NUR-507cL D1 response

· You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts formatted and cited in current APA style with support from at least 2 academic sources . Your reply posts are worth 2 points (1 point per response.) 

· All replies must be constructive and use literature where possible.

Response to Posts of Peers

Distinguished - 2 points Student constructively responded to two other posts and either extended, expanded or provided a rebuttal to each.

Fair - 1 point Student constructively responded to one other post and either extended, expanded or provided a rebuttal.

Poor - 0 points Student provided no response to a peer's post.

2 points

RESPOSE 1

Weekly Clinical Experience

Did you face any challenges, any success?

I found my first week of pediatrics clinical to be very interesting and different compared to the other clinical experiences that I had. Communications skills with children and their families are the base to form a positive relationship from the first interaction. These skills have an even greater influence in pediatrics since the way a physician educates a family about their child's illness affects subsequent physician -patient and physician-caregiver relationships. If the practitioner possesses both interpersonal and communication abilities, the child's parents or caregivers will collaborate with him in treating the child's condition, which will result in a positive clinical outcome. I hope by the end of my clinical rotation to gain the necessary skills to gain the parent’s confidence and to be able to build a practitioner-patient- caregivers relationship based on trust.

Describe the assessment of a patient, detailing the sign and symptoms, assessment, plan of care and at least three possible differential diagnosis with rationales.

R.H. is a 10-year-old male who presents to the clinical accompanied by his mom, with chief complaint of pain and redness in both eyes’ onset 3 days ago. Per his mom, she noticed this morning that her son could barely opened his eyes because of the eye discharge. R.H. states that his eyes are more painful with the movement and that warm compresses that his mom provided it helps. Patient states his pain is like a 5 on a scale from 0-10, is moderate, and described as itching. Constitutional patient is negative for chills or fever. HEENT negative for trouble swallowing. Eyes positive for pain, redness.Visual acuity 20/30 in both eyes. Pupils sensitive and equally reacting to light and accommodation. Conjunctiva red, eyelids with mild discharge. Respiratory negative for shortness of breath, lungs clear upon auscultation. Cardiovascular negative for chest pain and leg swelling. Musculoskeletal: no tenderness, normal range of motion in all extremities. Cervical back with normal range of motion and neck supple. Skin is warm with no visible discoloration or lesions. Neurological, no focal deficit present and she presents 5/5 motor bilaterally, normal speech, no dizziness, no gaze preference. Per mom patient has no allergies to medications, food, latex, or environmental.

Diagnosis: Conjunctivitis (H10.9)

Plan of care :

Visual acuity.

Polytrim (polymyxin B sulfate and trimethoprim ophthalmic solution) drops: instill one drop in the affected eye every three hours for 7 days.

Educate parent on proper use of the drops to avoid autoinoculation.

Clean the eyelashes several times a day with no -tears shampoo and warm water from inner canthus outward using a different cloth for each eye (Burns, et al., 2017).

Use warm soaks three or four times a day.

Patient and family should be instructed that conjunctivitis is highly contagious in the first 48 hours after treatment begins. Patient should use care when coming in close contact with others. Patient should avoid touching eyes, and not share towels and washcloths (Dunphy et al., 2019).

Return to the clinic in one week or go to the nearest emergency room if symptoms get worst or vision is affected.

Differential diagnosis:

Blepharitis, an inflammation of the eyelid margin brought on by irritants, contact lenses, , and infections. Poor hygiene, tear deficiency, rosacea, and seborrheic dermatitis of the scalp and face are also possible etiologic factors. Eyelids that are erythematous, edematous, and itchy as well as blurry vision with blinking are among the clinical symptoms (Burns, et al., 2017).

Dacryocystitis which is a blockage of the nasolacrimal duct that can lead to an infection in the lacrimal sac. Clinical manifestations include purulent discharge, tearing, edema, erythema, and pain in the lacrimal sac area (Burns at al., 2017).

Hordeolum, or stye, is an infection of either the sebaceous glands, the eyelids, or the meibomian glands of the eyelid. Clinical manifestations include a tender, swollen red furuncle. The patient complains of a foreign body sensation (Burns at al., 2017).

Mention the health promotion for this patient.

Patient and family educated on a healthy diet and the importance of maintaining a healthy weight. Patient and family educated on the importance of a good hygiene, importance of vaccination, and annual checkups.

  What did you learn from this week’s clinical experience that can be beneficial to you as an advanced nurse practitioner?

The medical field is undoubtedly one of the most demanding and rewarding of all, and to interact with patients and parents effectively across a wide range of socioeconomic and cultural backgrounds, practitioners must constantly improve their interpersonal and communication skills. As a student, I plan to implement various care concept into daily practice, based on training and education, to effectively manage and implement culturally proficient care.

Support your plan of care with the current peer -reviewed research guideline.

Conjunctivitis is as commonly presenting disease at ophthalmology clinics, caused mainly by viral infections, allergic reactions, or atopy. Environmental factors have also been implicated in incidences of conjunctivitis. Studies show that effect on environmental pollution can affect the ocular surface and therefore leading to conjunctivitis (Nam et al., 2022).

RESPOSE 2

1. Did you face any challenges, any success? If so, what were they?

The first week of starting a new clinical rotation always seem like the hardest to me and poses the most challenge. Firstly, the office is very busy, and I have no experience with children so I found that to be the most challenging. Day one I was a little overwhelmed but by day three, I was able to grasp the flow of the office and interact more with the care of the children. The success I would say was being able to complete my first head to toe assessment on a toddler, with the guidance of my preceptor, of course. I am looking forward to learning as much as I can from my pediatrics rotation.

2. Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.

This week’s patient that I would like to discuss is Christopher, a 3-year-old male who presents to the office with his mother, with complain of right ear pain. Per patient’s mother, “Chris has been increasingly irritable and has been pulling at his right ear for the past two days.” The vital signs were taken with BP:98/60, (sitting) Temp: 100.3 F (orally); H.R.: 115 ; R.R.: 22; Ht: 76 cm; Wt: 13kg. BMI (percentile): 20.5 (45%)

Focused Assessment:

Generally, the patient is healthy and appears well nourished.  He appears to be irritable     and cries intermittently. Patient noted to be pulling and guarding his right ear a lot. The patient's physical exam revealed HEENT- Normocephalic, with a regular hair    distribution. No masses or lesions noted on head. Eyes: PERRL, Sclera clear, conjunctiva pink. Lids normal. Patient is seen tugging and guarding ear, indicative of pain.  Nose with no deformity or discharge. Mouth/Throat: Oral mucosa pink and moist. Cardiovascular function with normal S1 and S2, no murmurs. The rate and rhythm are regular. No cyanosis or pallor. Capillary refill is < 2 seconds for bilateral upper and lower extremities. Respiration function with clear auscultation. The respiratory rate is regular and unlabored. Gastrointestinal with the soft, non-tender, non-distended abdomen. Bowel sounds are present in all four quadrants. Normal range of motion with normal strength to all four extremities, no tenderness on palpation, no swelling noted to musculature, no swelling or abnormalities noted to joint.

 Otoscopic examination was performed:  Erythema of the middle ear and bulging  of eardrum noted.

Plan of Care:

 Acute Otitis Media (AOM)  is an infection of the middle ear caused by bacteria or viruses. It is most common in infants and toddlers during the winter months (Chiappini & Marchisio, 2019). Acute otitis media (AOM) is the most common diagnosis in childhood acute sick visits. By three years of age, 50% to 85% of children will have at least one episode of AOM  (Chiappini & Marchisio, 2019). Symptoms may include ear pain (rubbing, tugging, or holding the ear may be a sign of pain), fever, irritability, and sometimes vomiting or lethargy  (Chiappini & Marchisio, 2019). The plan of care for the treatment of AOM includes pain management and antibiotics  (Chiappini & Marchisio, 2019). For Christopher, he has no known allergies according to his mother, so amoxicillin 90mg/kg twice daily for ten days will be prescribed. He will also be prescribed 160mg/5ml Tylenol every 4-6 hours as needed to manage fever and pain. Christopher’s mother should be educated on ensuring that he doesn't place any objects inside in his ears and ensues that she gives him all doses of his antibiotics, even if she notices he’s getting better. Christopher should return to the office in one week for a follow up. What did you learn from this week's clinical experience that can beneficial for you as an advanced practice nurse?

Differential Diagnosis

Upper Respiratory Infection (URI): Patient is having ear pain and there is fluid noted behind  the patient’s ear. Also has low grade temp. This could be an early sign of a URI.

Sinusitis: Patient has fluid behind the ear and redness noted in the ear canal. Also has low grade temperature.

Otitis Externa: Patient is pulling his left ear lobe and according to the patient’s mother he has been much more irritable lately.

3. what did you learn from this week?

I learned a lot from this week’s clinical experience. As I previously stated, I have no experience with the pediatrics field of nursing so this week I was able to learn about the stages of development and how to treat the different conditions affecting the Peds world. I also learned that it is important to listen attentively to the parent's concern even if the child is there only for a well visit. 

4. Support your plan of care with the current peer-reviewed research guideline.

Acute otitis externa is diagnosed in symptomatic children with moderate to severe tympanic membrane bulging or new onset otorrhea not brought on by the condition, as well as in children with modest bulging and either recent start ear pain (less than 48 hours) or significant tympanic membrane erythema (Venekamp et al., 2018). Depending on the patient's age, the severity of their symptoms, and whether they have unilateral or bilateral AOM, the recommended course of treatment may be observation, pain management, or antibiotics (Venekamp et al., 2018). When antibiotics are prescribed, the first line of treatment is usually high-dose amoxicillin (80 to 90 mg per kg per day in two divided doses) unless the patient has previously received amoxicillin for AOM within the previous 30 days or has concurrent purulent conjunctivitis; in these circumstances, amoxicillin/clavulanate is usually prescribed (Venekamp et al., 2018).  Based on the potential for cephalosporin allergy, cefdinir or azithromycin should be used as the first-line antibiotic in patients with penicillin allergy (Venekamp et al., 2018). Tympanostomy tubes should be considered when a child has three or more AOM episodes in six months or four episodes in 12 months with one event in the previous six months (Venekamp et al., 2018).