Week 4 DS post

Week 4 Discussion Part I

Table 1 Innocent versus Pathologic Murmur

Table 2 Pediatric Cardiac Conditions

Auscultatory Findings- Innocent versus Pathologic Murmur

Innocent Murmur - list 4 and describe the auscultatory findings

Pathologic Murmur – list 4 and describe the auscultatory findings

Complete the table.

Cardiac Condition Description Clinical Findings Treatment/ Management

Atrial Septal Defect

Ventricular Septal Defect

Tetralogy of Fallot

Coarctation of the Aorta

Transposition of the Great Arteries

Table 3 Differential Diagnoses for vomiting

Table 4 Do Not Miss GI Conditions

Fill in the table with 5 common differential diagnoses for a chief complaint of vomiting.

Differential Description Clinical Findings/ Presentation

Management

1.

2.

3.

4.

Fill in the following

Condition Description Clinical Features/ Presentation

Management

Foreign Body Ingestion

Appendicitis

Intussusception

Hirschsprung Disease

Pyloric Stenosis

Table 5 Enuresis

Table 6

GU Anomalies

List 4 differential diagnoses for enuresis.

Differentials Description Clinical Findings/ Presentation

Management

1.

2.

3.

4.

Complete the requested information related to Common Genitourinary Anomalies

Brief Pathyphysiolog y

Description Clinical Features

Management

Hypospadias

Epispadias

Hydrocele

Cryptorchidis m Testicular Torsion

Table 7 Respiratory Conditions in Children

Table 8

Differential Diagnoses for Pediatric Cough

Complete the information.

Condition Causative Agents Clinical Findings Treatment/ Management

URI "common cold"

Allergic rhinitis

Rhinosinusitis

Bronchiolitis

RSV

Pneumonia

Asthma

List the top 3 differential diagnoses for cc: “cough” in pediatric patients

Differentials Description Clinical Findings Treatment/ Management

1.

2.

3.

Table 9 National Asthma Education and Prevention Program Expert Panel Report (EPR3)

Complete the information below.

Asthma Classification and Step Before Treatment

Symptoms Nighttime Symptoms

Lung Function

Step 1: Intermittent

Step 2: Mild Persistent

Step 3: Moderate Persistent Step 4: Severe Persistent

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?