Practicum: Journal Entry – Custom Nursing Help

Case study
Patient is a 20 months old African American female who was brought to the pediatric office by her mother with a chief complaint of diarrhea and vomiting for 3 days. Mother stated that her stools as liquid and foul smelling, with no mucous, slime or blood. Mother states that her baby is unable to keep anything down, vomiting after each feeding, including water. Her baby has had about 5 episodes of diarrhea and 4 episodes of vomiting a day. Mother reports that her baby is not feeding well and her activity level has decreased, she looks weak and tired to her . And in the last few hours, she has a decreased number of wet diapers. Mother reports that her last weight at 18 month check up was 24 pounds .
Exam: VS T 37.0, P 110, RR 25, BP 100/75, weight 23 pound, HT 33.7 inches . She is alert, sitting on her mother’s lap , looks tired and cries sometimes during the exam. HEENT: anterior fontanel closed, minimal tears, lips dry, mucous membranes tacky, no oral lesions or erythema, TMs normal. Her neck is supple. Heart exam reveals mild tachycardia, no murmur. Lungs are clear. Abdomen is flat, soft, and non-tender with hyperactive bowel sounds. No wet diaper during the exam. Moves all Her extremities. No rashes present. Her capillary refill time is less than 3 seconds and her skin turgor is slightly diminished.
Possible Diagnosis: Gastroenteritis and Dehydration
Reflect on a this pediatric patient above who presented with gastrointestinal disorders during your Practicum clinical experience. Describe your experience in assessing and managing the patient and his or her family as their primary care practitioner. Include details of your “aha” moment in identifying the patient’s disorder as relates to your class reading and references. Then, explain how the experience connected your classroom studies to the real-world clinical setting.
Class Reading /References
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.
◦Chapter 32, “Gastrointestinal Disorders” (pp. 739–788)
•Diagnosis, management, and prevention of rotavirus gastroenteritis in children by Parashar, U.D., Nelson, E.A., Kang, G. in BMJ. 2013 Dec 30;347:f7204. doi: 10.1136/bmj.f7204. Copyright 2013 by BMJ Publishing Group. Reprinted by permission of BMJ Publishing Group via the Copyright Clearance Center.
•Blackmer, A. B., & Farrington, E. A. (2010). Constipation in the pediatric patient: An overview and pharmacologic considerations. Journal of Pediatric Health Care, 24(6), 385–399.
Centers for Disease Control and Prevention. (2003). Managing acute gastroenteritis among children: Oral rehydration, maintenance, and nutritional therapy. Morbidity and Mortality Weekly Report, 52(RR-16), 1–20. Retrieved from http://www.cdc.gov/mmwr/PDF/RR/RR5216.pdfRunning head: EVALUATION OF BEHAVIOURAL AND MENTAL HEALTH 1
EVALUATION OF BEHAVIOURAL AND MENTAL HEALTH 2
Journal Entry
Gloria Okoye
Walden University
NURS – 6541N – 1
Prof. Nogueira
06/23/16
WK 4 Journal Entery Topic:Assessment and Management of Behavioral and Mental Health Patient
Eating disorder is defined as the behavioral and mental disorder that is characterized by the abnormal eating habits that may result to serious fatal illness that may lead to severe disturbances and discomfort to a person. Binge Eating Disorder (BED) is an example of eating disorder that is characterized by the recurrent intake of food in large quantities and at a fast rate that often leads to the patients’ discomfort. The psychological result of this condition is usually shame and distress (Burns, Brady, & Starr, 2013).
Assessment and Management of a Behavioral and Mental Health Patient
A 7 year old African American male patient visits the clinic in the company of the father and the parent explained that the child has been experiencing difficulties and discomfort in his abdominal areas such as swollen stomach or a full bladder. Father states that he has no fever, vomiting , bowel changes . He has been current with his immunization and has no developmental problem. After evaluation it is noted that the bowel movements of the patient are normal. On further inquiry it is noted that the patient takes in a lot of food and water frequently. The eating schedule for the patient has not been recorded. During the examination time , I noted the patient opening a candy bar one after the other for a total of three in a span of 5 minutes. After questioning the patient, he showed signs of anxiety and shame and commented that he was tense, his father states that he ound out that eating makes him calm down when they go to the doctor’s office or when he is uncomfortable.
On assessment, he weighes 70 pounds, HT 45.5 inches with BMI of 153.4 which puts him on obese. V/S :WNL
Diagnosis and Medical Goal
I informed the patient’s’ parent that the patient is not sick, but has a condition named Binge Eating Disorder (BED) that is characterized by the patient irregular eating patterns, large amounts of food intake than for normal patient, continuous eating, secretive eating, depression and shame after the eating. The parent affirmed to this thinking that the patient had a healthy eating pattern.
My “aha” moment was when I experienced the patients fast food intake in the form of a candy bar that contains enough calories to sustain a heavy breakfast and snack in less than five minutes. This is when I remembered of the characteristics of BED such as fast and in large quantities of food intake (Hagan, 2014). In addition to this, the patients’ response in shame and disgust and his acute obesity portrayed the characteristic that the patient has an eating disorder.
My goal of treatment was to regulate the patients eating pattern so as to control the behavior and mental health, so in collaboration with the parent, we schedule a calories-based timetable and quantity scheme that he is supposed to take with strict regulation from the parent (Jonovich, 2014). Vitamin additives accompanied the meals so as to ensure that there is no interference of patient’s body requirements. Referral for family group program was set up for evaluation of any underlying depression , anxiety or any other psychosocial issues at this time and to also teach him better way to manage stress also counselling for any deep issues or emotion that child and parents might be dealing with.
Lab: cholesterol , thyroid , BS to check for medical condition that can cause unhealthy eating habit.
F/u scheduled for 1 month for feedback on the eating schedule and goal
References
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Paediatric primary care (5th ed.). Philadelphia, PA: Elsevier.
Hagan, J. F., Jr., Shaw, J. S., Duncan, P. M. (Eds.). (2008). Bright futures: Guidelines for health supervision of infants, children, and adolescents (3rd Ed.). Elk Grove Village, IL: American Academy of Paediatrics
Jonovich, S. J., & Alpert-Gillis, L. J. (2014) Impact of paediatric mental health screening on clinical discussion and referral for services. Clinical Paediatrics, 53 (4), 364-371 Retrieved from the Walden Library databases
 
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