NR 602 Week 5 Case Study Discussion Issues in Growth

Case Study Discussion – Part 1

What additional OLDCART and ROS information would you like? Why?

Differential diagnoses with rationale?

Further history and ROS needed to more fully develop your differential diagnoses?

Case Study Discussion – Part 2

Please add the following to your response:

Primary diagnoses and differential diagnosis with rational and the following in brief for your primary diagnosis:

Case Study Discussion – Part 3

Written summation of case in SOAP format.

Case Study Discussion – Part 1

What further OLDCART and ROS information is important today specific to their chief complaints? What are their chief complaints/concerns? NR 602 Week 5 Case Study Discussion Issues in Growth

What are the differential diagnoses based on the chief complaints for Lily and Riley with rationale?

Case Study Discussion – Part 2

Assessment
Primary diagnoses for Lily and Riley with rationale
Differential diagnoses with rationale
Plan for one primary diagnoses based on one current evidence-based journal article
Further diagnostic work-up not included above
Medications
Referrals
Conservative measures
Patient education
Follow-up plan

Case Study Discussion – Part 3

Written summation of case in SOAP format.

Child with Fever and Respiratory or Skin Issues

Kayla brings Riley, now 17 months, in for complaint of fever and rash. The fever began “a couple of days ago” and is of normal levels in the morning then gets as high as 103 to 104 degrees in the afternoons. Riley has also had clear rhinorrhea and in the last 24 hours he has developed a red, diffuse rash to the torso and abdomen that does not itch and a dry cough in the last day. Mother reports he is drinking, but not as well as usual. He did have a good wet diaper this morning, but is not really eating much and is not playing. NR 602 Week 5 Case Study Discussion Issues in Growth

Medications: Mother is giving OTC Robitussin cough and cold at 1 tsp last night and this morning. Liquid Tylenol ½ a tsp last night and this morning.
She is very concerned about the level of the fever and the fact that after 3 days he is not improving.
Discussion Questions Part One

We will begin by focusing on gathering history in an ill child.

What ‘red flags’ did you note in the historical data?
What data is most important to include in this particular case and which historical data that might be gathered on a well-child exam can be left out of this ill visit?
What are your differential diagnoses? NR 602 Week 5 Case Study Discussion Issues in Growth
What parts of the physical exam will you focus on today to rule in or out your differentials?
Discussion Part Two (graded)

Physical Examination Riley:
V/S: Height: 81 cm (31.89 in), Weight: 13 kg (28.66 lbs), B/P: 94/60, T: 100.6, HR: 114 BMP/reg., Resp: 28, reg, non-labored, SpO2: 97%
17 months old, Height 51st percentile, Weight 87th percentile (CDC, 2016)
General: somewhat lethargic and cries some throughout exam. SKIN: Diffuse erythemamtous rash in fine popular patches across the torso and very erythematous to the cheeks. HEENT: Head normocephalic atraumiatic. Conjuctiva clear, non-icteric, but mildly injected PERRL. Unable to complete fundoscopic exam. Tympanic membranes intact with scant clear fluid posteriorly bill and mild injection. EAC unremarkable. NR 602 Week 5 Case Study Discussion Issues in Growth

Pinna/tragus w/o tenderness. Nares patent, mucosa mildly injected with sl. edema to the inferior and medial turbinates bill, moderate clear rhinorrhea. Pharynx with mild slight erythema, tonsils 2/4 bill. Oral exam unremarkable. Neck supple w/mild anterior cervical lymphadenopathy bill. Thyroid small, firm, equal bill. CARDIOPULMONARY: Heart RRR w/o murmur. Lungs with mild expiratory wheeze in posterior bases. Respirations even and unlabored. Abdomen rounded normative bowel sounds throughout, soft, non-tender, no masses or organomegaly. NR 602 Week 5 Case Study Discussion Issues in Growth

Lab: WBC 6.9, Lymph 50%, Neutrophils 40%, Monocytes 6%, Eosinophils 3%

Discussion Questions Part Two

After reviewing the physical exam.
What were your ‘red flags’ on physical exam?