NURS 6541 Week 4 Discussion: Evaluation & Management of HEENT Disorders
NURS 6541 Week 4 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. NURS 6541 Week 4 Discussion: Evaluation & Management of HEENT Disorders.
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 14-month-old brought Native American boy 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 she has rice cereal popping in her throat.” Mom is worried because her son seems to have a lot of ‘bouts of colds”. Per mom, he oral intake is decreased. He didn’t want to eat this morning.
PE: Smiling, alert Caucasian boy.
VS: Temp of 99.9, pulse 112, resp. 42 reveals the following: respiratory rate is 58 HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip.
CV: Her capillary refill is less than 3 seconds
PULM: lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields. NURS 6541 Week 4 Discussion: Evaluation & Management of HEENT Disorders.
Case Study 2
HPI: Kevin is a 5-year-old with an intermittent 2-day history of nasal congestion and cough in the early morning. Her mother reports thick, green nasal discharge. She is afebrile, and appetite and sleep are normal.
PMH: A smiling Asian American boy 5-year-old, 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 distressed.
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 for NURS 6541 Week 4 Discussion: Evaluation & Management of HEENT Disorders:
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? NURS 6541 Week 4 Discussion: Evaluation & Management of HEENT Disorders.
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Week 6 Discussion: Diagnosis and Management of Respiratory, Cardiovascular and Genetic Disorders
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: A 14-month-old brought Native American boy 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 she has rice cereal popping in her 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 Caucasian boy.
VS: Temp of 99.9, pulse 112, resp. 42 reveals the following: respiratory rate is 58 HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip.
CV: Her capillary refill is less than 3 seconds
PULM: lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields. NURS 6541 All Weeks Course Discussions
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 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 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: respiratory rate 18,
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. NURS 6541 All Weeks Course Discussions
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. NURS 6541 All Weeks Course Discussions
NURS-6541 Week 7 Discussion: Diagnosis and Management of Skin Disorders
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. NURS 6541 All Weeks Course Discussions
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 a differential diagnosis 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 a differential diagnosis 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. NURS 6541 All Weeks Course Discussions
NURS-6541 Week 9 Discussion: Diagnosis and Management of Genitourinary Disorders
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 weeks 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. She’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 Week 10 Discussion: Diagnosis and Management of Musculoskeletal and Neurologic Disorders
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.
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.