NURS 6541: Primary Care of Adolescents and Children 

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NURS 6541: Primary Care of Adolescents and Children 

NURS 6541 Entire Course Weekly Discussions And Assignments

NURS 6541 Week 1: Overview of Growth and Development

When we work with parents in a spirit of true partnership, mothers, fathers, and other caregivers are more likely to invite and welcome providers’ support in evaluating needs, developing goals, and identifying effective ways to strengthen the family and provide care for children.

—Child Welfare Information Gateway

Primary care of pediatrics begins in infancy and progresses through adolescence. During these stages of growth and development, children depend upon their families and health care providers to meet their individual health needs. As an advanced practice nurse, you must assess the family unit as a whole in order to determine the needs of the patient and the family. It is essential to work closely with parents and caregivers to provide care to pediatric patients and maintain patients’ health and well-being.

This week you explore the impact of sociocultural influences on assessments of children and families. You also examine strategies for assisting families in making health-related decisions for children at different stages of growth and development.

Note: Throughout this course, the term parent will be used to represent a pediatric patient’s caregiver, which may include a parent, stepparent, foster parent, guardian, and so on.

Learning Objectives

By the end of this week, students will:

  • Analyze personal strengths and weaknesses in working with children
  • Analyze theories in pediatric nursing practice
  • Apply theories in pediatric nursing practice

NURS 6541: Primary Care of Adolescents and Children

Assignment: Practicum – Journal Entry

As a future advanced practice nurse, it is important that you are able to connect your didactic experience to your Practicum experience. By applying the concepts you study in the classroom to clinical settings, you better prepare yourself for your future professional career. Each week, you complete an assignment that prompts you to reflect on your Practicum experiences and relate them to the material presented in the classroom.

To prepare for this course’s Practicum experience, address the following in your Practicum journal:

  • Explain what most excites and/or concerns you about pediatric clinical experiences. Include a description of your strengths and weaknesses in terms of working with children and how these strengths and weaknesses might impact your Practicum experience.
  • Discuss your personal definition of family and family roles might impact the assessment of a child and his or her family. Then, explain how culture (both the culture of the provider and that of the child and his or her family) may further influence the assessment.
  • Select and explain a nursing theory to guide your practice with pediatric patients.
  • Based on your strengths, weaknesses, and theory of nursing practice, develop goals and objectives for the Practicum experience in this course. Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice from this week’s Learning Resources.
  • Create a timeline of Practicum activities based on your Practicum requirements.
  • 2–3 page limit. Use title page and references according to APA.

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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.

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.

Learning Objectives

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
  • 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

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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: Primary Care of Adolescents and Children

NURS 6541 Week 3: School-Age Children and Adolescents

If adolescents cannot trust that their health information will be both private and secure, they may not seek these services.

—American Academy of Pediatrics

This statement released by the American Academy of Pediatrics draws awareness to a topic of growing importance. According to the CDC’s National Center for Health Statistics, over 9% of school-age children and adolescents do not visit a health care provider regularly (U.S. Department of Health and Human Services, 2012). While this may be partially attributed to access to health care, concerns of privacy and trust also keep patients from obtaining necessary services. Patients are sometimes hesitant to share private information such as details of sexual activity or drug use with providers for fear that their parents will find out. In your role as the advanced practice nurse, you must be prepared to handle any provider-patient confidentiality issues that may arise with pediatric patients in clinical settings.

This week you explore the role of the provider regarding confidentiality between pediatric patients and their families. You also examine treatment and management strategies for school-age children and adolescents.

Learning Objectives

By the end of this week, students will:
  • Analyze the role of the provider regarding confidentiality between pediatric patients and their families
  • Understand and apply key terms, principles, and concepts related to growth and developmental issues for school-age children and adolescents
  • Evaluate diagnoses for pediatric patients
  • Evaluate treatment and management plans

    Assignment 1: Practicum – SOAP Note

    SOAP Note submissions are a way to reflect on your Practicum experiences and connect these experiences to your classroom experience. SOAP Notes, such as the ones required in this course, are often used in clinical settings to document patient care. Please refer to this week’s Learning Resources for guidance on writing SOAP Notes.

    Select a patient who you examined during the last 3 weeks. With this patient in mind, address the following in a SOAP Note:

    • Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent, as well as possible reasons for these discrepancies.
    • Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.
    • Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
    • Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.
    • Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?

    By Day 7

    You will submit this Week 3 SOAP Note.

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NURS 6541 Week 4: Evaluation and Management of HEENT Disorders

Patients with disorders of the eye, ear, nose, and throat (EENT) often present with a variety of symptoms that can be associated with multiple disorders. This makes diagnosis difficult because what may appear to be a gastrointestinal or respiratory disorder, for example, might actually be an EENT disorder such as otitis media. Consider 8-month-old Melissa, who presents with a complaint of tugging on her left ear, fussiness, and decreased appetite over the last 3 days. She does not have a fever, and her physical examination is normal. As the advanced practice nurse caring for patients like Melissa, you must always consider the differential diagnoses and perform the appropriate assessments and diagnostics prior to providing treatment and management recommendations for patients and their families.

This week you explore eye, ear, nose, and throat disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives

By the end of this week, students will:

  • Assess pediatric patients for eye, ear, nose, and throat disorders
  • Evaluate differential diagnoses for pediatric eye, ear, nose, and throat disorders
  • Analyze treatment and management plans for pediatric patients with eye, ear, nose, and throat disorders
  • Analyze strategies for educating parents on their children’s disorders
  • Evaluate the impact of culture on the treatment and management of eye, ear, nose, and throat disorders
  • Understand and apply key terms, principles, and concepts related to eye, ear, nose, and throat disorders in pediatric patients
  • Assess pediatric patients with signs of eye, ear, nose, and throat disorders

Discussion: Evaluation & Management of HEENT Disorders

In clinical settings, head, eye, ear, nose, and throat (HEENT) 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 HEENT 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.

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:

HPI: A mother presents with her 2-year-old African American male 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.

PE: Pt is walking around room, exploring in no acute distress.
HEENT: Mild nasal congestion, clear postnasal drainage, and lungs clear to auscultation. Ear exam reveals right tympanic membrane erythematous, translucent, in a neutral position, with no pus or fluid noted. Left tympanic membrane is full, reddish/orange in appearance, and opaque with pus.
Neck: Shotty anterior cervical adenopathy
Lungs: Clear to auscultation

Case Study 2

HPI: Kevin is a 5-year-old Asian American boy with an intermittent 2-day history of nasal congestion and cough in the early morning. His mother reports thick, green nasal discharge. He is afebrile, and appetite and sleep are normal.

PE: A smiling male patient sitting on mom’s lap.
HEENT: Tympanic membranes pearly gray without fluid in a neutral position, no cervical adenopathy, nasal turbinates are red, and clear rhinorrhea and postnasal drip.
CV: RRR, no murmurs or gallop
PULM: clear to auscultation

Case Study 3

HPI: 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.”

PMH: A Polish 8-year-old boy, in mild distress.
HEENT: Tympanic membranes partially obscured by cerumen but in neutral position and transparent, 2+ enlarged and red tonsils with exudate, strawberry tongue, and petechiae on the soft palate enlarged tonsillar and anterior cervical lymph nodes.
CV: RRR
PULM: Clear to auscultation bilaterally

To prepare:

  • Review “Eye Disorders” and “Ear Disorders” in the Burns et al. text.
  • Review the three case studies focusing on the case that is assigned to you. 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.

By Day 3

Post an analysis of your assigned case by responding to the following:

    • What additional questions will you ask?
      • Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).
    • What additional examinations or diagnostic tests, if any will you conduct?
    • What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.
    • What is your most likely diagnosis and why?
    • How will you treat this child?
      • Provide medication treatment and symptomatic care.
      • Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
    • Patient Education, Health Promotion & Anticipatory guidance:
      • Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
      • Include any socio-cultural barriers that might impact the treatment and management plans.
      • Health Promotion:
        • What immunizations should this child have had?
        • Based on the child’s age, when is the next well visit?
        • At the next well visit, what are the next set of immunizations?
        • What additional anticipatory guidance should be provided today?

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to a colleague who chose one of the first three case studies and a second colleague who chose one of the last three case studies. Choose colleagues who selected a different case study than you did.

  • Explain how culture might impact the diagnosis, management, and follow-up care of patients with the respiratory, cardiovascular, and/or genetic disorders your colleagues discussed.
  • Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.

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NURS 6541 Week 5: Evaluation and Management of Respiratory, Cardiovascular, and Genetic Disorders

Baby Eden was only 1 month old when she presented with difficulty breathing, a high fever, and wheezing. Eden’s mother thought her daughter had a common cold, but the baby’s illness quickly led to admission to the pediatric intensive care unit. A diagnosis of respiratory syncytial virus (RSV) resulted in a weeklong hospital stay with antibiotic treatments (Azar, 2012). Like RSV, many respiratory disorders such as asthma and pneumonia also present symptoms often identified with common cold and flu viruses. As an advanced practice nurse, you must be able to distinguish between the various respiratory disorders to appropriately diagnose and treat pediatric patients. This is essential because, similarly to RSV, many disorders can quickly develop into a serious health issue.

An advanced practice nurse must know when to diagnose and treat, when to gather additional information prior to a diagnosis, and when to refer for specialized care. Consider 5-year-old Cristian Serrano. After waking up one morning with a fever and rash that covered his body, Cristian’s mother took him to his health care provider for examination. He was immediately diagnosed with scarlet fever and sent home with antibiotics. However, Cristian had not been properly diagnosed; his illness was actually the result of Kawasaki disease. Fortunately, the misdiagnosis was discovered quickly enough that there was no long-term damage to his heart’s arteries (Pritchett, 2011). With Kawasaki disease and other cardiovascular and genetic disorders, diagnostics and continued patient observation are sometimes necessary prior to determining diagnoses. In your role, you must be able to identify patient situations that require different approaches than the more typical diagnosis and treatment response.

This week you explore respiratory disorders in pediatric patients, as well as pediatric cardiovascular and genetic disorders, including the pathophysiology, epidemiology, and patient presentation. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives

By the end of this week, students will:

  • Assess pediatric patients for respiratory disorders
  • Assess pediatric patients for cardiovascular and genetic disorders
  • Evaluate differential diagnoses for pediatric respiratory disorders
  • Evaluate differential diagnoses for pediatric cardiovascular and genetic disorders
  • Analyze treatment and management plans for pediatric patients with respiratory disorders
  • Analyze treatment and management plans for pediatric patients with cardiovascular and genetic disorders
  • Analyze strategies for educating patients and families on the treatment and management of respiratory disorders
  • Analyze strategies for educating patients and families on the treatment and management of cardiovascular and genetic disorders
  • Evaluate the impact of culture on the treatment and management of respiratory disorders
  • Evaluate the impact of culture on the treatment and management of disorders (D/A)
  • Understand and apply key terms, principles, and concepts related to respiratory disorders in pediatric patients
  • Analyze the pathophysiology and epidemiology of disorders
  • Analyze protocols for the management of disorders in pediatric patients
  • Assess pediatric patients with signs of cardiovascular and genetic disorders
  • Assess pediatric patients with signs of dermatologic disorders*
  • Assess pediatric patients with signs of eye, ear, nose, and throat disorders*
  • Evaluate diagnoses for pediatric patients
  • Evaluate treatment and management plans

NURS 6541: Primary Care of Adolescents and Children

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

  • Case Study 1: A-D
  • Case Study 2: E-I
  • Case Study 3: J-M
  • Case Study 4: N-R
  • Case Study 5: S-V
  • Case Study 6: W-Z

Case Study 1:

HPI: A 14-month-old Native American boy brought in by his mom due to cough, low grade fever and runny nose for the past 2 days. This morning, the mother noted that her son was breathing quickly and “it sounds like he has rice cereal popping in his throat.” Mom is worried because her son seems to have a lot of “bouts of colds”. Per mom, his oral intake is decreased. He didn’t want to eat this morning.

PE: Smiling, alert Native American boy.
VS: Temp of 99.9, pulse 112, respiratory rate is 58, Pulse ox 96%
HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip.
CV: His capillary refill is less than 3 seconds
PULM: lung sounds are diminished in the bases, he has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields.

Case Study 2:

HPI: Brian is a 14-year-old known asthmatic with a 2-day history of worsening cough and shortness of breath. He reports using his albuteral inhaler every 3-4 hours over the previous 24 hours. He has a long-acting inhaled corticosteroid. He can’t recall which one. He said he ran out a few weeks ago and has not had time to obtain a refill. He denies cigarette smoking, but his clothing smells like smoke.

PE: Patient is sitting by himself. His parents are in the room during the visit. No purse lip breathing noted. Occasional nonproductive coughing during the interview.
PULM: You note prolonged expiration and expiratory wheezes in all lung fields. There are no signs of dyspnea.

Case Study 3:

HPI: A father brought his 7-year-old son with a 3-day history of cough. Dad states that his son is coughing up yellow mucus. The boy is afebrile and is sleeping through the night, but the father’s sleep is disturbed listening to his son coughing. Dad says he thinks his son has bronchitis and is requesting treatment.

PE: VS: Temp 98.4, Pulse 76, respiratory rate 18, pulse ox 99%.
HEENT: there is no cervical adenopathy, nasal turbinates are slightly enlarged, and there is moderate clear rhinorrhea.
PULM: lungs are clear to auscultation, patient is able to take deep breaths without coughing.

Case Study 4

HPI: Miguel is a Latino 15-year-old male who presents for a sports physical. He is a healthy adolescent with no complaints. He plays basketball.

PE: He is 6 feet 5 inches tall and weighs 198 pounds.
MS: You note long arms and long thin fingers. He has joint laxity in his wrists, shoulders, and elbows.

Case Study 5:

HPI: Trina’s mother is concern that her daughter is a picky eater and refuses to eat fruits and vegetables. Her physical activity includes soccer practice for 1 hour a week with one game each weekend from September through November.

FMH: negative for myocardial infarction, but both parents take medication for dyslipidemia.
PE: Trina is a Native American 10-year-old female very engaging when answering questions. Vital signs are as follows: BP 122/79, P 98, R 20. Wt. 110, Ht. 4’11

Case Study 6:

HPI: You see a 2-month-old for a well-child visit. She is breastfed and nurses every 2 to 3 hours during the day, but her mother reports she is not nursing as vigorously as before. She sleeps one 4-hour block at night. PMH: Birth weight was 7 pounds 5 ounces. Weight gain over the last 2 weeks reveals gain of 5 ounces per week.

PE: Fussy two-month-old Chinese infant.
PULM: lung sounds are clear
CV: a new III/VI systolic ejection murmur is noted along the left lower sternal border, cap refill is brisk, skin is pink and moist.
ABD: bowel sounds noted in all quadrants.

To prepare:

  • Review “Respiratory Disorders,” “Cardiovascular Disorders,” and “Genetic Disorders” in the Burns et al. text.
  • Review and select one of the six provided case studies. Analyze the patient information.
  • 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 patients and families on the treatment and management of the respiratory disorder.

By Day 3

Post an analysis of your assigned case by using the following:

    • What additional questions will you ask?
      • Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds, and so forth that might be pertinent in arriving to your differential diagnoses)
    • What additional examinations or diagnostic tests, if any will you conduct?
    • What are your differential diagnoses? What historical and physical exam

features support your rationales? Provide at least 3 differentials.

  • What is your most likely diagnosis and why?
  • How will you treat this child?
    • Provide medication treatment and symptomatic care.
    • Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
  • Patient Education, Health Promotion & Anticipatory guidance:
    • Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
    • Include any socio-cultural barriers that might impact the treatment and management plans.
    • Health Promotion:
      • What immunizations should this child have had?
      • Based on the child’s age, when is the next well visit?
      • At the next well visit, what are the next set of immunizations?
      • What additional anticipatory guidance should be provided today?

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to a colleague who chose one of the first three case studies and a second colleague who chose one of the last three case studies. Choose colleagues who selected a different case study than you did.

    • Explain how culture might impact the diagnosis, management, and follow-up care of patients with the respiratory, cardiovascular, and/or genetic disorders your colleagues discussed.
    • Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.

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NURS 6541 Week 6: Behavioral and Mental Health Issues

Behavioral and mental health issues can impact every facet of a child’s life, making the most basic activities difficult for patients and their families. This was the case for 13-year-old Kara. For more than 8 years, Kara suffered from temper tantrums, impulsiveness, inappropriate behavior, difficulty in judgment, and sleep issues. Her behavior created problems at home and at school. As an advanced practice nurse working with pediatric patients, you must be able to assess if these types of problems are caused by psychological, social, or underlying growth and development issues.

This week, as you explore behavioral and mental health issues in pediatric patients, you consider strategies for promoting positive behavior, mental wellness, and good self-perception. You also examine growth and development and psychosocial issues, as well as management strategies and potential cultural impact on care.

Learning Objectives

By the end of this week, students will:

  • Analyze common self-perception, behavior, and mental health issues in pediatric patients
  • Analyze strategies that promote good self-perception, positive behavior, and mental wellness in pediatric patients

Select a patient who you examined during the last 3 weeks. With this patient in mind, address the following in a SOAP Note:

  • Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent, as well as possible reasons for these discrepancies.
  • Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.
  • Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
  • Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.
  • Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?

By Day 7

You will submit this SOAP Note.

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NURS 6541 Week 7: Evaluation and Management of Dermatological Disorders

Skin disorders can be very challenging for adolescents and children because they often not only impact physical health but also mental and emotional health. Moderate to severe acne, for instance, impacts approximately one in five adolescent patients, and studies show that these patients are more than twice as likely to develop mental health problems than those without acne (Peeples, 2010). Like acne, many other skin disorders such as eczema or roseola also impact pediatric patients emotionally, often resulting in issues with self-confidence for even preschool-age patients. In your role as the advanced practice nurse, you must support these patients and treat the whole patient to improve physical and mental health.

This week you explore differential diagnoses for common skin disorders in pediatric patients. You also examine factors that impact the presentation, treatment, and management of patients with these disorders.

Learning Objectives

By the end of this week, students will:

  • Analyze common skin disorders in pediatric patients
  • Assess pediatric patients for skin disorders
  • Evaluate differential diagnoses for pediatric skin disorders
  • Analyze treatment and management plans for pediatric patients with skin disorders
  • Evaluate the impact of patient race, ethnicity, and culture on the presentation of dermatologic disorders
  • Understand and apply key terms, principles, and concepts related to skin disorders in pediatric patients
  • Assess pediatric patients with signs of dermatologic disorders

 

NURS 6541: Primary Care of Adolescents and Children essay help

Dermatologic disorders can present due to an actual skin problem or as the result of a systemic problem that manifests in the skin. Depending on the type of disorder, the presentation might be unique, making a quick diagnosis possible. However, some disorders have similar presentations in terms of symptoms and appearance, making diagnosis more difficult. Skin color and tone can also contribute to difficulty in diagnosis, making it important to consider cultural variations during assessments. In this Discussion, you examine the following case studies of skin disorders.

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

  • Case Study 1: A-D
  • Case Study 2: E-J
  • Case Study 3: K-Q
  • Case Study 4: R-Z

Case Study 1

An adolescent presents to your office with a complaint of an itchy, red rash that first appeared on his lower legs 1 week ago after he returned from a camping trip. The rash has since spread to the upper legs, trunk, and groin. He denies fever or other systemic symptoms.

Case Study 2

An 8-month-old presents to your office with a rash on both cheeks that has progressively worsened over the last week. Mom first noticed the rash after his 6-month checkup. He has generalized dry skin and rubs at his cheeks often.

Case Study 3

A 24-month-old presents with a red rash that began on his trunk yesterday and has now spread to the face and upper extremities. His grandmother reports that earlier in the week, the toddler had intermittent fevers up to 101.5°F without other symptoms. The fever broke approximately 48 hours ago and the rash began a few hours later.

Case Study 4:

You see a 9-year-old male who presents with a white, scaly patch on the back of his head. There is some alopecia in the area with hair breakage noted at the scalp.

To prepare:

  • Review the DermNet NZ and Dermnet Skin Disease Atlas websites in this week’s Learning Resources.
  • Select one of the four case studies of skin disorders. Analyze the skin disorder in the case you selected including lesion type, lesion distribution, color, and any ancillary findings.
  • Consider 3 differential diagnoses for the skin disorder in the case study you selected. Determine the most likely diagnosis for the patient.
  • Think about a treatment and management plan for this disorder. Consider appropriate dosages for any recommended treatments.

By Day 3

Post an explanation of the skin disorder in the case study you selected. Include in your explanation the lesion type, lesion distribution, color, and any ancillary findings. Then, present 3 differential diagnoses and explain which is the most likely diagnosis for the patient and why. Finally, explain a treatment and management plan for the patient’s skin disorder, including appropriate dosages for any recommended treatments.

Read a selection of your colleagues’ responses.

By Day 6

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

  • Explain how the skin disorders in the case studies your colleagues selected might look different in patients of various racial, ethnic, and cultural backgrounds.
  • Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.

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NURS 6541: Primary Care of Adolescents and Children

NURS 6541 Week 8: Gastrointestinal Disorders

Many gastrointestinal (GI) disorders have overlapping symptoms, making diagnosis difficult, especially for those disorders that are less common among pediatric patients. This was the case for 8-year-old Erin. After becoming sick with flu-like symptoms, Erin’s parents took her to their family health care provider, who diagnosed her with a viral infection that would simply run its course. However, after 3 weeks, Erin had lost all energy and 25 pounds. She was so weak, her parents had to carry her into the emergency room. Diagnostic tests revealed a massive bleeding lesion in her colon, confirming a suspected diagnosis of Crohn’s disease (Nationwide Children’s Hospital, n.d.). Like Crohn’s, many GI disorders initially present with flu-like symptoms. As an advanced practice nurse, you must identify when to treat these symptoms, when to order diagnostics, and when to refer for specialized care.

This week you explore gastrointestinal disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives

By the end of this week, students will:

  • Assess pediatric patients for gastrointestinal disorders
  • Evaluate differential diagnoses for pediatric gastrointestinal disorders
  • Analyze treatment and management plans for pediatric patients with gastrointestinal disorders
  • Analyze strategies for educating patients and families on the treatment and management of gastrointestinal disorders
  • Evaluate the impact of culture on the treatment and management of gastrointestinal disorders
  • Understand and apply key terms, principles, and concepts related to gastrointestinal disorders in pediatric patients
  • Assess pediatric patients with signs of gastrointestinal disorders

Assignment: Practicum – SOAP Note #3: Comprehensive

Your Well Child Note is due by Day 7 of Week 8. Take some time to review the provided example. Select a patient who you examined during the last 4 weeks. With this patient in mind, address the following in a SOAP Note:

  • Subjective: What details did the patient or parent provide regarding the personal and medical history? Include any discrepancies between the details provided by the child and details provided by the parent, as well as possible reasons for these discrepancies.
  • Objective: What observations did you make during the physical assessment? Include pertinent positive and negative physical exam findings. Describe whether the patient presented with any growth and development or psychosocial issues.
  • Assessment: What were your differential diagnoses? Provide a minimum of three possible diagnoses. List them from highest priority to lowest priority. What was your primary diagnosis and why?
  • Plan: What was your plan for diagnostics and primary diagnosis? What was your plan for treatment and management? Include pharmacologic and non-pharmacologic treatments, alternative therapies, and follow-up parameters, as well as a rationale for this treatment and management plan.
  • Reflection notes: What was your “aha” moment? What would you do differently in a similar patient evaluation?

By Day 7

Please submit the Week 8 SOAP Note.

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NURS 6541: Primary Care of Adolescents and Children 

NURS 6541 Week 9: Evaluation and Management of Renal and Genitourinary Disorders

The care of genitourinary (GU) disorders can range from primary care diagnosis and treatment to referral for specialized care, making it essential for you to identify when a patient’s needs fall within your scope of practice. Consider Hannah, who received specialized treatment for a GU disorder. When Hannah was born, her bladder was misshapen and located outside of her body, requiring immediate surgery. Although the surgery was a success, she began to present with complications at age 2. As is common among children with her condition, bladder exstrophy, she suffered from frequent urinary tract infections (Miami Children’s Hospital, 2012). Although you might not treat bladder exstrophy as an advanced practice nurse, you must be able to treat resulting complications that present later in the patient’s life. In your role, you will care for pediatric patients with GU disorders, and like Hannah, some of these patients will have unique needs, requiring long-term treatment and management.

This week you explore genitourinary disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives

By the end of this week, students will:

  • Analyze treatment and management plans for pediatric patients with genitourinary disorders
  • Analyze strategies for educating patients and families on the treatment and management of genitourinary disorders
  • Evaluate the impact of culture on the treatment and management of genitourinary disorders
  • Understand and apply key terms, principles, and concepts related to genitourinary disorders in pediatric patients
  • Evaluate diagnoses for pediatric patients
  • Evaluate treatment and management plans
  • Assess pediatric patients with signs of hematologic and metabolic disorders*
  • Assess pediatric patients with signs of gastrointestinal disorders*

*These Learning Objectives support assignments that are due this week but were assigned in Weeks 8 and 9.

NURS 6541: Primary Care of Adolescents and Children

Many genitourinary (GU) disorders such as kidney disease begin developing during childhood and adolescence (Johns Hopkins Children’s Center, 2010). This early onset of disease makes it essential for you, as the advanced practice nurse caring for pediatric patients, to identify potential signs and symptoms. Although some pediatric GU disorders require long-term treatment and management, other disorders such as bedwetting or urinary tract infections are more common and frequently require only minor interventions. In your role with pediatric patients, you must evaluate symptoms and determine whether to treat patients or refer them for specialized care. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following three case studies.

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-T
  • Case Study 4: U-Z

Case Study 1

HPI: This is a 3 year old girl with a 2-day history of complaints of dysuria with frequent episodes of enuresis despite potty training about 7 months ago. She is afebrile and denies vomiting.

PMH: Last UTI, 6 months ago.
PE: Dipstick voided urine analysis reveals: specific gravity 1.015, Protein 1+ non-hemolyzed blood, 1+ nitrites, 1+ leukocytes, and glucose-negative.

Case Study 2

Jacob is a 1.5 week old brought in by his distressed mother. While changing his diaper last night, she noted that his penis was edematous and erythematous. He has been crying and fussy. Per mom, no other complaints. He’s been breastfeeding every 1-2 hours without any issues.

PE: Stable VS and growth patterns. Essentially a normal examination with the exception of a slightly erythematous and edematous glans penis with retracted prepuce.

Case Study 3

HPI: Mark is a 15-year-old with complaint of acute left scrotal pain with nausea. The pain began approximately 6 hours ago after a wrestling match. He describes the pain as a dull ache and has gradually worsened to where he can no longer stand without doubling over. He is afebrile and in marked pain.

PE: Physical exam is negative except for elevation of the left testicle, diffuse scrotal edema, and the presence of a blue dot sign.

Case Study 4

HPI: Maya is a 5-year-old who presents for a well-child visit. She is a healthy child with no complaints.

PE: VS stable; Height and weight within the 60th percentile. Head to toe examination is normal.
Diagnostics: Routine urinalysis indicates 2+ proteinuria; specific gravity 1.020; negative for glucose, blood, leukocytes, and nitrites. 60th percentile for height and weight.

To prepare:

  • Review “Genitourinary Disorders” in the Burns et al. text.
  • Review and select one of the three provided case studies. Analyze the patient information.
  • 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 patients and families on the treatment and management of the genitourinary disorder.

By Day 3

Post an analysis of your assigned case by responding to the following:

  • What additional questions will you ask?
    • Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).
  • What additional examinations or diagnostic tests, if any will you conduct?
  • What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.
  • What is your most likely diagnosis and why?
  • How will you treat this child?
    • Provide medication treatment and symptomatic care.
    • Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
  • Patient Education, Health Promotion & Anticipatory guidance:
    • Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
    • Include any socio-cultural barriers that might impact the treatment and management plans.
    • Health Promotion:
      • What immunizations should this child have had?
      • Based on the child’s age, when is the next well visit?
      • At the next well visit, what are the next set of immunizations?
      • What additional anticipatory guidance should be provided today?

Read a selection of your colleagues’ responses.

By Day 6

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

  • Describe how culture might impact the diagnosis, management, and follow-up care of patients with the genitourinary disorders your colleagues discussed.
  • Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.

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NURS 6541: Primary Care of Adolescents and Children

NURS 6541 Week 10: Evaluation and Management of Musculoskeletal and Neurological Disorders

For many children and adolescents, sports are one way to build friendships, work in teams, engage in healthy competition, and earn scholarships—Tracy Yatsko was no exception. Tracy played on her high school’s basketball and track teams until suffering from a severe concussion. Initially, her concussion was thought to be mild. However, the dizziness and nausea lingered into the next evening when she collapsed in the locker room after another game. Tracy spent much of the remaining school year at home with migraines, nausea, vomiting, and difficulty concentrating. She was prescribed several different medications, was forced to stop playing sports, and lost many friends (Mishori, 2012). Sports injuries such as concussions are only one of several musculoskeletal and neurologic disorders that impact pediatric patients. Patients with these disorders often require extensive care, and as the advanced practice nurse, it is your role to provide this care, develop treatment strategies, and identify factors that impact adherence to care.

This week you explore musculoskeletal and neurologic disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives

By the end of this week, students will:

  • Assess pediatric patients for musculoskeletal and neurologic disorders
  • Evaluate differential diagnoses for pediatric musculoskeletal and neurologic disorders
  • Analyze treatment and management plans for pediatric patients with musculoskeletal and neurologic disorders
  • Analyze strategies for educating patients and families on the treatment and management of musculoskeletal and neurologic disorders
  • Evaluate the impact of culture on the treatment and management of musculoskeletal and neurologic disorders
  • Understand and apply key terms, principles, and concepts related to musculoskeletal and neurologic disorders in pediatric patients

NURS 6541: Primary Care of Adolescents and Children

Musculoskeletal and neurologic disorders can present complications for pediatric patients from infancy to adolescence. These disorders affect patients physically and emotionally and often impact a patient’s ability to participate in or carry out everyday activities. Patients with these disorders frequently need long-term treatment and care requiring extensive patient management and education plans. Musculoskeletal and neurologic disorders present various symptoms because they affect multiple parts of a patient’s body. Consider treatment, management, and education plans for the patients in the following three case studies.

  • Case Study 1: A-F
  • Case Study 2: G-M
  • Case Study 3: N-T
  • Case Study 4: U-Z

Case Study 1:

HPI: Clay is a 7-year-old male who presents in your office with complaints of right thigh pain and a limp. The pain began approximately 1 week ago and has progressively worsened. There is no history of trauma.

PE: Pleasant Caucasian boy, in mild distress. VS and growth pattern stable.
MS: flexion and internal rotation of the right hip and limited abduction of the right hip. Limb lengths are equal.

Case Study 2:

HPI: A 12-year-old girl presents with left knee pain during and after playing soccer. She’s been a member of an elite soccer team for the last 6 years. She has 2 hour practices 3 times a week. Does not recall any injuries.

PMH: asthma, eczema
MS: Anterior/posterior drawer tests negative; negative ballottement; negative edema/erythema; bony tenderness, slight swelling at the left tibial tubercle.

Case Study 3:

HPI: Trevon is an 18-month-old with a 3-day history of upper-respiratory-type symptoms that have progressively worsened over the last 8 hours. Mom states he spiked a fever to 103.2°F this morning and he has become increasingly fussy. He vomited after drinking a cup of juice this afternoon and has refused PO fluids since then.

PE: VS: Temp: 102.5°F;
HEENT: Marked irritability with inconsolable crying, and he cries louder with pupil examination and fights head and neck assessment
ABD: negative abdominal exam
NEURO: You are unable to elicit Kernig’s or Brudzinski’s signs due to patient noncompliance.

Case Study 4:

HPI: Molly is a 12-year-old who comes to your office after hitting her head on the ground during a soccer game. Her mother reports that she did not lose consciousness, but that she seems “loopy” and doesn’t remember what happened immediately following her fall. She was injured when she collided with another player and fell backward, striking her head on the ground. She has no vomiting and denies diplopia but complains of significant headache.

PE: Physical examination is negative except for the presence of slight nystagmus. All other neurologic findings including fundoscopic examination are normal.

To prepare:

  • Review “Neurologic Disorders” and “Musculoskeletal Disorders” in the Burns et al. text.
  • Review and select one of the three provided case studies. Analyze the patient information.
  • 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 patients and families on the treatment and management of the musculoskeletal or neurologic disorder.

NURS 6541: Primary Care of Adolescents and Children

By Day 3

Post an analysis of your assigned case by responding to the following:

  • What additional questions will you ask?
    • Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).
  • What additional examinations or diagnostic tests, if any will you conduct?
  • What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.
  • What is your most likely diagnosis and why?
  • How will you treat this child?
    • Provide medication treatment and symptomatic care.
    • Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
  • Patient Education, Health Promotion & Anticipatory guidance:
    • Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
    • Include any socio-cultural barriers that might impact the treatment and management plans.
    • Health Promotion:
      • What immunizations should this child have had?
      • Based on the child’s age, when is the next well visit?
      • At the next well visit, what are the next set of immunizations?
      • What additional anticipatory guidance should be provided today?

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the wayslisted below. Respond to colleagues who selected different case studies than you did.

  • Explain how culture might impact the diagnosis, management, and follow-up care of patients with the musculoskeletal and/or neurologic disorders your colleagues discussed.
  • Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.

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NURS 6541: Primary Care of Adolescents and Children

NURS 6541 Week 11: Evaluation and Management of Hematological and Metabolic Disorders

Hematologic and metabolic disorders often require long-term treatment and management plans. In your role as an advanced practice nurse, you support patients, their families, and other members of the care team throughout this process as adherence to some plans can be difficult. Consider Charlie Rider. At age 4, Charlie was diagnosed with acute lymphoblastic leukemia and underwent care for 4 years. When he was finally strong enough to return home from the hospital, there were many restrictions placed on him because his body was vulnerable to infection. He could not go to indoor gatherings, eat in restaurants, or have friends visit. These restrictions were part of the management plan set up for Charlie (Dana-Farber/Children’s Hospital Cancer Center, 2013). As an advanced practice nurse, you work with pediatric patients like Charlie and their care teams to help develop and facilitate management plans for various hematologic and metabolic disorders. It is important to consider factors that impact these plans, as each patient has unique needs and circumstances.

This week you explore hematologic and metabolic disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives

By the end of this week, students will:

  • Assess pediatric patients for hematologic and metabolic disorders
  • Evaluate differential diagnoses for pediatric hematologic and metabolic disorders
  • Analyze treatment and management plans for pediatric patients with hematologic and metabolic disorders
  • Analyze strategies for educating patients and families on the treatment and management of hematologic and metabolic disorders
  • Evaluate the impact of culture on the treatment and management of hematologic and metabolic disorders
  • Understand and apply key terms, principles, and concepts related to hematologic and metabolic disorders in pediatric patients
  • Assess pediatric patients with signs of hematologic and metabolic disorder

Final Exam: Week 11

This Exam covers the content you have explored throughout Weeks 7-11 of this course. This Exam is a test of your knowledge in preparation for your certification exam. No outside resources including books, notes, websites, or any other type of resource are to be used to complete this quiz.

You have 200 minutes to complete the Exam. You may only attempt this Exam once.

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