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
Week 9 Discussion Comment.
Make a comment using your own words in each discussion but please provide at least one reference for each comment.Do a half page for discussion #1 and another half page for discussion #2 for a total of one page.
Provide the comment for each discussion separate.
Discussion #1
Subjective
CC: “fever ranging from 101 – 104.7 for 7 days”
HPI: 18 month old female comes in with her mother with complaint of this being the 7th day with her running fever. The fevers range from 101 to 104.7. Mom took her to the ER on the 4th day of running a fever. In the ER they drew blood and urine cultures which were negative, CBC, and CMP.
ROS: Mother admits to fever x 7 days. She took her to the ER on the 4th day. Blood and urine cultures resulted negative.
MEDICAL HISTORY: none noted
OBJECTIVE:
Vitals: Temperature: 101.5 degrees Fahrenheit, Heart rate: 120 beats/minute, Respiratory rate: 20 breaths/minute, Blood pressure: 90/40
Physical exam: She has injected conjunctiva, palmar redness, magenta-colored lips, red macula, excoriating rashes in the diaper area
Labs and diagnostic exam: CBC and CMP was ordered in the ER. CRP, ESR, ALT, AST. Laboratory parameters are used for the diagnosis and evaluation of conditions of patients for any inflammatory disease. The severity of inflammation in KD is reflected by inflammatory parameters; thus, laboratory findings are helpful for diagnosing incomplete KD and evaluating patients for early prediction of IVIG non-responsiveness (Lee, Rhim, & Kang, 2015). A high white blood cell count and the presence of anemia and inflammation are signs of Kawasaki disease.
ASSESSMENT
Primary diagnosis: Kawasaki disease Clinical manifestations of KD include prolonged fever,10-11 days, conjunctival injection, oral lesions, polymorphous skin rashes, extremity changes, and cervical lymphadenopathy, all of which comprise diagnostic criteria (Lee, Rhim, & Kang, 2015). Electrocardiogram measure the electrical impulses of your child’s heartbeat. Kawasaki disease can cause heart rhythm problems.
Differential diagnosis: Group A streptococcal Pharyngitis. Fever, headache, rash, and tiny red spots on the area at the back of the roof of the mouth (soft or hard palate). If untreated, strep throat can cause complications, such as kidney inflammation or rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a specific type of rash, or heart valve damage.
Stevens-Johnson Syndrome (SJS) and toxic epidermal necrosis (TEN) are very serious skin conditions that can happen as a result of illness or as side effects to medications. Unexplained widespread skin pain. A red or purplish rash that spreads. Blisters on your skin and the mucous membranes of the mouth, nose, eyes and genitals. Shedding of skin within days after blisters form.
Treatment: To reduce the risk of complications, it is best to begin treatment for Kawasaki disease as soon as possible to lower fever and inflammation and prevent heart damage. Infusion of an immune protein (gamma globulin) intravenously can lower the risk of coronary artery problems. High doses of aspirin may help treat inflammation. Aspirin can also decrease pain and joint inflammation, as well as reduce the fever. Kawasaki treatment is a rare exception to the rule that says aspirin shouldn’t be given to children. Aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in children recovering from chickenpox or flu. Children should be given aspirin only under the supervision of a doctor. Once the fever goes down, your child may need to take low-dose aspirin for at least six weeks and longer if he or she develops a coronary artery aneurysm. Aspirin helps prevent clotting. Monitoring health of the heart at regular intervals, often at six to eight weeks after the illness began, and then again after six months (Pilania, Bhattarai, & Singh, 2018).
Education: It is important to keep the follow up appts after treatment. First follow up within 2 weeks and repeat EKG. Then again 6 to 8 weeks after their fever first started. Live viral vaccines should be postponed at least 11 months after IVIG, because IVIG can cause the vaccines to be ineffective. Follow a heart healthy diet and lifestyle. Cholesterol levels should be checked every 5 years (Healthy Children, 2020).
ANTICIPATORY GUIDANCE: Follow heart healthy diet. Seek early treatment recurrent fevers and keep follow ups to monitor the heart after treatment.
Discussion #2
The answers to the questions are to be posted in following the SOAP NOTE FORMAT below. You are to include the headings and subheadings below in your answer:
SUBJECTIVE CC: seven-day history of fever ranging from 101 to 104.7 degrees Fahrenheit. HPI: An eighteen-month-old child, well-known to your practice, presents to the ER with a seven-day history of fever ranging from 101 to 104.7 degrees Fahrenheit ROS: Eyes- sclera positive for Injected conjunctiva, lips magenta, red macula, extremities- palmar erythema, groin/genitalia positive for excoriating rash. MEDICAL HISTORY – none, 18 month- old, no other history provided
OBJECTIVE VITALS
Temperature: 101.5 degrees Fahrenheit
Heart rate: 120 beats/minute
Respiratory rate: 20 breaths/minute
Blood pressure: 90/40
PHYSICAL EXAM
• Injected conjunctiva
• Palmar redness
• Magenta-colored lips
• Red macula
• Excoriating rashes in the diaper area
LABS & DIAGNOSTIC RESULTS -urine and blood cultures (negative), CBC and CMP done in ER. Additional testing recommended to include CRP and ESR. CBC and blood cultures to evaluate presence of infection, and oxygenation status, especially to rule out endocarditis that could be related to the condition. CPR (c reactive protein) is elevated in response to inflammation, before ESR does. CRP levels between 0.3 and 3.0 indicate high risk for trauma, infection or inflammatory disease. ESR (erythrocyte sedimentation rate) also shows inflammation severity in symptomatic patients with ongoing disease processes that need further investigation. In an 18 month-old child the ESR should be below 10 (Pagana & Pagana, 2018).
ASSESSMENT PRIMARY DIAGNOSIS – Kawasaki Disease M30.3- a severe and systemic form of vasculitis with persistent fever over 4 days, bilateral injection of conjunctiva, progressive skin rash, oral mucosa swelling ad erythema with rashes on hands and feet. The disease is fatal if left untreated and requires immediate attention to prevent the complication of cardiac damage and coronary artery disease (Tanaka et al, 2020). The patient presented with all of these symptoms to the ER, making this the primary diagnosis.
DIFFERENTIAL DIAGNOSIS
Streptococcal scarlet fever A38.9- Streptococcal infections can manifest with fever and subsequent rash of the body and is the most common infection presenting with fever and rash in children. Group A streptococcus (GAS) pathogen in children presents with symptoms of scarlet fever, tonsillitis, high fever, rheumatic fever, and glomerulonephritis. Penicillin (PCN) is usually used to treat the infection, and erythromycin is used in patients with PCN allergy. Most cases are treated with antibiotics good success and resolution of symptoms (Li et al, 2020).
Viral infection B34.9- viruses can cause several rashes in children. Infections with visible rases include measles, zika, roseola, rubella, hand-foot and mouth or unknown/unclassified infections. Most are self-limiting and require comfort measures and do not progress (Castro & Ramos-e-Silva, 2020).
PLAN TREATMENT- intravenous immunoglobulin (IVIG), intravenous prednisolone (PSL) and in some cases high dose aspirin if indicated for cardiac changes such as aneurysm or coronary artery disease. Careful monitoring of I&O, activity and atherosclerosis is essential. The risk of skin damage is also a factor and needs continued monitoring as part of the care plan (Zhong, 2020).
EDUCATION-Teaching of post treatment care to the parents is essential. Diet full of nutrients and proper rest after treatment is important. The importance of follow up care for prevention of heart disease is the most important teaching goal. Signs of coronary aneurysms or decreased cardiac output such as lethargy, pallor, breathing difficulty, decreased appetite and decreased output should be stressed to be reported to doctor immediately. Careful wound care and rash treatment should be done to prevent skin infection and cellulitis (Tanaka et al, 2020).
ANTICIPATORY GUIDANCE- As the Nurse Practitioner caring for the patient, the next step in this evaluation is to have careful follow up for cardiac complications related to Kawasaki disease and any secondary infections such as pneumonia, cellulitis or endocarditis (Zhong et al, 2020).
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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