Writing Homework Help

Children Health Module 2 Clinical discussion

Although I had no clinical rotations this week, I had some more condensed clinical rotations in the previous weeks in the facility I am doing my preceptorship in where I also spend 12 hours a day each time I go there. The population there is quite diverse, and I can see many pediatric patients from different age categories. This exposure strengthened my clinical skills and critical thinking when dealing with children since most of my clinical career life I dealt mainly with adults. I feel I am getting better at formulating the right differential diagnosis and reaching the right management plan.

The case I had is a 19-month female accompanied by her mother presenting with an itchy rash to extremities, diaper area, and mouth that started yesterday. The mother states that she always gets a rash when she is teething, but this is worse. Has tried oatmeal baths, cortisone creams, and she takes Claritin daily. Past Medical History is irrelevant with no past events. Family health history: Mother and father healthy. Preventive care: Up to date with immunizations. Social history: lives in a smoke-free home with parents. Nutrition history: age-appropriate. Developmental history: meeting developmental milestones. ROS: General: No weight change, generally healthy, no change in activity level. Head: No injury, no bruising. Eyes: Normal vision, no tearing, no pain. Ears: No change in hearing, no bleeding. Nose: No epistaxis, no coryza, no discharge, no foreign body. Mouth: No dental difficulties, no gingival bleeding. Neck: No stiffness, no pain, no tenderness, no noted masses. Chest: No dyspnea, no wheezing, no hemoptysis, no cough. Heart: No syncope, no orthopnea. Abdomen: No change in appetite, no abdominal pains, no bowel habit changes, no emesis, no melena. GU: no change in nature of urine. Musculoskeletal: No pain in muscles or joints, no limitation of range of motion. Neurologic: No weakness, no tremor, no changes in mentation. Psychiatric: no changes in sleep habits. Denies fever, vomiting, foreign travel. Not exposed to similar sick contacts. Physical exam and assessment show normal vital signs with temperature 98.5, pulse 100 beats per minute, and respiratory rate of 26 breaths per minute. All examination is normal except for the skin which shows Scattered small erythematous papules to bilateral lower and upper extremities, mouth, and buttocks with no open areas and no drainage notes. The plan is as follows: If symptoms are no better, or there are worsening of symptoms instructed to seek medical attention or go to the emergency room. Access to the patient portal and education was provided. Follow up within 48 hours. The family should follow up with PCP and schedule a well-check if not already completed this year. Rest, increase fluids, Claritin AM, Benadryl PM, Motrin for comfort. Continue eczema baths and hydrocortisone cream. The following instructions were given to the parents: good handwashing, do not share cups, utensils, straws, or anything by mouth, etc. Allergy control in the household includes changing filters monthly, keeping windows closed, removing carpet, and considering air filtration in the bedroom. The parents were also taught to go to the website pollen.com to anticipate allergy needs. Parents’ education was done for signs of infection to monitor for including but not limited to fever, chills, erythema, drainage, swelling, decreased range of motion, pain. A differential diagnosis is concluded including diaper rash, hand, foot, and mouth disease (coxsackievirus infection), drug eruption, allergies, eczema, or teething reaction. Eczema is a term used interchangeably with dermatitis which can be pruritic, erythematous, inflamed, and papulovesicular. It is very important to determine if it is a coxsackievirus since this virus is a subtype of the enteroviruses. Enteroviruses can cause aseptic meningitis and have also been associated with paralysis, neonatal sepsis, encephalitis, and other respiratory and GI symptoms (McCance Burns et al., 2017, p.495).

I learned a lot from the diverse pediatric population I was exposed to but mainly to obtain a meticulous history to reach the right differential diagnosis and follow up with the cases with their PCP to learn if symptoms subsided or if there is another definitive diagnosis we should learn about.

References

Dlugasch, L., & Story, L. (2021). Applied pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.

McCance Burns, C. E., Dunn, M. A., Brady, A. M., Starr, B. N., Blosser, G. C., & Garzon, L. D. (2017). Pediatric Primary Care. (6th ed.). St. Louis, MO: Elsevier.