1) What additional questions would you like to ask prior to beginning your physical examination of the patient? (Select 5-7 of the most important questions)
? Any unusual frequent or several colds
? Any mouth infections or sores
? Did teeth erupt on time
? Does the child use bottle
? Does she sleep with a bottle
? Is her immunization up to date
? Has anyone else at been sick
? Is the discharge from the nose watery, purulent or bloody
? How high is her temperature
2) What components should your physical examination include?
? Inspection pg 382 look and listen to determine if there is poor air movement during breathing.
3) What equipment will you make sure to have with you when you begin your assessment
? Otoscope with short wide-tipped nasal speculum attachement
? Two tongue blades
? 4 x 4 cotton gauze pad
4) How will you assess the patient’s developmental level?
? Will check her weight and height to see if its within the expected percentile
? Will check if she met the expected milestones at the right time like when did she say her first words, did her teeth erupt on time and were they in the right position
? Does she sit or walk alone. Does she climb and skips
? Does she stack blocks, use crayon to draw, and feed herself
? Does she have speech problem
? Does she socialize
? How does her development compare to her siblings or peers
5) What should you consider when preparing to examine the patient?
? Consider giving her a toy
? Do the oral exam towards the end of the complete examination
? Play games with her
? Sit on her mothers lap
5b) The nurse practitioner writes an order for lab work, so you need to draw blood. What strategy will you use to successfully draw blood from the patient who is crying and upset.
? Distract the child with a toy and have the mother hold her down
6) After evaluating ordered lab work, the physician admits the patient to the pediatric unit at the hospital. What is the potential impact of hospitalization on the patient’s growth and
? This can hinder or delay the acquisition of motor skills
? Can affect ability to control and direct voluntary muscle movement
? Hospitalization may negatively impact the child’s ability to reach milestone like toileting , autonomy etc
? Changes in routine can alter sense of security
? Exposure to loud noises, bright lights and sudden movements can be perceived as traumatic
? Separation between a child and caregiver due to hospitalization can be distressing and impact on developing or maintaining secure attachment.
7) What are some of the barriers/obstacles you need to consider, recognizing that the patient’s mother does not speak or understand English well?
• Cultural factor
8) Based on the information provided in the case study, what are two possible diagnoses this patient might be given? How would you differentiate between these two possibilities
• Seasonal allergies
• Pocket book of hospital care for children—-who
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