Module 06 Content

1. Purpose of Assignment
   This assignment will help to identify the normal growth and development by topic for each age group. In the final column of the assignment, you need to observe a child and apply the information you gathered and document your findings in comparison by the particular age of that child.

   Competency
   Compare principles of growth and development when caring for pediatric clients.

   Instructions
   Using the template linked below:
   Module-06-Worksheet-Development-Assignment.docx

   Explain the topics in the worksheet by age. Identify one milestone and one expected norm for each category by age group.
    

2. I attach the worksheet below for the assignment

   After you fill out the milestones and expected norms for each category by age group, observe a child of any age for 30 minutes to an hour, and apply the knowledge that you learned to the child you are observing and record this information in the purple Observation Data column.

    

• For this assignment, you are to complete a clinical case – narrated PowerPoint report that will follow the SOAP note example provided below. The case report will be based on the clinical case scenario list below.  

  You are to approach this clinical scenario as if it is a real patient in the clinical setting.

  Instructions:
  Step 1 – Read the assigned clinical scenario and using your clinical reasoning skills, decide on the diagnoses. This step informs your next steps.
  Step 2 – Document the given information in the case scenario under the appropriate sections, headings, and subheadings of the SOAP note.
  Step 3 – Document all the classic symptoms typically associated with the diagnoses in Step 1. This information may NOT be given in the scenario; you are to obtain this information from your textbooks. Include APA citations.

  Example of Steps 1 – 3:
  You decided on Angina after reading the clinical case scenario (Step 1)
  Review of Symptoms (list of classic symptoms):
  CV: sweating, squeezing, pressure, heaviness, tightening, burning across the chest starting behind the breastbone
  GI: indigestion, heartburn, nausea, cramping
  Pain: pain to the neck, jaw, arms, shoulders, throat, back, and teeth
  Resp: shortness of breath
  Musculo: weakness

  Step 4 – Document the abnormal physical exam findings typically associated with the acute and chronic diagnoses decided on in Step 1. Again, this information may NOT be given. Cull this information from the textbooks. Include APA citations.
  Example of Step 4:
  You determined the patient has Angina in Step 1
  Physical Examination (list of classic exam findings):
  CV: RRR, murmur grade 1/4
  Resp: diminished breath sounds left lower lobe
  Step 5 – Document the diagnoses in the appropriate sections, including the ICD-10 codes, from Step 1. Include three differential diagnoses. Define each diagnosis and support each differential diagnosis with pertinent positives and negatives and what makes these choices plausible. This information may come from your textbooks. Remember to cite using APA.
  Step 6 – Develop a treatment plan for the diagnoses. Only use National Clinical Guidelines to develop your treatment plans. This information will not come from your textbooks. Use your research skills to locate appropriate guidelines. The treatment plan must address the following:
  a) Medications (include the dosage in mg/kg, frequency, route, and the number of days)
  b) Laboratory tests ordered (include why ordered and what the results of the test may indicate)
  c) Diagnostic tests ordered (include why ordered and what the results of the test may indicate)
  d) Vaccines administered this visit & vaccine administration forms given,
  e) Non-pharmacological treatments
  f) Patient/Family education including preventive care
  g) Anticipatory guidance for the visit (be sure to include exactly what you discussed during the visit; review Bright Futures website for this section)
  h) Follow-up appointment with a detailed plan of f/u
  CLINICAL CASE SCENARIOA 7-month-old male child arrives at your clinic for a well-child examination. His family recently emigrated to the United States from West Africa. His medical history is positive for abdominal pain and his family history is positive for maternal hypertension and paternal hyperlipidemia. The father smokes a pack a day and smokes in the home. The child’s sole source of nutrition is goat’s milk. He appears to be healthy on examination and his point-of-care complete blood count shows large red blood cells. Today, his vitals are as follows: weight 18.3 lbs, height 27.2 inches, BP 80/56, HR 100, RR 26, and Temperature is 98.6 F.

  Diagnosis – Megaloblastic Anemia
  As you develop your narrated PowerPoint, be sure to address the criteria discussed in the video above and the instructions listed below:

  FOLLOW THE TEMPLATE BELOW for the Clinical Case Report – SOAP PowerPoint Assignment:

  DO NOT INCLUDE THESE INSTRUCTIONS IN THE POWERPOINT. POINTS WILL BE DEDUCTED. REFER TO THE EXAMPLE CASE REPORT FOR GUIDANCE.

  SUBJECTIVE (S): Describes what the patient reports about their condition.
  For INITIAL visits gather the info below from the clinical scenario and the textbook. DO NOT COPY AND PASTE THE SCENARIO; EXTRACT THE RELEVANT INFORMATION.

  Historian (required; unless the patient is 16 y/o and older): document name and relationship of guardian
  Patient’s Initials + CC (Identification and Chief Complaint): E.g. 6-year-old female here for evaluation of a palmar rash
  HPI (History of Present Illness): Remember OLD CAARTS (onset, location, duration, character, aggravating/alleviating factors, radiation, temporal association, severity) written in paragraph form
  PMH (Past Medical History): List any past or present medical conditions, surgeries, or other medical interventions the patient has had. Specify what year they took place
  MEDs: List prescription medications the patient is taking. Include dosage and frequency if known. Inquire and document any over-the-counter, herbal, or traditional remedies.
  Allergies: List any allergies the patient has and indicate the reaction. e.g. Medications (tetracycline-> shortness of breath), foods, tape, iodine->rash
  FH (Family History): List relevant health history of immediate family: grandparents, parents, siblings, or children. e.g. Inquire about any cardiovascular disease, HTN, DM, cancer, or any lung, liver, renal disease, etc…
  SHx (Social history): document parent’s work (current), educational level, living situation (renting, homeless, owner), substance use/abuse (alcohol, tobacco, marijuana, illicit drugs), firearms in-home, relationship status (married, single, divorced, widowed), number of children in the home (in SF or abroad), how recently pt immigrated to the US and from what country of origin (if applicable), the gender of sexual partners, # of partners in last 6 mo, vaginal/anal/oral, protected/unprotected.
  Patient Profile: Activities of Daily Living (age-appropriate): (include feeding, sleeping, bathing, dressing, chores, etc.), Changes in daycare/school/after-school care, Sports/physical activity, and Developmental History: (provide a history of development over the child’s lifespan. If a child is 1y/o or younger, provide birth history also)
  HRB (Health-related behaviors):
  ROS (Review of Systems): Asking about problems by organ system systematically from head-to-toe. Included classic associated symptoms (this includes pertinent negatives and positives).
  OBJECTIVE: Physical findings you observe or find on the exam.
  1. Age, gender, general appearance
  2. Vitals – HR, BP, RR, Temp, BMI, Height & Percentile; Weight & Percentile, Include the Growth Chart
  3. Physical Exam: note pertinent positives and negatives (refer to the textbook for classic findings related to present complaint and the diagnosis you believe the patient has)
  4. Lab Section – what results do you have?
  5. Studies/Radiology/Pap Results Section – what results do you have?

  RISK FACTORS: List risk factors for the acute and chronic conditions

  ASSESSMENT: What do you think is going on based on the clinical case scenario? This is based on the case. You are to list the acute diagnosis and three differential diagnoses, in order of what is likely, possible, and unlikely (include supporting information that helped you to arrive at these differentials). You must include the ICD-10 codes, the definition for the acute and differential diagnoses, and the pertinent positives and negatives of each diagnosis.
  You are to also list any chronic conditions with the ICD-10 codes.

  NATIONAL CLINICAL GUIDELINES: List the guidelines you will use to guide your treatment and management plan

  TREATMENT & MANAGEMENT PLAN: Number problems (E.g. 1. HTN, 2. DM, 3. Knee sprain), use bullet points, and include A – F below for each diagnosis and G – H after you’ve addressed all conditions.

  Example:
  1. HTN
  a) Vaccines administered this visit & vaccine administration forms given,
  b) Medication-include dosage amounts and mg/kg for drug and number of days,
  c) Laboratory tests ordered
  d) Diagnostic tests ordered
  e) Non-pharmaceutical treatments
  f) Patient/Family education including preventive care

  2. HLD
  a) Vaccines administered this visit & vaccine administration forms given,
  b) Medication-include dosage amounts and mg/kg for drug and number of days,
  c) Laboratory tests ordered
  d) Diagnostic tests ordered
  e) Non-pharmaceutical treatments
  f) Patient/Family education including preventive care
  Also discussed:
  g) Anticipatory guidance for next well-child visit (be sure to include exactly what you discussed during the visit; review Bright Futures website for this section)
  Return to the clinic:
  h) Follow-up appointment with a detailed plan for f/u and any referrals

  Submission Details:

  • Post the Week 2 Clinical Case Report SOAP Note Assignment to the Discussion Board below by the date assigned.
  • Name your Case Report SOAP note document NSG6435_W2_SOAP_LastName_FirstInitial.ppt.
  • Below is an Example Clinical Case Report – Remember yours must be narrated PowerPoint: 

The goal of this benchmark assignment is to gauge your ability to research and report on common ailments. You are encouraged to expound on each item to show your depth of understanding.

Essays: (at least 300 words each)

1. A 12 year old boy complains of achy joints usually after soccer practice. He complains of pain upon waking in the morning although pain lessens as he is more active during the day. He has been diagnosed with juvenile arthritis. What is the role of genes in the development of arthritis? 
2. Compare and contrast osteoarthritis and rheumatoid arthritis. 
3. A 79 year old male presents with a fever. Upon assessment it is noted that he has a large reddened area on his left calf. It is warm and tender to the touch. Compare and contrast the diagnosis of erysipelas and cellulitis. Which is the correct diagnosis? Why? 
4. Sally, a 43 year old female, is at her doctors for a regular checkup. During the exam, the doctor notices white patches inside Sally’s mouth. Sally tells the doctor that she noticed it as well but that it didn’t hurt so she wasn’t concerned. After Sally’s doctor asks a few more question, he finds out that she has been on antibiotics for just over a week. What is the correct diagnosis? What is the cause of these white patches and what treatment plan should be taken? Could Sally have prevented this outbreak? 

Discussion Prompt

Case Study
Anna Sanchez, a 21-year-old nursing student, comes to her nurse practitioner in December with a 5-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling” cough, especially at night, and she has had episodes of repetitive sneezing. She gets frequent “colds” every spring and fall.

Physical Examination

• Vital Signs: Afebrile; respiratory rate, pulse, and blood pressure all normal
• Skin: Flaking erythematous rash on the flexor surfaces of both arms
• Head, Eyes, Ears, Nose, and Throat:Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous with clear postnasal drainage (NOTE: Nasal polyps are common in allergic rhinitis. They are edematous protrusions of the mucosa that are infiltrated with neutrophils, eosinophils, and plasma cells.)
• Lungs: Clear to auscultation and percussion

Initial Post: Answer the following questions about Anna Sanchez and her condition.

1. What evidence suggests that Anna does not have an acute severe infection?
2. If Anna has allergic rhinitis, what type of hypersensitivity reaction is involved?
3. A skin test indicates that Anna is allergic to cat dander. Two months ago, Anna’s roommate brought home a cat. Why didn’t Anna’s symptoms start when the cat entered the household, rather than 3 weeks later?
4. What class of antibodies bind to the mast cells?
5. What physiological mechanisms caused the redness of Anna’s nasal mucosa?
6. What mechanisms caused Anna’s clear postnasal drainage?

Response # 1: Carefully read the initial posts made by the other students in your small group.

• Respond to the initial post of one of your peers in your discussion group. Identify 1 differential diagnosis for the case study presented. Identify the underlying pathophysiology and clinical presentation of the Differential Diagnosis you identified in your response to your peers. Please Note: you may not duplicate a differential diagnosis posted by another peer in the discussion thread.

Response #2: Go back into your own initial post.

• Identify what diagnostic testing or additional information you might need to establish a diagnosis.
• Identify what you believe is the correct diagnosis for the patient in the case study with the rationale for your response.
• Identify why the differential diagnoses left by your peers are or are not the correct diagnosis and support this with evidence from research and from the case posted by your peers.

Construct a detailed outline of one of the readings from Module 1 (your choice. A good outline will include a thesis of the article, as well as the important arguments and points offered in support of that thesis. 

The outline is worth 20 points and should be no less than 250 words in length. 

Outside research is not necessary, but if you use external sources you must provide complete citations. Your outline will automatically be checked for text that matches websites and other submitted outlines. Failure to cite your sources is academic misconduct and will result in a failure of the assignment.

I have provided a copy of how the outline should look!