Description
Please respond to discussion below using current APA edition and 2 scholarly references. Must be at least 150 words.
As previously mentioned, pediatrics will continue to be a challenge for me. Although I am comfortable working with peds in the emergency department setting, it is a little more overwhelming in the clinic. The success I had this week is that I was able to assess my patient’s lungs and report back to the physician what I heard and thought it was, and my assessment was correct. It boosted my confidence and helped me to trust myself more.
Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnoses with rationales.
A 9-year-old male presented to the office for abnormal lab results. The initial appointment was his annual, and neither the patient nor the mother had any complaints at the time. Labs revealed a Hemoglobin A1C of 5.9. No family history of diabetes.
Assessment: Pre-Diabetic
Plan of care: Lifestyle modification, change in types of food the child eats by changing what the mother cooks and purchases at the store. The whole family needs to help with changing what food the child consumes and what they consume. He will do as the family does. Educating the mother to also educate the father and siblings about the changes that need to be made as far as food consumption, moderation, and physical activity (Thipsawat, 2023). Repeat test in 3 months and follow up. Most children’s numbers improve with lifestyle changes alone.
Differential diagnoses:
Type 1 Diabetes Mellitus- The autoimmune disease known as type 1 diabetes (T1DM) is defined by the death of beta cells in the pancreas, which results in insufficient insulin production. It can present with high blood glucose levels, just like pre-diabetes. However, signs of T1DM typically appear sooner, including polyuria, polydipsia, and inadvertent weight loss. Examining the existence of autoimmune markers and the requirement for insulin therapy are key components in differentiating between pre-diabetes and type 1 diabetes (Akil et al., 2021).
Metabolic Syndrome- Several illnesses, including insulin resistance, dyslipidemia, hypertension, and abdominal obesity, are associated with metabolic syndrome. Features such as increased fasting glucose levels and central obesity may be present in children with metabolic syndrome. To differentiate metabolic syndrome from pre-diabetes, it is important to assess other components of metabolic syndrome and take lifestyle factors into account (Al-Hamad & Raman, 2017).
Insulin Resistance Syndrome- Insulin resistance syndrome is a condition marked by decreased insulin sensitivity, which is frequently linked to obesity. Blood glucose levels may rise as a result of this illness. Boys who have insulin resistance syndrome may exhibit symptoms like dyslipidemia, acanthosis nigricans (darkened skin patches), and abdominal obesity. Insulin resistance syndrome and pre-diabetes can be distinguished by taking lifestyle factors into account and doing a metabolic abnormality assessment (Al-Beltagi et al., 2022).
Mention the health promotion intervention for this patient.
A comprehensive strategy centered on lifestyle changes to enhance general health and stop the development of type 2 diabetes is used in the health promotion intervention for a young boy with pre-diabetes. Promoting a healthy, well-balanced diet, frequent physical activity, and supportive weight management ought to be prioritized. Making healthy food choices should be emphasized in the education of the child and their family, with a particular focus on cutting back on processed and sugary meals. To improve insulin sensitivity and maintain a healthy weight, regular physical activity should be promoted. Examples of this include playing energetic games and going for daily walks (Thipsawat, 2023). Crucial elements of the intervention include encouraging frequent blood glucose monitoring, scheduling follow-up visits with medical professionals regularly, and offering the child and family continuing support and information. The goal of this all-encompassing strategy is to reduce the young boy’s chance of getting type 2 diabetes later in life by enabling him to acquire and maintain healthy lifestyle habits.
What did you learn from this week’s clinical experience that can be beneficial for you as an advanced practice nurse?
I learned to trust myself and my assessment. Also, do not overthink when it comes to children. What it is, is what it is when it comes to kids. Additionally, education is very important, probably more so with the children’s population. As a provider, you have to educate the parents and have the parents work with you to give the child the best outcome for their health.
