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Nurse Practitioner Pediatric.
Describe your clinical experience as a Nurse Practitioner in a child and family clinic for this week/ 0-18yrs old
Weekly Clinical Experience 3 Describe your clinical experience for this week.
Did you face any challenges, any success? If so, what were they? 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. What did you learn from this week's clinical experience that can beneficial for you as an advanced practice nurse? Support your plan of care with the current peer-reviewed research guideline.
Sample Answer
Patient Case Study: Acute Illness
Client: Isabella (Age 6)
Signs and Symptoms (S&S) & Assessment
Chief Complaint: Sore throat for 2 days.
HPI: History of present illness includes the sudden onset of a sore throat 48 hours ago. States it hurts to swallow (odynophagia). Reports mild headache and subjective fever at home. No cough, no runny nose, denies difficulty breathing. She is drinking fluids well but has decreased appetite.
Vitals: T 101.5°F (Oral), HR 110, RR 20, O2 Sat 99% on room air.
Physical Exam:
HEENT: Pharynx is erythematous and edematous. Tonsils are enlarged (2+) with white/yellow patchy exudate bilaterally. No petechiae on the soft palate. Anterior cervical lymphadenopathy is tender bilaterally.
Lungs: Clear to auscultation bilaterally.
Skin: No rash noted.
Assessment: Based on the Centor criteria (or the modified version for children), Isabella scores high due to tonsillar exudate, swollen anterior cervical nodes, and fever. Rapid Strep Test was performed and was positive for Group A Streptococcus.
Plan of Care
Diagnosis: Group A Streptococcus Pharyngitis (Strep Throat).
Pharmacologic Treatment: Prescribe Amoxicillin 50 mg/kg/day orally divided into two doses (BID) for a 10-day course. The specific dosage would be calculated based on her weight.
Symptomatic Relief: Recommend Acetaminophen or Ibuprofen as needed for pain and fever control. Encourage cool fluids (popsicles, cool drinks) to soothe the throat and prevent dehydration.
Infection Control: Counsel the family on discarding her toothbrush after 2 days of antibiotics, washing linens, and ensuring she remains home from school/daycare until she is fever-free for 24 hours AND has completed 24 hours of antibiotic therapy.
Follow-up: Call/electronic message follow-up in 48 hours to ensure symptom improvement and medication adherence. Stress the importance of completing the full 10-day course to prevent complications like Acute Rheumatic Fever.
Differential Diagnoses (DDx) and Rationales
DDx
Rationale
1. Viral Pharyngitis
Most common cause of sore throat in children. Usually presents with associated upper respiratory symptoms (cough, rhinorrhea) and less prominent tonsillar exudate than bacterial causes. Less likely here due to the prominent exudate and high fever.
2. Infectious Mononucleosis (Epstein-Barr Virus)
Often presents with severe pharyngitis, tonsillar exudate, and significant cervical lymphadenopathy. Key differentiator is the presence of posterior cervical lymphadenopathy and often splenomegaly, which were absent in Isabella's assessment.
3. Peritonsillar Abscess (PTA)
A complication of tonsillitis. Presents with severe unilateral sore throat, fever, trismus (difficulty opening the mouth), and "hot potato" voice. Isabella's symptoms are bilateral and not severe enough to suggest PTA.
🍎 Health Promotion Intervention
The health promotion intervention for Isabella's family focused on Antimicrobial Stewardship and Comprehensive Hand Hygiene.
Antibiotic Education: Educated the parents on why Amoxicillin is the best choice for Strep throat and the critical importance of adherence to the full 10-day course (even after symptoms resolve) to prevent the long-term, non-suppurative complication of Acute Rheumatic Fever (ARF).