NUR-507cL D2 Response

cLD2 Responses

• You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Each response should be 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.
• Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
• Your assignment will be graded according to the grading rubric.

Discussion Rubric
Criteria	Ratings			Points
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

 

#1

Did you face any challenges, any success?

This week my clinical experience was a valuable lesson and a learning opportunity in achieving my future goals as a nurse practitioner. Learning was made easier by the pleasant environment and my preceptor’s patience in answering all my inquiries. I came to the realization that clinical experience is a crucial component of my education because a nurse practitioner’s skills and degree of communication are different from those of a register nurse. I believe I’ve had a lot of success because patients and their families were willing to open to me about their conditions, and we developed a rapport right away. I now feel more confident in my abilities and the clinical field, and I believe that this experience will help me succeed in my career.

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

M.P. is a 4-year-old male child presents to the clinic accompanied by his mother with chief complain of fever and right ear pain onset one day. Per mom patient became fussy 3 days ago and he was not eating as well as he used to. This morning, patient woke up with 100.3 fever and complaining of right ear pain, and mom gave over the counter Motrin. She states that M.P. started to feel better after that. Patient points a pain of 6 on Wong-Baker FACES pain scale currently. During otoscope examination, right tympanic membrane is erythematous and visible yellow discharge observed in the external ear canal. Left ear tympanic membrane and ear canal normal. Negative for congestion, rhinorrhea, and sore throat. Eyes are negative for discharge and visual disturbance. No sclera icterus, conjunctivae normal. Per mom patient has no known allergies to drugs, latex, and environmental.

Diagnosis: Otitis Media [H66.90]

Fever [N50.9]

Plan of Care:

Amoxicillin-clavulanate: 8.5 ml by mouth every 12 hours for 10 days.

Children’s Tylenol 6 ml by mouth every 4-6 hours for fever.

Motrin 6 ml by mouth every 6-8 hours for fever or pain.

You may alternate the Tylenol and Motrin every 6 hours.

Education given to mom to start antibiotic immediately and look for signs of allergic reaction such as nausea, vomiting, diarrhea, rashes.

Take antibiotic with food to avoid upset stomach. Should diarrhea occur from antibiotic, give probiotics or yogurt for flora replenishment.

Encourage fluids during the day such as water, juices, and popsicles.

Keep the ears dry, no swimming, do not use q- tips to clean ears.

Follow up with pediatrician in 24-48 hours for re-evaluation.

Differentia diagnosis.

Otitis externa, also known as swimmer era, refers to an infection or inflammation of the external ear canal. Clinical manifestations include ear pain, pruritus, sensation of fulness in the ear, and hearing deficits (Burns et al., 2017).

Another differential diagnosis is TMJ syndrome. TMJ syndrome is caused by inflammation of the mastoid and can cause ear pain and fullness (Dunphy, 2019).

Cholesteatoma which results from a chronic ear infection and involves the formation of an epidermal inclusion cyst of the middle ear. Infection, hearing loss, dizziness, and facial muscle paralysis are some of the complications (Burns et al., 2020).

Mention the health promotion for this patient.

Mom educated on importance of vaccinations with pneumococcal vaccine, annual influenza vaccine, and to choose day care facilities with fewer children (Burns et al., 2017).

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

This week I have gained the teamwork experience in resolving patients’ problems and good communication skills with patients and their families. The moments of everyday caring change lives by elevating the voices of people and improving conditions for those around you. Building a patient-provider relationship and creating a follow up protocol for the patients is another way to build trust with the patients and their families. Caring, listening, and understanding patient’s needs are stages in a successful therapeutic relationship between patient and advanced nurse practitioner.

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

The risk factors for acute otitis media that studies identified were the cold season, male gender, premature birth, low birth weight, artificial alimentation in the first year of life, incorrect dietary diversification, child’s becoming a community member, higher number of siblings, association of respiratory tract infections, of chronic diseases or immune deficiencies, allergic status, exposure to pollutants. To prevent premature and late complications, it is important to accurately specify the diagnosis and establish individualized therapy according to guidelines. It is also essential to follow up and ensure directly observed therapy for children through the collaboration of a pediatrician with the family doctor and the ENT specialist (Drochioi et al., 2017).

 

#2

Discussion Post 2

I have been having a great experience with my preceptor. We are seeing lots of different pediatric patients for various things. Many well-child visits, but also a lot of sick visits. They have mentioned that sick visits have increased dramatically since Christmas. This week I had a patient come in with complaints of abdominal pain and vomiting. The patient is a 6-year-old male who has no significant medical history. Upon assessment, the patient appeared to be uncomfortable and was guarding his abdomen. His vitals were within normal limits, and he had no fever. His abdomen was soft but tender on palpation in the right lower quadrant. He also reported a decreased appetite.

Possible differential diagnoses for the patient’s symptoms include acute appendicitis, gastroenteritis, and constipation. Acute appendicitis is a possibility due to the tenderness in the right lower quadrant and decreased appetite. Gastroenteritis is another possibility due to the vomiting and abdominal pain, but the absence of diarrhea makes it less likely. Constipation is also a possibility due to the abdominal pain and decreased appetite (Garzon et al., 2019).

Based on the assessment, my plan of care for the patient includes further diagnostic testing, such as a urinalysis and a CBC to rule out any infections or inflammation. An abdominal ultrasound was ordered to visualize the appendix and rule out appendicitis. In the meantime, the patient will be advised to rest and drink plenty of fluids.

A health promotion intervention for this patient would be to encourage the child to eat a healthy and balanced diet that includes plenty of fruits, vegetables, whole grains, and lean proteins. Avoid foods that are high in sugar, fat, and salt. Encourage the child to drink plenty of water and limit sugary drinks. Encourage the child to engage in physical activity on a regular basis, such as playing outside, going for walks or bike rides, or participating in organized sports. Physical activity can help improve digestion and promote overall health and well-being (Jones et al., 2021).

Stress can worsen abdominal pain and vomiting, so it is important to help the child manage stress. Encourage relaxation techniques such as deep breathing, meditation, or yoga. Create a calm and supportive environment at home, and avoid exposing the child to stressful situations as much as possible. Encourage good hygiene as good hygiene practices can help prevent the spread of germs that can cause vomiting and other illnesses (Jones et al., 2021). Encourage the child to wash their hands regularly, cover their mouth when coughing or sneezing, and avoid sharing food and drinks with others.

We advised the patient’s mother that if the child’s symptoms persist or worsen despite the health promotion interventions, it is important to seek medical attention again to ensure that there are no underlying medical conditions that require further treatment. We did follow up with that patient and the ultrasound came back negative for appendicitis. The patient was severely constipated.

I learned this week that sometimes diagnosing is like piecing a puzzle together. We uncover and decipher the patient’s symptoms; even then, a clear diagnosis is not always apparent. It is important to look at all possibilities to find out what the diagnosis is. A fear of mine is that I will miss something and cause a patient harm.