A 4-year-old is brought to the primary care office as a follow-up to a recent emergency visit for a broken leg

Order InstructionsMUSCULOSKELETAL DISORDERSAs a pediatric nurse practitioner, it is essential that you properly assess, diagnose, treat, and refer (as appropriate) to common, chronic, musculoskeletal disorders. Providing anticipatory guidance and patient and family education is vital.

CASE STUDYA 4-year-old is brought to the primary care office as a follow-up to a recent emergency visit for a broken leg. He was injured while using the slide at home. In reviewing the chart, you note several episodes of “bone pain,” “sprain,” and two arm fractures since the age of 12 months. The child has maintained less than 5% on the growth chart since the age of 2 years.Through the family history, you discover two first-degree relatives and one second-degree relative also had histories of frequent fractures and “bone issues” at a young age.Slide presentation:1. Include 3 physical abnormalities identified based on the case.2. Explain to the patient what further screening tests you would like to do. Or would you recommend it and why?3. State your primary diagnosis and explain your rationale to the patient’s family.4. Provide the correct diagnosis, treatment plan, and rationale to the patient’s family.5. Name two referrals that you would like to make (one referral can be to the specialist for this condition).

LEARNING RESOURCESRequired Readings• Kliegman, R. M., Toth, H. Bordini, B. J., & Basel, D. (2018). Nelson pediatric symptom-based diagnosis. Elsevier.o Chapter 34, “Gait Disturbances” (pp. 614–632)• Marcdante, K. J., & Kliegman, R. M. (2019). Nelson essentials of pediatrics (8th ed.). Elsevier.o Chapter 159, “Wilms Tumor” (pp. 610)o Chapter 160, “Sarcomas” (pp. 611–616)o Section 24, “Neurology” (pp. 681–720)o Section 26, “Orthopedics” (pp. 739–768)• Zitelli, B. J., McIntire, S. C., & Nowalk, A. J. (2018). Zitelli and Davis’ atlas of pediatric physical diagnosis (7th ed.). Elsevier.o Chapter 22, “Orthopedics” (pp. 759–844)• Birnkrant, D. J., Bushby, K., Bann, C. M., Apkon, S. D., Blackwell, A., Colvin, M. K., Cripe, L., Herron, A. R., Kennedy, A., Kinnett, K., Naprawa, J., Noritz, G., Poysky, J., Street, N., Trout, C. J., Weber, D. R., Ward, L. M., & DMD Care Considerations Working Group. (2018). Diagnosis and management of Duchenne muscular dystrophy, part 3: Primary care, emergency management, psychosocial care, and transitions of care across the lifespanLinks to an external site.. The Lancet Neurology, 17(5), 445-455. https://doi.org/10.1016/S1474-4422(18)30026-7• Davis, B. P., Barzin, A., & Page, C. (2019). The caseLinks to an external site.. Journal of Family Practice, 68(1), E15–E19.• Hoover-Fong, J., Scott, C. I., Jones, M. C., & Committee on Genetics. (2020). Health supervision for people with achondroplasiaLinks to an external site.. Pediatrics, 145(6), e20201010. https://doi.org/10.1542/peds.2020-1010• Ireland, P. J., Pacey, V., Zankl, A., Edwards, P., Johnston, L. M., & Savarirayan, R. (2014). Optimal management of complications associated with achondroplasiaLinks to an external site.. The Application of Clinical Genetics, 7, 117–125. https://doi.org/10.2147/TACG.S51485• Nichols, L. R. (2017, March). The Ponseti method: Bracing phaseLinks to an external site.. The Nemours Foundation. https://kidshealth.org/en/parents/ponseti-bracing.html• Osteogenesis Imperfecta Foundation. (n.d.). OI informational fact sheetsLinks to an external site.. https://oif.org/informationcenter/factsheets/• Fast Facts about OIDownload Fast Facts about OIhttps://oif.org/wp-content/uploads/2019/08/Fast_Facts_About_OI.pdf• Moving From Pediatric to Adult CareDownload Moving From Pediatric to Adult Carehttps://oif.org/wp-content/uploads/2019/08/Transition_from_Pediatric_to_Adult_Care.pdf• Education IssuesDownload Education Issueshttps://oif.org/wp-content/uploads/2019/08/Education__Education_Issues.pdf• Preparing to Send a Child With OI to SchoolDownload Preparing to Send a Child With OI to Schoolhttps://oif.org/wp-content/uploads/2019/08/Education__Preparing_to_Send_Child_to_School.pdf• Hearing Loss and Osteogenesis ImperfectaDownload Hearing Loss and Osteogenesis Imperfectahttps://oif.org/wp-content/uploads/2019/08/Hearing__Hearing_Loss_and_OI.pdf• Child Abuse or Osteogenesis ImperfectaDownload Child Abuse or Osteogenesis Imperfectahttps://oif.org/wp-content/uploads/2019/08/Child_Abuse__Child_Abuse_or_Ostegenesis_Imperfecta.pdf• Pfeiffer, K. M., Brod, M., Smith, A., Gianettoni, J., Viuff, D., Ota, S., & Charlton, R. W. (2021). Assessing physical symptoms, daily functioning, and well‐being in children with achondroplasiaLinks to an external site.. American Journal of Medical Genetics – Part A, 185(1), 33–45. https://doi.org/10.1002/ajmg.a.61903• Sharareh, B. (2021, June 14). Metatarsus adductusLinks to an external site.. https://www.orthobullets.com/pediatrics/4061/metatarsus-adductus• Yourgenome. (n.d.). What is achondroplasia?Links to an external site. https://www.yourgenome.org/facts/what-is-achondroplasiaRequired Resource• Beyond Achodroplasia. (n.d.). Height-for-age chartsLinks to an external site.. https://www.beyondachondroplasia.org/en/?option=com_content&view=article&id=11&Itemid=274