discussion

QUESTIONS TO INCLUDE IN THE RESPONSE OF THE CASE STUDY

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· Explain any red flags that you think your colleagues may have missed.

· Explain whether you would have interpreted any of the red flags differently.

· Explain the next steps you would recommend for this patient in terms of treatment and management.

· Explain how the management plan might change if the patients in the case studies your colleagues selected were at a different age.

CASE STUDY #1

After reviewing the subjective and objective findings provided in the case study information, there are certainly some aspects that raise developmental red flags. The nurse practitioner should discuss weight gain with the parent as her BMI is likely on the higher limits of normal, although it is impossible to determine the percentile without knowing her length. Most infants triple their birth weight within the first year of life and Brittany’s is greater than triple her birth weight (Hagan, Shaw, & Duncan, 2017). Although the amount of milk the child is consuming daily is within normal range, she may be consuming a large number of empty calories from other sources of nutrition. Physical milestones that are of concern include that the child does not walk independently at the current age of 16 months. Although it is on target for the child to mimic adult behavior and follow commands at this age, it appears that Brittany has a speech delay that should be investigated since the child has a four-word vocabulary.

Differentiation Between Normal and Abnormal Growth and Development

Brittany appears to be growing appropriately based on the information provided in the case study. Her parents should be informed of her actual BMI as determined by the World Health Organization (World Heath Organization [WHO], 2010).  As it pertains to speech development, a child at this age should have increased interest in naming pictures, have increased use of real words, and jargon should be sentence-like (Burns et al., 2017). Although a more in-depth examination should be provided by the practitioner, the developmental red flags that have been established in this assignment should be addressed with the parents to ensure the child gets the resources needed to get back on track; this will prevent missing any additional milestones.

Standardized Tools Used in Patient Care

The body mass index (BMI) tool should be used to discuss the child’s weight and growth progression (WHO, 2010). The BMI tool is useful in helping the family to understand where Brittany’s physical development as compared to other kids her age. Another standardized tool that should be used in Brittany’s care include The Capute Scales: Cognitive Adaptive Test and Clinical Linguistic and Auditory Milestone Scale as this tool is used in children from the ages of birth to 36 months (Burns et al., 2017). This tool helps test language and problem-solving skills to help with deciphering the speech problem. These standardized tools will help improve the overall development of this toddler and will also be useful in helping the family to understand how to be proactive in helping Brittany meet her milestones.

Health, Promotion and Anticipatory Guidance

By the age of sixteen months, the child should have received certain immunizations including: Hepatitis B (HepB); Rotavirus (RV); Diphtheria, tetanus, & acellular pertussis (DTap); Pneumococcal conjugate (PCV13); Haemophilis influence type b (Hib); Inactivated poliovirus (IPV); Influenza; Measles, mumps, rubella (MMR); Varicella; and Hepatitis A (HepA) (American Academy of Pediatrics [AAP], 2019). If the child is up to date with the recommended immunizations, the next set would begin at eighteen months of age, if the child is behind on vaccinations then the next action is catch up on all late or missed vaccinations. The recommended vaccinations at eighteen months of age include the third dose of HepB, the fourth dose of DTaP, the third dose of IPV, second dose of HepA, and Influenza if flu season (AAP, 2019). This child should return to clinic for the next set of immunizations at eighteen months of age or sooner if needed for sickness or other concerns from parents. It is likely that the practitioner will refer this child to a speech therapist and if weight gain does not plateau then a dietician may also be recommended to assist the parents with options for healthier choices.

Summary

Each child should be assessed holistically as their developmental progression will be unique and should be treated as soon. Although every child will not meet the milestones they are projected to meet at the textbook age, it does not mean the child will not meet the milestone. Some children need a more individualized and/or specialized approach. It is the responsibility of the nurse practitioner to adequately assess the patient to help discover the delays early-on to ensure they receive the individualized plan of care they require.

 

 

 

 

References

American Academy of Pediatrics. (2019). Immunization Schedules for 2019. Retrieved from https://redbook.solutions.aap.org/SS/Immunization_Schedules.aspx

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017). Pediatric Primary Care (6th ed.). St. Louis, Missouri: Elsevier.

Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2017). Bright futures: Guideline for health supervision of infants, children, and adolescents (4th ed.). Elk Grove Village, IL: American Academy of Pediatrics.

World Health Organization. (2010). National Center for Health Statistics. Retrieved from https://www.cdc.gov/growthcharts/who_charts.htm