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EDITOR
CONTRIBUTORS
My intention in writing this book was to provide examples that could be used without the need for adaptation. I would like to thank the many wonderful and expert clinicians who contributed their time and energy to the writing of this book.
Introduction
Illness, injury or illness can drastically change roles inside and outside the family system. When thinking about family practice, it is also important to recognize that the family is a system.
Remembering that the patient is part of a subsystem within the larger family system can help the reader understand that the patient's illness or condition not only affects the patient, but potentially has a ripple effect on many others within and outside the system. of the family. AD LIB: At liberty or whenever the patient wants to do something AMI: Acute myocardial infarction or heart attack.
Clinical Case Studies for the Family Nurse
The Neonate
Cardiovascular Screening Exam
SUBJECTIVE
OBJECTIVE
CRITICAL THINKING
What is the treatment plan and what should be the plan for follow-up care. Are there any standardized guidelines you should use to evaluate or treat this case?
RESOLUTION
Functional closure of the ductus occurs within 15 hours of birth in a normal full-term infant, but true closure with the inability to reopen takes about 3 weeks. There are no standardized guidelines in the literature for the assessment and/or treatment of patent ductus arteriosus.
- Pulmonary Screening Exam
- Skin Screening Exam
- Oxygenation
- Nutrition and Weight
No standardized guidelines for the assessment and/or treatment of transient tachypnea in neonates have been found in the literature. Risk factors for transient tachypnea in newborns in infants delivered vaginally at 37 weeks or later.
The Infant
Nutrition and Weight
Diet: Nelson's diet history shows that he successfully transitioned to a whole milk diet. Regarding Nelson's diet, there are two possible diagnoses: risk of constipation and risk of iron deficiency anemia.
Health Maintenance
However, based on Juancarlos' history of receiving a low-iron formula, the health care provider may consider obtaining a hemoglobin test to check for iron deficiency anemia. For the 9-month visit, the health care provider should discuss safety issues such as car safety (having the child in a rear-facing car seat) and water safety (water temperature < 120 degrees; never leaving the baby alone in the bath; keeping the toilet lid and bathroom door closed; empty mop buckets after each use).
Growth and Development
Given Kierra's history and physical examination and the elimination of the previous diagnoses, non-organic FTT is the most likely diagnosis at this time. Kierra's caregiver has not cared for an infant in the past, so it may be that she is unaware of the caloric needs of a 9-month-old.
Heart Murmur
Respiratory: RR = 24; clear in all patches; no accidental sounds noted; no withdrawals; no deformities of the thoracic cage noted. However, if any of the above studies were ordered, no abnormalities would be noted on the test.
Cough
Unnecessary painful interventions that can cause restlessness and increased oxygen demand in the child should be avoided. A single dose of dexamethasone (0.15 mg/kg) should be administered in the office and the child should be monitored for recovery.
Diarrhea
Observing Daniel's general appearance, he is alert and comforted by his mother when he cries. The most common differences in someone with Daniel's history are viral gastroenteritis, antibiotic-related diarrhea, and lactose intolerance.
Fall off Changing Table
Vance's vital signs have been measured and his weight in the office today is 5.24 kg. There are no known associations between unintentional head injury and ethnicity or gender in pediatric patients.
The Toddler/Preschool Child
Earache
Julia's external ear reveals that the pinnae are normal and the external ear is not sensitive to touch. Cholesteatoma should be considered in the differential because of Julia's past diagnosis of otitis media.
Bedwetting
Family Medical History: J'Quan's mother (26 years old) and father (26 years old) are healthy and have no history of chronic medical conditions. Telephone follow-up can be conducted with J' Quan's family to monitor progress over the next year until his 5-year healthy child visit.
Burn
Fatima's external ear shows that the pinnae are normal and that the external ear is not sensitive to touch. The goal of treating Fatima's second-degree burn is to reduce pain and prevent infection.
Toothache
Lamin's external ear reveals that the pinnae are normal and there is no tenderness to palpation of the external ear. Prevention of dental diseases (good oral hygiene and regular dental check-ups) should be discussed with Lamin's parents.
Abdominal Pain
Jasmine's parents should be educated about constipation, including management guidelines and when to seek medical care. American Academy of Pediatrics - Medical Specialty Society (2005) also developed guidelines for the diagnosis and treatment of chronic abdominal pain in the pediatric population.
Lesion on Penis
Lionel's external ear reveals that the pinnae are normal and the external ear is not sensitive to touch. Part of the head is visible; and no discharge, erythema, or swelling is observed.
The School - Aged Child
Skin Rash
Bacterial culture: Positive for Staphylococcus aureus + / − Streptococcus pyogenes • Bacterial culture of nares: Negative or positive for Staphylococcus aureus. Methicillin-resistant Staphylococcus aureus (MRSA) accounts for up to 80% of all cases of impetigo in some areas of the country.
Eye Irritation
Examination of the oropharynx shows normal size tonsils 0/4 without exudates or drainage. Other family members, including close contacts of the patient, should use good hygiene and handwashing practices (AAO, 2008; Cronau et al., 2010).
Cough and Diffi culty Breathing
Once the diagnosis of asthma is established, the severity of a patient's asthma can be graded, based in part on the frequency of symptoms, physical examination findings, and severity of exacerbations. Medicinal treatment should be started as soon as the diagnosis of asthma exacerbation is confirmed.
Obesity
Sleep apnea should also be considered because of the history of snoring; however, it is a less common complication in obese children accounting for approximately 7% of cases (Mallory et al., 1989. It is associated with loud snoring and labored breathing and only occurs in a small percentage of obese children.
Sore Throat
Bony landmarks are visible and no fluid is noted behind the tympanic membranes. There is nothing in this patient's psychosocial history that would affect how this case is treated.
Rash and Fever
Angela's outer ear reveals that the needles are normal and that there is no tenderness to touch the outer ear. There is no inflammation of her tonsils and no oral lesions were observed.
Incontinence
Sometimes children with type 1 diabetes mellitus are asymptomatic and the diagnosis is made after an incidental finding during a physical examination. The difference between type 1 and type 2 diabetes is that the insulin deficiency in type 2 is relative and not absolute.
Disruptive Behavior
Family history: Jack's mother has a history of Hashimoto's thyroiditis and depression and has been treated for both conditions. Jack's behavior is more extreme than his peers and interferes with his social and academic development.
Nightmares
Night terrors (sometimes known as sleep terrors) occur in stage IV of the sleep cycle. Including Dexter's grandmother in the treatment plan may also help reduce or reduce the occurrence of night terrors.
The Adolescent
Birth Control Decision - Making
Keisha's history of unprotected sex and her last menstrual period (LMP) 32 days ago raise concerns about possible pregnancy and sexually transmitted diseases. If Keisha gets her period, she can call the clinic and get DMPA within the first 5 days of her cycle.
Funny Feeling with Urination
What diagnostic or imaging studies should be considered to help or confirm the diagnosis. He should be encouraged to tell all previous partners and his current partner about chlamydia.
Weight Loss
Susie may have questions or information for you that she is not comfortable discussing in front of her mother. Do you have headache, visual changes, constipation or diarrhoea, abdominal pain, dry skin, excessive fatigue.
Menstrual Cramps
Endometriosis should be considered if Dina has a positive family history of endometriosis in a first-degree relative. Symptoms of primary dysmenorrhea usually peak in the first 48 hours of menstruation.
Mother ’ s Concern
Which aspects of the physical examination would you like to pay special attention to? It is also important to ask why he is taking his mother's painkillers.
Sexual Identity
The non-disclosure agreement and the reasons why non-disclosure must be broken (abuse, suicide, murder) must be explained to the young person at the first visit and as necessary. Explain the "confidentiality agreement" and inform the young person when it can be broken.
Missed Periods
Why is it important to ask Shana what she feels her boyfriend would want if she were pregnant. If Shana's pregnancy test is negative today, she should come back in 2 weeks for a repeat test if she has not had a period.
Left Knee Pain and Swelling
It is important to gauge the patient's reaction to the situation and determine the need for a mental health referral. If the patient was over 18 years old, she would probably have a skeletally mature skeleton; and standard adult reconstruction procedures could be used.
Women ’ s Health Cases
Headache
Rarely, she has had a headache after a stressful day, but denies premenstrual headaches or frequent headaches until 2 weeks ago. The headaches tend to last a few hours and go away when she can sleep.
