Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.  

MC Discussion:

Nsg6435 Week 6 Discussion

Which essential questions will you ask this pediatric patient or his/her caregiver during this well-child check? Why are these questions important? What lab tests or diagnostic studies will you order and why?

From his previous visit I would ask how Benjamin is doing with his temper tantrums, and how Mom is addressing them. I would ask Mom if he were doing well without his bottle, as using a bottle after 2 years pus him at risk for dental caries. Asking Mom if she is teaching him to brush his teeth in the morning and before bedtime should be done now also (Policy on Early Childhood Caries (Ecc): Unique Challenges and Treatment Options. Council on Clinical Affairs. Adopted 2000., 2016).  Nutrition is important at this age, so I would ask Mom what type of foods he is eating now as he was noted to be a picky eater. I would ask Mom how he is doing with his potty-training. In addition, I would ask her how he is doing socially in preschool. It is also important to ask about family dynamics and if there have been any family stressors at home. Assessing safety will include asking Mom if she has the proper car seat and placing it forward-facing in the middle of the back seat (“Child Passenger Safety,” 2011). Talking to Mom about childproofing and storage of dangerous household chemicals is essential, as this is the most likely cause of child morbidity and mortality at this age. I would assess appropriate developmental milestones for Benjamin’s age at this time using the Bright Futures milestones guidelines (Hagan et al., 2017).

The only testing indicated today would be a fingerstick hemoglobin/hematocrit.

What diagnoses would you give the patient in this case? Include the findings that support the diagnoses.

Diagnosis 1: Atopic dermatitis, or eczema. After determining that no one else in the household has this rash, we can rule out scabies.

Diagnosis 2: Anemia, his Hgb is 10.5, which is low. This is  most likely iron-deficient considering his picky eating habits and his age.

What is your treatment recommendation and education for the patient and family? Why? Include anticipatory guidance.

For Benjamin’s eczema I would recommend the use of a topical otc 1% hydrocortisone cream topically to affected areas twice a day as needed. If the itching is keeping him up at night, he can have children’s Benadryl at bedtime orally as needed. If this doesn’t improve, we can add children’s Claritin once daily orally as needed. I would educate his mother to look for triggers that cause a rash, such as certain foods, grass etc.

Benjamin’s anemia can be treated by diet initially. His excessive cow milk intake can cause anemia because of its low iron content. Also limiting his juice intake should make him hungrier to eat meals. Iron-enriched cereals and vegetable should be encouraged. An iron supplement trial of 7 mg/day should also be initiated. Flintstone’s Complete vitamin gummies with iron meets this requirement. We will recheck this at his next visit, and if his Hgb is still low we can then obtain a CBC, ferritin, B6  and 12 level and iron level for further work-up (Hay et al., 2014).

References

Child passenger safety. (2011). PEDIATRICS, 127(4), e1050–e1066. https://doi.org/10.1542/peds.2011-0215

Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2017). Bright futures: Guidelines pocket guide (4th ed.). American Academy of Pediatrics.

Hay, Hay, & Hay. (2014). Current diagnosis and treatment pediatrics (22nd ed.). MCGRAW HILL.

Policy on early childhood caries (ecc): unique challenges and treatment options. council on clinical affairs. adopted 2000. (2016). American Academy of Pediatric Dentistry. Retrieved September 23, 2021, from http://www.aapd.org/media/Policies_Guidelines/P_ECCUniqueChallenges.pdf