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

Dear writer I need a clinical discussion week for a pediatric FNP class clinical rotation. This is for a clinical rotation shadowing a pediatrician in her office. Please pick a case to speak of seen at a pediatrician office not a hospital admission case. I will also provide a sample of a fellow classmate clinical experience post. in addition provide the class book please use it for discussion. Any questions let me know.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.Classmate post:This week was active in the pediatric clinic with many children and families getting back into their normal routine. Although many families are slightly apprehensive and hesitant about getting to their normal lives again, they are all taking the proper precautions to keep themselves and their children safe during the pandemic. Working together as a team along with the medical assistants and other nurses, we were able to keep the consistent and effective workflow in the pediatric clinic to tend to all the families and children coming in to be seen and treated. One child that was seen this week in our clinic was a young 14-year-old with generalized itchiness to her whole body. The patient states she has been itching over the last week and is not sure if she ate anything or was near anything that may have caused the itching to begin. She states she has not eaten anything unusual, does not take any medications, has not begun any new medications, does not have any pets, has not used any new or unusual lotions or soaps, was not bitten by anything unusual, and had not been near any plants or shrubs that may have caused the itching. The patient presents with red bumps over her entire body, but mainly on the neck, upper legs, and upper arm area. The area is red, itchy, swollen, and contain pruritic wheals. The wheals do not contain any fluid or pus-filled. The patient does not present with other signs and symptoms of anaphylaxis such as swelling and closing of the throat, trouble breathing, dizziness, fever, swelling of the eyelids, lips, or tongue. The patient has not been in contact with any changes in temperatures, extreme exercise, sunlight, or has dealt with any changes or stressors that may have caused her the urticaria.The patient was diagnosed in today’s visit with Urticaria. Urticaria is one of the most common skin disease, characterized by the development of wheals (hives), angioedema, or both and it is classified as acute or chronic form based on the duration of illness. Urticaria of longer than 6 weeks duration is classified as chronic urticaria, which is further classified into chronic spontaneous or inducible urticaria. Acute urticaria is more prevalent than chronic urticaria; however, chronic urticaria has a more significant impact on the quality of life due to recurrence and unknown etiology. Common causes or triggers of acute urticaria in children include infections, medications, and foods (Shin, 2017). Differential diagnoses of Urticaria could be Pediatric Contact Dermatitis, Atopic Dermatitis, and Urticarial Vasculitis. Wheals are a feature of other inflammatory diseases, including urticaria pigmentosa, urticarial vasculitis, auto-inflammatory syndrome (cryopyrin-associated periodic syndrome), and nonmast cell-mediated angioedema (hereditary angioedema and drug-induced angioedema). These diseases are not classified as subtypes of urticaria due to their different pathomechanisms. However, they should be considered in the differential diagnosis when a patient presents with urticarial manifestations (Choi, 2015). Urticaria, one of the most common skin diseases worldwide, is characterized by itchy wheals, angioedema, or both. Although urticaria most commonly presents in children as a single episode lasting several days or weeks, many infants and children suffer from persistent urticaria. Chronic urticaria (CU) in children is a complex condition that differs from that in adults. Urticaria manifests as wheals, angioedema, or both. A wheal is a central swelling of variable size, mostly surrounded by reflex erythema. It is accompanied by an itching or burning sensation and is transitory in nature. The skin returns to its normal condition within 2-24 hours after the appearance of symptoms (Choi, 2015).My preceptor scheduled for the patient to receive both an allergy panel testing as well as a CBC (Complete Blood Count), to better identify the cause of the patient’s generalized itchiness due to her Urticaria. These two tests would be reliable and helpful in diagnosing airborne allergies such as pollen, dust mites, as well as diagnose food allergies. Allergy testing in combination with blood tests such as the CBC, are helpful tools in determining substances the patient is allergic to and will help the physician create a most efficient treatment plan to alleviate and eliminate the signs and symptoms of the allergy. The patient was prescribed Clindamycin 300 mg 1 tablet to be taken orally every 6 hours for 10 days to eliminate the symptoms experienced by the patient. She was also prescribed Derma-Smoothe, a topical cream that can be applied directly to the area needed 3 times a day, avoiding the eyes, underarm, or groin area. Education was given to the patient and her mother on the benefits of using a gentle body wash and cream such as Cetaphil which will help in soothing the skin.Education played a large factor in our experience with this patient and her family. It is important to create a trusting bond and incorporative positive communication with our patients and their families to create a close patient-physician relationship. By doing this, our patients are better able to communicate their concerns with us, and we as health care providers are better able to treat and create better health care outcomes for our patients.ReferencesChoi, S. H., & Baek, H. S. (2015). Approaches to the diagnosis and management of chronic urticaria in children. Korean journal of pediatrics, 58(5), 159. DOI: 10.3345/kjp.2015.58.5.159Shin, M., & Lee, S. (2017). Prevalence and causes of childhood urticaria. Allergy, asthma & immunology research, 9(3), 189-190. DOI: 10.4168/aair.2017.9.3.189Classmate post 2:Module 4 Discussion Weekly ExperienceThis week the office continues giving services through telemedicine; many families agreed with new modality and found its comfort and a very accessible way of received medical services from their homes. Many events influenced these decisions, including the office personnel and my preceptor. The clinical experience I found very interested was the case of O.F, a 9-year-old child whose mother contacted the primary provider because the patient was complaining of ear pain for three days. O.F is a white, Hispanic, male patient with no known medication allergies, immunizations up to date, no surgical history, in proper compliance with annual check-ups and dental visits. The patient and his mother are aware of current COVID 19 viral infection and the importance of social distance and hand hygiene to prevent diseases and the spread of infection. O.F spends most of his time at home playing videogames but also time outdoor in the house pool, he is amiable and socializes well, lives in a smoke-free house, parents drink alcohol only socially and are very involved in his care. O.F complains of mild right ear pain accompanied by some pruritus; symptoms started about 4 days ago after spending some time swimming at their home pool. O. F’s mother denies any fever episode, dizziness, headache, nausea, vomiting, rash, or any altered mental status. They also denied any contact with persons having respiratory symptoms or any other infection. O. F’s mother denies fever, malaise, or decreased appetite, no chills, night sweats, unexplained weight loss, or weight gain. They also denied blurred vision, difficulty focusing, ocular pain, visual changes, or dry eyes. No presence of headache, weakness, numbness, tingling, memory difficulties, involuntary movements or tremors, loss of consciousness, or paresthesia’s. Mother and patient denied nightmares, mood changes, anxiety, depression, nervousness, insomnia, suicidal thoughts, exposure to violence, or excessive anger. On physical exam mother states, O.F has been complaining of mild right ear pain accompanied by some pruritus for the past three days; the child appears quiet and doesn’t complain of ear discomfort. NO cough, no history of recent respiratory infections, SOB, wheezing, difficulty breathing, exposure to secondary smoke, exposure to T.B. or hemoptysis. O.F is an active child who engages in outdoor activities playing actively without problems, denies any history of a heart murmur, chest pain, palpitations, dyspnea, activity intolerance, or edema. The rest of the systems assessment were regular, O.F has a healthy appearance, well-nourished, and developed, with normal gait in no distress. The patient is oriented, able to communicate with the preceptor and me, good judgment, rational and logical thoughts. O.F is very cooperative, and his mother describes mild ear pain that increased when manipulating the right auricle, as instructed to do so. Patient hearing is intact, and mother states noticed redness and mild inflammation on the ear canal, no other lesions noted.The patient denies difficulties swallowing, or throat pain. The patient’s mother noticed right retro-auricular lymph node enlargement, mild tenderness to touch no other masses present. A diagnosis of Unspecified Otitis Externa of Right Ear was made, also called Otitis externa (O.E.), or “Swimmer ear” which is inflammation secondary to infection of the external auditory canal, the auricle, or both, the condition can be found in all age groups but is very frequent in children from swimming. As a differential diagnosis, we can mention Ear canal trauma, but O. F’s mother denies any ear or head trauma; Otitis media, but there is no history of fever, night pain or dysphagia, and pain only increased when manipulating right auricle. The plan of treatment of external otitis and for a mild to moderate infection include topical medications, especially those to protect the ear from additional moisture and avoidance of further mechanical injury by scratching.Pharmacological treatment included dexamethasone/ciprofloxacin (otic suspension) 0.3%/0.1% instill 4 drops in affected ear q12hr for 7 days, and Acetaminophen 325mg oral tablet 1 tab (12 mg/kg/dose) orally q4-6hr for pain or in case of fever.Non-Pharmacologic treatment is encouraged to educate parents, and patients about managing external otitis include cleaning the ear canal, treating inflammation and infection, and pain control. All these instructions are designated to educate mothers on how to clean the external ear canal properly, removal of cerumen, desquamated skin, and purulent material if present to facilitates healing and enhances penetration of ear drops into the site of inflammation. The treatment plan will educate both patient and parent in how to prevent infection and complications, and to dry ear canal with topical drops after swimming. O.F will experience symptom improvement within 36 to 48 hours after treatment is initiated, but it is recommended to finish medication even if feeling better; the full resolution will be in about six days.