Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
SUBJECTIVE
Jake, 4 weeks old, presents to a pediatric practice in January for a weight check. He is accompa-nied by his mother, Laura. Laura says she experienced no perinatal complications, and was dis-charged 2 days postpartum, while Jake remained in the hospital for another 5 days for feeding and weight gain. Laura has been bringing Jake into the primary care office twice a week for weight checks, but this is the first time he is being seen by the nurse practitioner in the practice.
Birth history: Jake was the full‐term product of a spontaneous vaginal delivery after a 10‐hour labor to a Gr 3, P1, SAB 2, 40 y.o. mother. Laura underwent several years of fertility interven-tions, which included two first‐trimester spontaneous pregnancy losses. During this recent pregnancy Laura received regular prenatal care, was healthy, and took no medications except for prenatal vitamins. She neither smoked any substances nor drank any alcoholic beverages during her pregnancy. Jake’s Apgar scores were 9 at 1 minute, 9 at 5 minutes, and 10 at 10 minutes. His birth weight was 4 lbs., 10 oz. (2.098 kg). He had an uneventful extended hospital course focused on feeding and gaining weight with breastfeeding, plus bottle feedings/day of fortified pumped breast milk or formula fortified for 24 calories/oz. every other feeding for catch‐up growth. After an initial postnatal weight loss, Jake started gaining about 30–40 gms/ day while still hospitalized. His discharge weight was 4 lbs. 5 oz. (1.9561 kg). Jake’s hospital discharge plan was:
• Keep Jake warm, check his temperature several times a day.
• Breastfeed every 2 hours around the clock.
• Reinforce pumped milk bottle feeding with a teaspoon of human milk fortifier for each 3 oz. of breast milk for 24 calories/oz. three times a day.
• Twice‐weekly weight checks.Social history: Before Jake was born Laura was an executive for a biomedical company, and her husband Craig is an executive for a global investment company. They live in a single‐family home in an upscale suburb of a large northeastern city. When Laura became pregnant she and
Craig decided that the time commitment involved with both of their careers would not be con-ducive to attentive parenting, so they made the mutual decision that Laura would stay home with Jake. Craig works long hours. He also travels regularly for work. He currently carries the health care benefits in his job, so Laura feels she cannot complain about his being away so often. Craig is a member of the local country club, and is part of a group that trains for marathons, while Laura tends to be more reserved, preferring her small circle of friends mostly from her work. None of Laura’s friends are at home with babies, and Laura does not see them regularly since leaving work. Laura’s parents, besides living a distance away, are elderly and in poor health, and not a direct source of support. She has a brother who lives close to her parents, but no other siblings. The paternal grandparents live in the southwest United States and are retired. When asked who she considered her main support to be, Laura said it was Craig. However, Craig is not available much of the time to help Laura with Jake. Jake’s frequent feeds have created tension between the parents because Craig cannot get a full night’s sleep to go into work the next day with Jake in a bassinet in the room. Laura eventually moved into Jake’s room to remain close to him and to make her available for his frequent feeds without disturbing Craig. Laura has a previous history of depression since her teens that worsened during her struggles with infertility and pregnancy losses. She had an eating disorder in high school and in the early years of college, but denies any issues with eating since then. She has periodically taken Citalopram, but not in several years, and was resistant to medication while going through infertility treatments and while breastfeeding. She believes that all medications prescribed or over the counter while breastfeeding are unsafe for the baby. Laura is continuing with prenatal vitamins but is taking no medications.
Diet: Laura is continuing with every‐2‐hour breastfeeding. She tried to pump milk to provide time for bottle feeding when Jake was first discharged from the hospital, but experienced trouble obtain-ing more than 1 oz. of pumped milk in total at a time, which she didn’t believe was enough for his supplemental increased calorie bottles. She decided to nurse Jake every 2 hours through the night, since he is an avid feeder. She is not supplementing feedings with fortified formula at this time, since she felt it affected her milk supply to not be nursing every 2 hours. Laura is unsure if she misses any of her own meals because Jake’s care is so absorbing, and Laura feels she has no time to herself to care for her own needs.
Elimination: Jake has small amounts of yellow loose stools with most feedings, and has about 8–10 wet diapers/day.
Sleep and feeding behavior: Jake is difficult to awaken for the frequent feedings, falls asleep during feedings, and mostly sleeps when not feeding. When awake he can be difficult to comfort even to latch on for feeding, but once latched on will settle well into the feeding. If Jake is fussy Laura tends to offer the breast more often than the recommended 2 hours. Jake nurses 10 minutes on one breast and 30–50 minutes on the other breast. He requires frequent stimulation to remain awake during feedings.
Family medical history: Both parents are in good physical health. Craig has seasonal allergies, but no history of chronic respiratory problems. Both parents are of average height and weight by report. Neither Craig nor Laura are smokers, nor do they allow Jake near smokers. The maternal grandparents are in their 80s, with a history of heart disease, Type 2 diabetes, and arthritis. The paternal grandparents are in their late 70s, with a history of arthritis, hypertension, and hyperlip-idemia. There is a history of breast cancer in paternal extended family members, and seasonal allergies in both maternal and paternal extended family.
Medications: Jake was given his first dose of Hepatitis B (Hep B) vaccine upon hospital discharge.
He has had no other immunizations, nor is he currently taking any medications.
Allergies: No known allergies. No untoward reaction to the Hep B vaccine.
OBJECTIVE
General: Jake appears very small for his age. He sleeps quietly during the visit until being undressed for the weight check. Once becoming fussy he is difficult to comfort, and seems to resist cuddling, arching away and escalating rapidly in his distress, which Laura says is typical for him. Throughout the appointment Laura has a noticeably flat affect. She vacillates between a passive posture often looking off out the window and not observing the baby during the exam, to reacting with anxiety, especially as he becomes inconsolably fussy.
Vital signs: Jake’s temperature is 36.3°C, AP is 110, R is 40, BP is 50/40.
Measurements: Weight 5 lbs. (<5th percentile), head circumference 33 cm (< 10th percentile), and length 18.5 inches (10th percentile).
Skin: Pink, some sagging skin still on his thighs, with some flaking skin, lips moist, good skin turgor, occasional milia on his facial cheeks and nose.
Nose: Clear, no discharge.
Mouth: Palate intact, some white patches on left side of his mouth, easily removed with a cotton swab.
Abdomen: Soft, small, easily reducible umbilical hernia.
Cardiorespiratory: Chest clear, no murmurs.
Genitourinary: Circumcised, testicles descended, normal urine stream observed.
Neurologic: Movements smooth, symmetrical. Poor state control moving from active sleep to full‐out crying. Jake does not respond readily to the usual comfort measures such as holding, position changes, or walking while softly bouncing or rocking. Somewhat hyperactive Moro reflex, strong sucking and rooting, and asymmetrical tonic neck reflexes present. Two‐beat ankle clonus is noted bilaterally. He can be brought into the quiet alert state slowly. Once he calmed, he fixed on a bright red ball and visually tracked the ball 180 degrees. He was attentive to his mother’s voice briefly. No vocalizations were heard this appointment aside from fussing, but Laura stated she has heard the beginnings of some cooing recently.
CRITICAL THINKING
What is the diagnosis and its contributing factors?
• For Jake
• For Laura
Why must concerns about Laura be addressed at this appointment?
What additional information is needed?
What are the treatment options?
• For Jake
• For Laura
What are the plans for referral and follow‐up care? Include resources that may be needed to determine treatment options.
What demographic characteristics might affect this case?
Are there any standardized guidelines that should be used to treat this case? If so, what are they?
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
CLICK ON THE LINK HERE: https://www.perfectacademic.com/orders/ordernow
Do You Have Any Other Essay/Assignment/Class Project/Homework Related to this? Click Here Now [CLICK ME] and Have It Done by Our PhD Qualified Writers!!