Discussion Peer/Participation Prompt
Instructions:
Please respond to two peers’ post regarding their differential diagnosis list and/or plan.
What did you find interesting about their response?
How did their differential diagnosis list or plan compare to yours?
Do you agree with their plan and recommendations?
Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Estimated time to complete: 2 hours
need 2 peer responses i will provide both peer posts below
peer#1
Amanda Holman
SundayMay 22 at 3:12am
Unit 3 Discussion C.C. 5-year-old well-child visit
Positive Information
Wt.: 97 lbs. (98.3%), BMI: 22.54 (97%).
The patient was delivered via cesarean section for being in a breech position.
Father vapes at home.
Dental caries on B, C, M, L.
Negative Information
The patient reports liking school and has made some friends.
Patient reports enjoying PE.
Father denies concerns with development, behavior, or nutrition.
There were no complications at birth.
There were no complications throughout the pregnancy.
The infant’s mother denies tobacco use, drug use, or alcohol use during pregnancy.
The infant was breastfed.
Parents drink less than or equal to 2 drinks with dinner only.
Allergies: No known drug allergies.
Takes a daily vitamin.
The home is free from firearms.
The patient was born at 39 weeks gestation.
The child lives with her mother and father who have been married for 2 years.
Parents report employment.
No family medication problems established
Denies any concerns, unexplained fevers, growth, and developmental concerns.
Denies any rash, lesions, or concerns with eczema.
Denies headache, trauma, or falls.
Denies any concerns with ears, nose, or throat.
Denies pain with ROM neck. Denies masses or lumps.
Denies any chest pain, cyanosis, heart racing, or sweating.
Denies any cough, congestion, wheezing, or difficulty breathing.
Denies food intolerances. Denies weight loss, nausea, vomiting, constipation, or diarrhea.
Negative for burning or blood in the urine.
Denies pain, trauma, or numbness.
Denies changes in senses.
Denies difficulty concentrating, tearful episodes, anxiety, or seclusion.
Denies increased thirst or urination.
Denies bruising or bleeding.
VS: Temperature: 98.1 F, 107/62, HR: 66, RR: 20, 100% on RA, Ht: 55 in (93.52%),
Well developed, well-nourished, and hydrated, with no apparent distress. Appropriate dressed.
No evidence of rash or lesions
Normocephalic.
The lids and conjunctiva are normal. Pupils are irises are normal fundoscopic exam reveals red
reflex present bilaterally.
Normal external ears and nose. Normal external auditory canals and tympanic membranes.
Hearing is grossly normal.
Oropharynx: normal mucosa, palate, and posterior pharynx.
Supple and no lymphadenopathy.
Normal rate and rhythm. Normal S1 and S2 heart sound heard on auscultation with no S3 or S4. No
murmurs. Femoral pulse 2+ bilaterally.
Normal respiratory rate and pattern with no apparent distress. Bilateral breath sounds clear on
auscultation without rales, rhonchi, or wheezes.
Normal bowel sounds. No masses or tenderness or organomegaly were observed.
Normal female genitalia. Tanner stage 1.
Grossly normal tone and muscle strength. Normal range of motion in extremities.
Other information
Other information I would obtain includes if anyone else lives in the home, last dental visit, last vision visit, last hearing test, how long the father has vaped in-home, flossing routine, brushing routine, activity levels/exercise, immunization history, language spoken in the home, and food/drink preferences or diet choices. I would also assess for financial need and ensure alcohol and vape supplies were kept in a place the child could not get access to.
Differential Diagnoses
1. Dental Caries, unspecified K02.9
2. Body Mass Index, pediatric greater than or equal to 95th percentile for age Z68.54
3. Other problems in social environment Z60.8 (vape exposure in-home) or contact with and suspected exposure to environmental tobacco smoke Z77.22
a. Diagnostic
N/A
b. Therapeutic
N/A
c. Education
Educate patient and parents on the importance of a healthy lifestyle. Provide verbal and written information on healthy food choices, portions, drink choices, and at-home exercise ideas. Encourage child and family to take advantage of balanced school meals when available. Explain the importance of vaping cessation to the Father and the negative side effects of secondhand exposure in the household. Assess for readiness for nicotine cessation and collaborate if needed. Provide information on proper brushing techniques and the importance of avoiding sugary beverages and candy to help prevent dental caries.
d. Collaboration
Refer to pediatric dentistry office for evaluation and treatment of dental carries, Xrays, and cleaning. Refer to Nutritionalist for further information or outreach on healthy food choices, preparation, and caloric intake. Refer to local YMCA or equivalent for activity programs if family and patient seem interested. Refer Father to cessation outreach if needed to support vaping cessation if he chooses to do so. Follow up in an office in two months to evaluate for progress. Flag chart to follow up and ensure the patient is seen for dentistry concerns.
Health promotion
Health promotion for this age group would include avoiding exposure to secondhand smoke, wearing a seatbelt, staying up to date on immunizations, attending yearly medical physicals, screening for hearing needs, screening for vision needs, correcting current dentition concerns, following up for dental cleanings every 6 months, increasing access to healthy food choices, and increasing physical activity. (Centers for Disease Control and Prevention, 2022)
Developmental milestones
According to the Mayo Foundation for Medical Education and Research (2021), developmental milestones for this patient would include rhyming, ability to tell others their name, rule-following, gender awareness, stand on one foot for 8 seconds without falling, skip, understand common foods, recognize money, copy shapes, count to ten, and use the restroom without help.
References
Centers for Disease Control and Prevention. (2022). Promoting health for adults. Centers for Disease Control and Prevention. Retrieved May 22, 2022, from https://www.cdc.gov/chronicdisease/resources/publications/factsheets/promoting-health-for-adults.htm (Links to an external site.)
Mayo Foundation for Medical Education and Research. (2021). Child development: Know what’s ahead. Mayo Clinic. Retrieved May 22, 2022, from https://www.mayoclinic.org/healthy-lifestyle/childrens-health/in-depth/child-development/art-20045155
Reply
peer #2
Whitney Bowles
MondayMay 23 at 11:26am
NU632 Unit 3 Discussion Case
Pertinent Positives:
Social History: father vapes in the home, both parents consume alcohol
Family History: Mother and father deny any significant medical history
BMI: 22.54 (97%)
HR: 66
Pertinent negatives:
Father reports no concerns with development, behavior or nutrition.
There were no complications throughout the pregnancy.
ROS is negative
Physical exam is without abnormal findings.
Additional information I would obtain would include any extended family medical history of conditions such as hypothyroidism, obesity or adrenal gland disorders. I would also like to get an assessment of daily nutritional intake at each meal to assess for intake of high sugar, high fat and high calorie substances. Assessment of daily activity for the family can also help gauge level of exercise.
Differential Diagnosis:
Obesity
Cushing syndrome
Hypothyroidism
Discussion:
Childhood obesity is on the rise and has become a global pandemic. Childhood obesity can lead to an increase in the risk of mortality and morbidity as well as chronic conditions such as hypertension and cardiovascular disease (Smith et al., 2020). Based on the height and weight of the child her body mass index is in the 99th percentile which is defined as obese. In order to promote wellness, the child’s weigh needs to be addressed. Education regarding proper dietary intake, increasing activity and drinking plenty of water should be discussed with the parent and child.
In addition, other diagnoses such as Cushing syndrome and hypothyroidism should be ruled out. Cushing syndrome may be an unlikely cause as the child’s vertical growth is adequate in the 93% range. A cortisol level could be drawn to assess for abnormalities. Hypothyroidism is another differential that should be ruled out. Hypothyroidism can result in weight gain, fatigue and insomnia. To assess for this a TSH, T3 and T4 should be ordered and drawn (Leung & Leung, 2019).
Dependent on the diagnosis, careful follow up should be warranted. Childhood obesity can result in multiple medical syndromes so discussion with the parents on the importance of addressing is a top priority.
Lastly, I would reassess the child’s resting heart rate as it is below the normal standards. An expected heart rate for a five-year-old child would be between 76-120 and this child’s falls below that. If the child looks well it is not an emergent concern but would want to be further assessed for normal parameters.
References
Leung, A., & Leung, A. (2019). Evaluation and management of the child with hypothyroidism. World journal of pediatrics : WJP, 15(2), 124–134. https://doi.org/10.1007/s12519-019-00230-w (Links to an external site.)
Smith, J. D., Fu, E., & Kobayashi, M. A. (2020). Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities. Annual review of clinical psychology, 16, 351–378. https://doi.org/10.1146/annurev-clinpsy-100219-060201
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