Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and possible differential diagnosis.

The cases have to be pediatric cases seen in an doctors office visit. I will, in addition, attach the class book to use as a reference. Instructions: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 possible differential diagnosis.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 1:The first day of my pediatric rotation was met with much anticipation and excitement. This is a specialty that I am extremely interested in and can picture myself practicing shortly. My preceptor and the office staff were incredibly warm, welcoming, and took the time to explain many of their office protocols and I was able to witness what a typical day in the pediatric office consisted of. Having had three years of experience in the area of pediatrics I had a basic understanding of what a newborn and infant assessment consisted of. I felt very comfortable assessing the newborns with the assistance of my preceptor nearby to answer any questions the parents had. One of the successes I had during my first week of pediatric rotations was to learn of the importance of a thorough infant assessment. A comprehensive and throughout patient health assessment is the first step in developing a plan for the best treatment and overall health of the patient. When a comprehensive patient assessment is conducted, any underlying or potential health issues may be found as they did with one of my first patients.M.G., a three-week-old infant presented to the clinic with intolerances to the Enfamil formula he has been fed since birth. His mother began getting worried when the infant began presenting with symptoms of digestive problems including colics after feeding, large amounts of spitting up the formula, gassy, and fussiness after feeds. According to the mother, the infant continues becoming increasingly restless and tenses his legs, arms, and abdomen hours after feeds as if the infant is noticeably upset. My preceptor suggested the mother switch the infant to Nutramigen, a hypoallergenic formula that is easily digested and which causes minimal discomfort to infants. This formula may be immediately switched and was even given samples in the office before purchasing later on during the week.After my preceptor interviews the mother regarding the type and amount of formula the infant receives, burping habits, and background information regarding anything else the infant ingests and questions inquiring about newborn care, my preceptor begins to assess the infant. Immediately we noticed the infant had difficulty turning the neck toward the right side of the shoulder. He did not have any difficulty turning to the left side of the shoulder. We noticed the infant had an inclination to turn the chin away from the contracted muscle and the head was tilted toward the affected muscle. My preceptor inquired how long this had been occurring. The mother, seemingly unaware this could be a sign something was wrong with the infant answered the infant had done this since birth. My preceptor believed this infant was suffering from Congenital Muscular Torticollis. Congenital muscular torticollis (CMT) is a common postural deformity evident shortly after birth, typically characterized by ipsilateral cervical lateral flexion and contralateral cervical rotation due to unilateral shortening of the sternocleidomastoid muscle (Sargent, 2019).My preceptor educated the mother on the signs and symptoms of these conditions and the reasons why this happens. One of the reasons may be the way the infant was positioned in utero before birth. Physical therapy would be of great benefit to the infant. Prompt referral to a physician and physical therapist with experience in treating infants, as soon as CMT or asymmetry is noticed. Evidence shows that starting physical therapy earlier shortens the time to achieve normal neck motion while reducing the need for surgery. Physical therapy intervention is suggested to improve neck range of motion, strength, and postural alignment. Referrals to physical therapists (PTs) for CMT have continued to rise in recent years, perhaps due in part to the “Back to Sleep” campaign in the United States and Canada, as well as to improvement in physician identification of this condition (Kaplan, 2017). My preceptor asked the mother to come back to the clinic in one month for a follow-up examination to discuss how the infant is feeding with the new formula given as well as how physical therapy has been for the infant’s neck.This week was a great start to my pediatrics rotations. It has taught me the importance of not only meticulously and carefully examining our patients, but also the importance of being a critical thinker as a clinician. These traits are significant in not only becoming a good nurse practitioner but an exceptional one.ReferencesKaplan, S. L., Dole, R. L., & Schreiber, J. (2017). Uptake of the congenital muscular torticollis clinical practice guideline into pediatric practice. Pediatric Physical Therapy, 29(4), 307-313. DOI: 10.1097/PEP.0000000000000444Sargent, B., Kaplan, S. L., Coulter, C., & Baker, C. (2019). Congenital muscular torticollis: Bridging the gap between research and clinical practice. Pediatrics, 144(2), e20190 DOI: https://doi.org/10.1542/peds.2019-0582 582.sample 2:This week’s clinical experience was a bit daunting. We encountered a mother and her 6 y/o f child with PMH of Rolandic Epilepsy diagnosed by EEG at age 4 ½, who presents today after a visit to the ED 2 days ago for another seizure episode of her daughter, and ended before reaching the hospital. She’s is concerned about her daughter keeps having seizures more frequently in the past 2 months and last longer than usual. Her daughter was prescribed Dilantin 100 mg daily, but she admits that she’s not giving her the medication. She’s currently living with her daughter’s grandmother, father, brother, sister, and maternal grandmother.On Physical Exam: General: Pt is alert, responsive, and communicates at an age-appropriate level; Gross motor: Uses her arms and legs symmetrically, and has the strength to climb onto the exam table; no ataxia or movement disorder Gait: Walks with a stable gait; Cranial nerves: No abnormalities; Coordination: Can perform rapid alternating movements easily with hands and finger to her nose; negative Romberg test Sensory function: Intact; Reflexes: Symmetric (2+).Assessment and Plan: A mother and her 6 y/o f child with PMH of Rolandic Epilepsy diagnosed by EEG at age 4 ½, who presents today after a visit to the ED 2 days ago for another seizure episode of her daughter, and ended before reaching the hospital. She keeps having seizures more frequently in the past 2 months and last longer than usual. Her daughter has prescribed Dilantin 100 mg daily, but she admits that she’s not giving her the medication. Based on her Navajo’s cultural background, she believes that her daughter has a seizure because she looked at a sandpainting while she was pregnant.Problem #1: Non-adherent to MedicationAssessment: The mother mentioned to stop giving her the medication because she believes the medication is not helpful and based on her Navajo’s cultural background, she believes that her daughter has a seizure because she looked at a sandpainting while she was pregnant.Plan or care: Conflict tends to occur when the cultural background of a patient or family differs from our own and when one or more of the parties under stress. The communication barrier includes language barriers and a lack of understanding of the socio-cultural differences between healthcare providers and patients. The result can be mistrust, dissatisfaction, a higher incidence of illness, and poor outcomes. The practice of traditional medicine that is rooted in the patient’s culture is easily accessed by immigrant families. Often, they have brought with them the essential items for common remedies, or they may seek them in a neighborhood store with imported items from their native country. The store also may have information about persons in the community who are traditional healers or therapists. Many Latino immigrants rely on folk remedies which would be considered complementary and alternative medicines. Latinos commonly use herbs and medications brought from Central or South America or go to Mexico to purchase medicine or objects needed for cleansing, curing, or treating an ailment. Many Latinos rely on the combination of prayer, traditional medicine, and conventional medicine (Ransford et al, 2010). It is important to recognize the parallel utilization of health practices and use this as an opportunity to engage the family in decision making.For a better approach to improve understanding of potential risks and benefits of some traditional medicine used, hence a L.E.A.R.N communication model can be useful. Listen with empathy to the patient explanation of problems; Explain your perception; Acknowledge and discuss differences; Recommend treatment; Negotiate with the patient how the treatment will be carried out.Conversely, poor communication (paternalistic or controlled by the provider) has a higher potential for a poor outcome and malpractice litigation (Institute for Patient- and Family-Centered Care, 2010).Reference:Institute for Patient- and Family-Centered Care. Core concepts of patient- and family-centered care. http://www.ipfcc.org/pdf/CoreConcepts.pdf No pub date. Accessed August 12, 2014.Ransford, HE, Carrillo, FR, Rivera, Y. Health care-seeking among Latino immigrants: Blocked access, use of traditional medicine, and the role of religion. J Health Care Poor Underserved. 2010;21:862-78.Sample 3:This first week in Pediatric clinical for me was a complete challenge; we all know that our community, country, and the world are suffering the COVID 19 Pandemic. This disease changed our lives, how we work, act, and socialize daily. Mostly all providers are offering services by Telehealth and planning to open at the moment the county officers authorize so physically. The office in which I’m doing clinical is working partially, my preceptor and I meet the office personnel always keeping social distance, they explained to me the way patient’s visits are performed. Using an electronic platform, we see almost every patient, with the exception of infants and small children cases, that a preset appointment is made with one parent always following CDC practice during this Pandemic. It is required by the office and infection control guidelines the use of facemask by the parent and every child over three years of age to be able to receive service. The physical opening of the office will be gradually by capacity percentage and following social distance and CDC guidelines to prevent the spread of this viral infection among our population. The first day was to become familiar with the protocols, personnel, and dynamics of the office and be an observer during preceptor patient encounters. I was able to review guidelines by Pediatric organizations and groups regarding proper assessment, evaluation, and treatment of a pediatric patient. I was able to apply knowledge and experience I had about pediatric patients in a new way to provide care, a form of medicine known for years that become the current form of practice, during this world Pandemic: Medicine by Telehealth.The case that took my attention was a C.E 3-year-old female child with a Urinary Tract Infection. These days in which all families are practicing social distance by staying home, her mother states her child enjoys taking a hot tub bath, under her supervision, very frequently. And two days ago, she started to complain of pain during urinating, and she saw dark color urine. When she looked for other complaints, she found her daughter has lower abdominal pain and low-grade fever. For that reason, C. E’s mother contacted the provider’s office for a consultation. During the visit, the preceptor and I were able to assess the patient’s urine as cloudy and bloody, also noted by the mother that lately, C.E started to wet the bed, and she is already toilet trained. We proceed to prescribe treatment based on clinical symptoms described by the patient’s mother and encourage her to complete medication. Also, the parent has educated in the prevention of UTI and bladder infections by avoiding hot tub bath or swimming pools, and practice proper perineal hygiene. We order a Urinalysis and culture, advising the parent to take the child to the laboratory we sent an order for the study for a sample collection. Indication of proper treatment is implemented to prevent kidney infection and further complications; these infections can be dangerous and cause serious health problems in the child. The infection in C.E is treated it with antibiotics, increasing fluid intake, and adequate hygiene promotion. Further studies like Ultrasound and blood work must be indicated to look for another factor that may influence the infection like abnormal bladder function, constipation, urinary blockage, and poor toilet hygiene. A follow-up visit was scheduled to review the progress of the child and laboratory results, and the parent was advised to call the primary provider is C.E does not respond adequately to the treatment of if symptoms persist.It was an inspiring week, in which I applied nursing knowledge and parent experience in pediatric clinical practice.ReferencesHatch D, Hulbert W. (April 6, 2017) Pediatric urinary tract infections. American Urological Association. Retrieve from https://www.auanet.org/education/pediatric-urinary-tract-infections.cfm (Links to an external site.)Fisher DJ. (August 1, 2016). Pediatric urinary tract infection. Medscape. Retrieve from http://emedicine.medscape.com/article/969643