNP track and previous clinical courses. • Demonstrate an advancing understanding of the care of women and children. • Demonstrate the ability to analyze previous patients seen in the clinical setting be able to perform an evidenced-based review of their case, diagnosis, and plan, while guiding and taking feedback from peers regarding the case • Demonstrate professional communication and leadership, while advancing the education of peers. Course Outcomes 1. Integrate current evidence based clinical practice guidelines in the care of childbearing and childrearing families. 2. Appropriately apply anticipatory guidance and health promotion in the care of childbearing and childrearing families. 3. Assess growth and developmental milestones in the care of childbearing and childrearing families. 4. Construct an evidence based reproductive health management plan. 5. Identify and address healthcare needs of marginalized childbearing and childrearing families Requirements For Week 3 of the course you will be presenting your own case from clinical. The case should be clear, organized, and meet the following guidelines: Initial Case Presentation: Present only the subjective and objective data only on the patient organized as you would organize them in a SOAP (CC, HPI (no OLDCART for HPI); ROS, PE findings, and any lab or diagnostic findings for your patient. **Do not put the diagnosis or plan in initial post. No Assessment/Plan in the initial post. No citations or references are required for your initial post, you will post references in your summary post. WEEK 3: The case should be pediatric (a patient age 17 years or younger). WEEK 3 specific guidelines: The case must not be something overly simple. The list of things that should not be covered include sore throat, URI, UTI, ear infection, or contact dermatitis (poison ivy). You need to present a case that intrigued you or presents new content in a different light. *One of the above diagnosis can be presented if the findings were unusual and you clear such case with your course faculty prior to posting (at least 2 days before posting). In the pediatric case you must also include in the objective data growth chart percentiles for height, weight, and BMI, and tanner staging. A patient you saw both for initial complaint and follow-up would be ideal, but not required. Leading the Discussion: Post your subjective, objective, and diagnostic data for your patient by Wednesday at 11:59 PM MT. Interactive Dialogue: As a student you will also be required to respond to at least two (2) other students initial case presentation. In your responses, you must include the following: Your top three (3) differentials based on the information provided and why (rationale based on presentation findings), the primary diagnosis you are leaning toward, how you would treat that diagnosis. Use references to support your response. *DEADLINE - YOUR RESPONSES TO 2 STUDENTS ARE DUE BY FRIDAY AT 11:59 p.m. (MT). **If all students have a response, then choose the student with the least responses to their posting. Clinical Case Presentation Summary Criteria: By Sunday 11:59 p.m. MT, post a summary reply to your initial post and respond to any faculty questions to your initial posting or question(s) posed to the general class. Use references to support all of your responses. Criteria for Summary Post should include all of the following required elements: Summary post written in paragraph(s) type format (No SOAP note for Summary Post); discuss primary and any applicable secondary diagnoses along with treatment plan for each diagnosis. Scholarly and evidence based in-text citation support for all of the listed diagnoses; Scholarly and evidence based in-text citation for each treatment plan. Differential diagnoses are eliminated. Summarize your peer's posts to your presentation. *Remember not to use any patient identifiers in your posting (this would be full names or disclosure of clinic name, preceptor name, et cetera). Please include age, gender, and race. **To see view the grading criteria/rubric, please click on the 3 dots in the box at the end of the solid gray bar above the discussion board title and then Show Rubric. Search entries or author Filter replies by unread Unread Collapse replies Expand replies Subscribed ReplyReply to Week 3: Sick Child Clinical Case Presentation • Collapse SubdiscussionKristan Bannister KRISTAN BANNISTER Nov 10, 2019Nov 10 at 12:37pm Manage Discussion Entry NR603 Week 3 Sick Child Clinical Case Presentation Patient Information: The patient S.P. is a 6-year-old Hispanic female who presented to the primary care clinic with her mother. Chief Complaint: S.P. reported “tummy pain” to her mother, along with a low-grade temp of 99.8, positive for nausea, vomiting and diarrhea for 3 days. History of Presenting Illness: S.P. mother reports that the abdominal discomfort began and diarrhea, to her knowledge, approximately three days ago. Approximately one day later, the nausea, vomiting presented. The fever was first noticed yesterday, although S. P’s mother did not take her temperature prior, so she is unsure if she was febrile at time of symptoms first presenting. The last temperature recorded was 99.8 at home. The diarrhea is reported as semi watery in consistency, with occurrences approximately four times per day. No blood in stools reported. S.P does not appear to be urinating as much according to mother. S. P’s mother reports that S.P. is not eating and drinking as she previously was, and not engaging with usual activities of play. Mother is unaware of any weight loss. S. P’s mother has held her from school at the onset of her noticing the fever. Treatment measures include supportive care, which consists of soup, juice, and Tylenol PRN. Review of Symptoms: Constitutional: Positive fatigue and fever. HEENT: Denies symptoms Skin: Negative for rash, itching. Skin warm, dry. Cardiovascular: No concerns reported Respiratory: No concerns reported Gastrointestinal: Positive for generalized GI discomfort and diarrhea x3 days; Positive for nausea, vomiting x2 days. Negative for hematochezia. Genitourinary: Decreased urinary output reported. Neurological: No headache, dizziness reported. No change in bowel control. Lymphatic: No issues reported. Allergies: No known drug or food allergies Physical Examination Findings: Constitutional: Height: 44 inches; weight: 43 pounds. BMI: 15.6; BMI percentile: 55%. Height Percentile: 26.1%. Weight Percentile: 38.6%. Tanner Stage: 1. Appears well nourished and of appropriate size for age. HEENT: Head normocephalic. Eyes PERRLA bilaterally. TM’s pearly gray bilaterally. EAC’s pink and without obstruction. Mild cerumen noted bilaterally. Nasal turbinates pink, dry. Oral mucous membranes dry. Skin: Skin is warm, dry, without rash, lesions. Cardiovascular: RRR with s1 and s2 heard. AP-120, tachycardic. Respiratory: Respirations are even and unlabored. Lungs clear to auscultation to all lung fields. Gastrointestinal: Bowel sounds hyperactive x4 quadrants. Abdomen is soft, and tender to palpation in all four quadrants. Mild abdominal guarding noted with assessment. Negative organomegaly. Genitourinary: Urine is amber in appearance. Genital exam not preformed. Neurological: Alert and oriented. Affect is appropriate for situation. Lymphatic: Negative for lymph node enlargement throughout. Lab and Diagnostic Tests: Urinalysis in office unremarkable. No other diagnostic tests in office performed or available at this time. Reply Reply to Comment o Collapse SubdiscussionKristan Bannister KRISTAN BANNISTER Nov 12, 2019Nov 12 at 1:32pm Manage Discussion Entry Dr McPeters and class, I forgot to include some of my vital signs for my presentation B/P-98/62, R-22, T-99.8, P-120 Sorry about that, Kristan Reply Reply to Comment  Collapse SubdiscussionTatyana Pisarevskaya TATYANA PISAREVSKAYA Nov 12, 2019Nov 12 at 6:59pm Manage Discussion Entry Hello Kristan! Diarrhea (with or without nausea/vomiting) is a very common problem in young children and is defined as an increase in the number of stools or the presence of looser stools than is normal for the individual (three or more watery or loose stools in 24 hours) (Hartman, Brown, Loomis, & Russell, 2019). The differential diagnoses include a wide range of gastrointestinal conditions such as inflammatory bowel disease, intussusception, pseudomembranous enterocolitis, appendicitis, food allergy, lactase deficiency etc. Differential diagnoses 1. Acute gastroenteritis (Primary) Rationale: Acute gastroenteritis is defined as a diarrheal disease of rapid onset, with or without nausea, vomiting, fever, and abdominal pain (Hartman et al., 2019). Decreased of appetite and urine output can be seen in patients with an acute gastroenteritis. SP has abdominal discomfort and diarrhea x 3 days, nausea and vomiting. Temperature 99.8 F. Bowel movement was described as semi watery in consistency, with occurrences approximately four times per day. Mother reported decreased oral intake and urine output. PE revealed dry mucus membrane due to the dehydration, hyperactive bowel sounds, abdominal pain and guarding with palpation. Diagnostic: In children with mild illness, stool microbiological tests are not routinely needed when viral gastroenteritis is the likely diagnosis (Hartman et al., 2019). According to the provided data, the Clinical Dehydration Scale score approximately 1 to 4 points which means a mild (3% to 6%) dehydration. Treatment: The goals of acute gastroenteritis treatment include preventing dehydration, treating dehydration when it occurs, and reducing duration and severity of symptoms (Hartman et al., 2019). Mild dehydration from acute gastroenteritis can be managed at home, with oral rehydration therapy as the mainstay of treatment (Hartman et al., 2019). Children with mild dehydration should receive half-strength apple juice followed by preferred fluids (regular juices, milk) (Hartman et al., 2019). After each loose stool, the World Health Organization (WHO) recommends giving children younger than two years 50 to 100 mL of fluid and children two to 10 years of age 100 to 200 mL of fluid; older children may have as much fluid as they want (Hartman et al., 2019). Antiemetics can be given to prevent vomiting and improve hydration status. Ondansetron is a preferred drug due to the fewer side effects. The typical dose of ondansetron is 2 mg for children weighing 8 to 15 kg (17 lbs, 10 oz to 33 lbs), 4 mg for children weighing 15 to 30 kg (33 lbs to 66 lbs, 2 oz), and 8 mg for children weighing more than 30 kg (Hartman et al., 2019). Prevention: hand washing, daily administration of probiotics, and rotavirus vaccination. 2. Inflammatory bowel disease Rationale: The inflammatory bowel diseases (IBDs), including ulcerative colitis and Crohn disease, are chronic inflammatory disorders of the gastrointestinal tract (Rosen, Dhawan, & Saeed, 2015). Children present to the clinic with the classic symptoms of weight loss, abdominal pain, diarrhea, blood in the stool, fever (Crohn disease), nausea and vomiting, anorexia, and growth retardation (Rosen et al., 2015). Abdominal examination may reveal focal tenderness or fullness, rebound tenderness, and guarding that may indicate perforation or abscess that should be evaluated promptly with imaging (Rosen et al., 2015). 3. Lactose intolerance Rationale: Malabsorption of dietary lactose in the small intestine results in gastrointestinal symptoms such as abdominal pain, bloating, passage of loose, watery stools, and excessive flatus (Xiong, Wang, Gong, & Chen, 2017). Latinos have a prevalence of lactose intolerance of 50 to 80 percent. 4. Celiac disease Rationale: Celiac disease is an autoimmune disorder of the gastrointestinal tract caused by exposure to dietary gluten, which is a storage protein in wheat, rye, and barley (Pelkowski, & Vera, 2014). Clinical manifestations of celiac disease can be categorized as intestinal or extraintestinal. Intestinal clinical presentation includes abdominal pain, diarrhea, nausea, loss of appetite, weight loss, and flatulence (Pelkowski, & Vera, 2014). The extraintestinal manifestation includes anemia, dermatitis herpetiformis, elevated transaminase levels, delayed menarche, hematologic abnormalities, and other (Pelkowski, & Vera, 2014). Hartman, S., Brown, E., Loomis, E., & Russell, H. (2019). Gastroenteritis in children. Am Fam Physician. 99(3):159-165. Retrieved from Pelkowski, T., & Vera, A. (2014). Celiac disease: Diagnosis and management. Am Fam Physician. 89(2):99-105. Retrieved from Rosen, M., Dhawan, A., & Saeed, S. (2015). Inflammatory Bowel Disease in Children and Adolescents. JAMA pediatrics, 169(11), 1053–1060. doi:10.1001/jamapediatrics.2015.1982 Xiong, L., Wang, Y., Gong, X., & Chen, M. (2017). Prevalence of lactose intolerance in patients with diarrhea-predominant irritable bowel syndrome: Data from a tertiary center in southern China. Journal Of Health, Population, And Nutrition, 36(1), 38. Retrieved from Reply Reply to Comment  Collapse SubdiscussionSteadman McPeters STEADMAN MCPETERS Nov 13, 2019Nov 13 at 9:34pm Manage Discussion Entry Very good differentials, Tatyana! There is one that I am thinking that you did not include; however, Jessica did.............. Thanks! Dr. McPeters Reply Reply to Comment  Collapse SubdiscussionJessica Brown JESSICA BROWN Nov 12, 2019Nov 12 at 7:26pm Manage Discussion Entry Week 3 Peer Response Kristan, The differential diagnosis for the case study are as follows: Viral Gastroenteritis Appendicitis Inflammatory Bowel Disease Viral Gastroenteritis is a result of the norovirus causing inflammation of the stomach and intestines (Munnink & van der Hoek, 2016). The patient presents with generalized abdominal discomfort, nausea, vomiting, and diarrhea with a low grade temp. Viral gastroenteritis is considered as a differential diagnosis as the clinical signs and symptoms are abdominal cramping, nausea, vomiting, diarrhea, and low grade temps (Munnink & van der Hoek, 2016). Appendicitis is the result of an obstruction to the appendiceal lumen causing inflammation, ischemia, abscess formation, or perforation of the appendix (Jones, Lopez, & Deppen, 2019). Clinical presentation may include periumbilical abdominal pain, anorexia, malaise, nausea, vomiting, and fever (Jones, Lopez, & Deppen, 2019). The diagnosis was considered due to nausea, vomiting, diarrhea, abdominal pain, and malaise. This diagnosis was excluded due to McBurney’s point was not addressed and appendicitis symptoms start early and progress quickly with impending rupture within 48 hours of start of symptoms (Jones, Lopez, & Deppen, 2019). Inflammatory Bowel Disease involves ulcerative colitis and Crohn’s disease which are the result of chronic inflammation of the GI tract particularly the colon (Rosen, Dhawan, & Saeed, 2015). Clinical presentation includes weight loss, bloody diarrhea, abdominal pain, anemia, and poor growth. This diagnosis was excluded due to the patient not ever having bloody stools. The primary diagnosis is viral gastroenteritis. Treatment is based on symptoms. Hydration and replacement of electrolytes is the most important treatment goal. Medications such as ondanseteron 2-4 mg PO for one dose (Stuempfig & Seroy, 2019). Nonpharmacologic treatment may include a diet of bananas, rice, toast, apples and tea, although there is no statistical data to support this compared to regular diets (Stuempfig & Seroy, 2019). Tylenol may also be given for fever. Jessica References: Jones, M. W., Lopez, R., & Deppen, J. (2019). Appendicitis. Retrieved November 12, 2019, from Oude Munnink, B. B., & van der Hoek, L. (2016). Viruses Causing Gastroenteritis: The Known, The New and Those Beyond. Viruses, 8(2), 42. doi:10.3390/v8020042 Rosen, M. J., Dhawan, A., & Saeed, S. A. (2015). Inflammatory Bowel Disease in Children and Adolescents. JAMA pediatrics, 169(11), 1053–1060. doi:10.1001/jamapediatrics.2015.1982 Stuempfig, N. D., & Seroy, J. (2019, June 17). Viral Gastroenteritis. Retrieved November 12, 2019, from Reply Reply to Comment  Collapse SubdiscussionSteadman McPeters STEADMAN MCPETERS Nov 13, 2019Nov 13 at 9:35pm Manage Discussion Entry Very good work, Jessica! I am in agreement with you. There is one on your list that I think I am leaning towards more than anything.....we shall see! Dr. McPeters Reply Reply to Comment