NR 602 Week 8 Reflection NEW

NR 602 Week 8 Reflection NEW

NR 602 Week 8 Reflection NEW

NR 602 Week 8 Reflection Recent

Over the past eight weeks the curriculum in this class, the instructor, my classmates, and my clinical preceptor have all taught me many things. This course has prepared me to meet the MSN program outcome #6, the MSN Essential VII, and the Nurse Practitioner Core Competencies # 8 in many ways.

NR 602 Week 3 PBL Case Study Discussion Assessment of a Child Recent

Child with Fever and Respiratory or Skin Issues

Riley, who is now 17 months old, is brought in by Kayla with a fever and rash. The fever started “a few days ago,” is mild in the morning, and rises to 103 to 104 degrees in the afternoon. Riley also experienced evident rhinorrhea, and during the past day and a half, he has also acquired a dry cough in addition to a red, widespread rash across his torso and belly that does not itch. He is drinking, but not as much as usual, according to his mother. Despite not eating or playing much, he did have a good wet diaper this morning.

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?

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. 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.

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?

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