Description
Please respond to discussion below using current APA edition and 2 scholarly references. Must be 150 words. Going into this week my goal was to continue to gain confidence with interacting with pediatric patients. With my patient population usually being adult patients in the Emergency Department it has definitely been an adjustment switching to pediatrics. A challenge I found this week was remembering all of the proper milestones the patients were supposed to be hitting. After talking to my preceptor, she demonstrated the built in resource that is a part of our charting system under review of systems that outlines the proper developmental milestones they should be at. From there, I was able to utilize this built in resource to not only use it to assess the patients, but to also review for my own knowledge.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. Mention the health promotion intervention for this patient.An 11 year old pediatric patient presented to the office for complaints of cough, congestion, fatigue, and right ear pain for two days. He noted a friend of his at school was recently sick with similar symptoms. The mother denied any recent travel. The mother denied the patient having any significant past medical history and denied the patient having any allergies. Upon assessment, erythema noted to bilateral nares with clear bilateral nasal drainage. Erythema noted of the middle right ear with slight bulging of the tympanic membrane. The left ear was normal with no evidence of erythema, no visible abnormality of the tympanic membrane present. The patient denied any abdominal pain or tenderness to palpation. No masses or palpable abnormalities of the abdomen noted upon light and deep palpation. Lung sounds clear in all regions with no adventitious sounds present. S1 and S2 present with no murmur, gallop, or other abnormal sound present at this time. Three differential diagnoses for this patient include influenza virus, coronavirus, and otitis media. Otitis media often presents and can be diagnosed based on bulging of the tympanic membrane and erythema of the tympanic membrane (CDC, 2021). In relation to influenza and coronavirus, both can present with similar symptoms that include nasal congestion, cough, fever, and other symptoms (Bai & Tao, 2021). Due to the patient experiencing right ear pain, fatigue, congestion, and cough, as well as being exposed to a sick contact, these differential diagnoses are possible for this patient. The plan of care for this patient included a rapid flu and rapid covid-19 test. The patient was positive for flu B, thus the patient was prescribed oseltamivir at this time. In addition to this, the patient was also prescribed Amoxicillin due to it being first line treatment for otitis media in pediatric patients (CDC, 2021). The patient and mother were educated regarding taking the antibiotic as prescribed, making sure to complete the entire prescription even if he begins to feel better. Health promotion for this patient also included encouraging an increase in fluid intake, as well as making sure to perform proper hand hygiene to prevent the spread of the illness.What did you learn from this week’s clinical experience that can be beneficial for you as an advanced practice nurse?One aspect from this week’s clinical experience that can be beneficial as an advanced practice nurse is to address both the pediatric patient and the caregiver. For example, the patient I spoke about prior to this section was 11 years old and was able to answer the questions regarding the symptoms he had been having. Although the mother had to step in and add some details, most of the story was able to be obtained from the patient. By including both the patient and the mother in the care, the patient felt more comfortable with the interaction and was open to having the physical assessment completed due to being the one that reported the symptoms to us. Thus, this demonstrated the importance of both family and patient interaction and the importance of making the pediatric patient as comfortable as they can be in this environment to facilitate and assist with getting the patient the proper care.
