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
Four‐year‐old Javier presents to the office with his mother, Carol, with a complaint of bedwetting. Carol states that Javier consistently wets the bed each night although he remains dry throughout the day. According to his mother, Javier has never been dry at night but has been toilet‐trained during the daytime for 2 years. Carol is frustrated with this behavior because she is frequently washing bedsheets and having to buy new mattresses. She has a 5‐year‐old daughter who achieved daytime and nighttime dryness by the age of 3 years old. Carol said that Javier’s father is also frustrated with the bedwetting and will sometime spank Javier when he wets the bed. Carol says that her 5‐year‐old daughter teases Javier and calls him names such as “pee‐pee boy.” She says that she has already tried strategies such as limiting his liquid intake 2 hours before bed and waking him to urinate before she goes to bed. Carol states that often, when she goes to wake Javier before going to bed herself, he has already wet the bed. She does not know what to do now and has come to the office today because she would like assistance in resolving this issue. Javier has no other symptoms of illness.
Diet: Javier’s nutrition history reveals that he has a balanced diet with enough dairy, protein, fruits, and vegetables. He does not appear to eat or drink large amounts.
Elimination: He is voiding well (normal amounts) with no complaints of dysuria. Javier does have occasional constipation that is relieved with an over‐the‐counter laxative.
Sleep: Javier sleeps 11 hours at night and has no trouble falling or staying asleep.
Past medical history: Born via cesarean section at 38 weeks’ gestation. This was a repeat C‐section for Carol. Since being discharged at 4 days of age, Javier has had no hospitalizations. Javier had 4 teeth removed at 2 years of age, under general anesthesia, due to early childhood caries. He had an emergency department (ED) visit at 3 years of age for a broken arm after he fell from the jungle gym at day care. Javier passed his developmental screening at his last well‐child visit. He currently attends preschool and is doing well. He has no chronic illnesses and is taking no medications.
Social history: Javier lives at home with both parents and a 5‐year‐old sibling. His mother works as a store clerk, and his father is a school custodian. The family has no pets. There are no smokers in the home.
Family medical history: Javier’s mother (26 years old) and father (26 years old) are healthy and have no history of chronic medical conditions. His mother has sickle cell trait. His maternal grand-mother (48 years old) has a history of heart disease. His maternal grandfather (50 years old) has a history of liver disease. Javier’s paternal grandfather (51 years old) has a history of vertigo. His paternal grandmother (50 years old) has a history of high cholesterol.
Medications: Javier is currently taking no over‐the‐counter, prescription, or herbal medications. He has no known allergies to medication, food, or the environment. He is up to date for required immunizations.
OBJECTIVE
Javier’s vital signs are taken, and his weight in the office is 20 kg. His temperature is within the normal range at 36.7°C (temporal). When observing Javier’s general appearance, he is alert, pleas-ant, and interactive. He appears well hydrated and well nourished.
Skin: Javier’s skin is clear of lesions. There is no cyanosis of his skin, lips, or nails. There is no diaphoresis noted, and Javier has good skin turgor on examination.
HEENT: Javier’s head is normocephalic. His red reflexes are present bilaterally; and his pupils are equal, round, and reactive to light. There is no ocular discharge noted. Javier’s external ear reveals that the pinnae are normal and that there is no tenderness to touch on the external ear. On otoscopic examination, the tympanic membranes are gray bilaterally, in normal position with positive light reflexes. Bony landmarks are visible, and there is no fluid noted behind the tympanic membranes. Both nostrils are patent. There is no nasal discharge, and there is no nasal flaring. Javier’s mucous membranes are noted to be moist. He has 16 teeth present. There are no lesions present in the oral cavity.
Neck: Javier’s neck is supple and able to move in all directions without resistance. There is no cervical lymphadenopathy present.
Respiratory: Javier’s respiratory rate is 20 breaths per minute, and his lungs are clear to auscul-tation in all lobes. There is good air entry, and no retractions or grunting are noted on examination. No deformities of the thoracic cage are noted.
Cardiovascular: Javier’s heart rate is 96 beats per minute with a regular rhythm. There is no murmur noted upon auscultation.
Abdomen: Normoactive bowel sounds are present throughout, and Javier’s abdomen is soft and nontender. Javier has shotty nodes present in his inguinal area bilaterally. These nodes are mobile, nontender, and nonerythematous. There is no evidence of hepatosplenomegaly.
Genitourinary: Normal circumcised male genitalia without erythema or lesions. His testes are descended bilaterally.
Neuromusculoskeletal: Good tone and full range of motion in all extremities; extremities are warm and well perfused. Capillary refill is less than 2 seconds, and his spine is straight.
CRITICAL THINKING
What laboratory tests or diagnostic imaging studies should be ordered as part of a workup for bedwetting?
What is the most likely differential diagnosis and why?
What is the plan of treatment, referral, and follow‐up care?
Does this patient’s psychosocial history affect how you might treat this case?
What if the patient lived in a rural setting?
Are there any demographic characteristics that might affect this case?
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
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