26 Mar Keisha has come in for her annual well-child visit
Case Scenario 1: Keisha has come in for her annual well-child visit. Keisha enjoys preschool, she has been a healthy child, and she is at the 50% for height and weight. On exam, you note a Grade III/VI, mid-systolic murmur, heard best in the left sternal border.
• What additional information should the APRN know about Keisha? • What tests should the APRN order? • What should the APRN specifically include in the cardiac physical examination? • How should the APRN approach referrals?
Case Scenario 2: Mr. Jones has brought in his 3-year-old daughter Clara to be seen for vomiting and diarrhea for 2 days. He states that last night she vomited 3 times. She weighs 15kg. This morning she vomited her breakfast of pancakes and sausage.
• What more does the APRN need to know about Clara’s symptoms? • What should the APRN look for in the physical examination? • What are the signs and symptoms of dehydration? • What are 3 differentials the APRN should consider? • What is the calculation for pediatric volume replacement? • What type of anticipatory guidance should the APRN give Clara’s father?
Case Scenario 3: Mark is a 5-year-old male who was brought into the clinic today for a well-child exam. His mother reports that she is concerned that Mark wets his bed at night 3 to 4 times per week. She is at her wit’s end and does not know what to do.
• What does the APRN need to know about Mark’s condition? • What are some of the possible causes for Mark’s condition? • What strategies should the APRN share with Mark’s mother to help him stay dry at
night?
Case Scenario 4: Lindsey is an 8-year-old female brought into the clinic today for an evaluation of a “bad cough” for 2 weeks. She was diagnosed with a URI a week ago. Her vital signs are the following: Temperature 98.6° F, HR: 80, RR: 24, BP 110/50, Pulse Ox: 95%. She is alert and does not appear to be in distress. On exam, you note that she has inspiratory and expiratory wheezes and mild tracheal retractions.
• What more does the APRN need to know about this child? • What treatment(s) should the APRN provide in clinic today and why? • What diagnostic tests should the APRN order today and why?
• What education should the APRN provide Lindsey and her family?
Case Scenario 5: Wendy is a 13-year-old female who comes into your clinic with a complain of a sore throat, pain with swallowing, fevers of 102 F, headache, and body aches x 3 days. She weighs 110 pounds and has NKA. On exam you note erythema on the tonsils and pharynx, tender cervical lymphadenopathy, and no exudates.
• What is the standardized Brodsky tonsils grading scale? • What is the Centor Criteria? • What diagnostic studies should the APRN consider? • How should the APRN manage her symptoms? Be specific about treatment and
rationale. If prescribing, include dosages, precautions, and follow-up • How would you manage Wendy’s treatment plan if she were allergic to penicillin? If
prescribing, include dosages, precautions, and follow-up. • When can Wendy return to school?
Case Scenario 6: Luis is a 12-year-old male who lives in a dilapidated, older apartment complex. He has had a chronic cough since moving into that apartment building 8 weeks ago. His asthma has worsened despite using his albuterol inhaler more than usual (3 times a day or more) and steroid inhaler, complains of shortness of breath, wheezing, and chest tightness, and a dry cough at night and early morning hours (waking him up 2-3 times a week). Luis has had to miss school and is too tired to play with his friends.
• What diagnostic tests might you perform and why? • What is the gold standard for diagnosing asthma? • How would you manage his asthma symptoms? • What type of education should you give parents and Luis? • What is the proper way to use a metered dose inhaler?
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