Explain what most excited and/or concerned you throughout your pediatric clinical experience.
Critical reflection of your growth and development during your practicum experience in a pediatric neurology clinical setting has the benefit of helping you identify opportunities for improvement in your pediatric neurology clinical skills while also recognizing your clinical strengths and successes.
JOURNAL ENTRY (3 PAGES)
Write a 3-page Journal Entry that includes responses to the following:
1. Explain what most excited and/or concerned you throughout your pediatric clinical experience.
2. Discuss how your personal definition of ethical care of pediatric neurology patients has changed or stayed the same.
3. How has your understanding of cultural competence influenced your assessment of children and their families?
4. Explain how your understanding of vulnerable populations has changed and how it may have influenced the assessments you conducted during your pediatric neurology practicum.
5. Assess your progress in accomplishing the goals and objectives you developed in the first week for the pediatric neurology practicum experience.
o goals and objectives for this practicum experience. Ensure that they follow the SMART strategy, as described in the Learning Resources.
Skills Acquisition:
I will assess my improvement in formulating evidence-based treatment plans considering the developmental level of the specialized pediatric patients .
By the end of the 5th week of this winter class, I should be able to formulate evidence-based treatment plans considering the specialized pediatric patients’ developmental level with less preceptor supervision.
Knowledge Acquisition:
I want to learn about acute and chronic diseases affecting various body systems in pediatric outpatient practice in a specialized field such as neurology. I intend to broaden my knowledge by integrating appropriate theoretical perspectives to promote the health of specialized pediatric patients with less supervision from my preceptor.
By the end of 5th week of this winter class, I should be able to understand acute and chronic diseases affecting various body systems in pediatric outpatient practice in a specialized field such as neurology. I intend to broaden my knowledge by integrating appropriate theoretical perspectives to promote the health of specialized pediatric patients with less supervision from my preceptor.
Personal / Professional:
I want to enhance my ability to develop professional plans in pediatric nursing practice for the practicum experience and formulate diagnoses for specialized pediatric .
By the end of 5th week of this summer class, I should have built my confidence in developing professional plans in pediatric nursing practice for the practicum experience and formulating diagnoses for specialized pediatric patients.
6. Based on your pediatric neurology practicum experience, refine your existing goals and/or develop new goals for your continued education and professional practice. Be sure to consider the NAPNAP Position Statement on Children and Youth with Special Health Care Needs at https://www.napnap.org/napnap-revises-position-statement-on-children-and-youth-with-special-health-care-needs/Links to an external site. reflecting on your clinical
7. Write about strengths and opportunities for improvement.
8. Reflect on your pediatric neurology practicum experience, the patients you have seen, and the conditions you have diagnosed and treated.
Interesting case
SUBJECTIVE:
Chief Complaint: Headaches
History of Present Illness:
A 17-year-old female patient came into the clinic with complaints of recurrent headaches. These started four weeks ago, commonly felt at the back of her head and radiating forward, presenting both squeezing and throbbing sensations. She identifies experiencing both photo and phonophobia. The patient’s feels nauseous during these headache episodes; however, she reports that it has not led to vomiting. In some instances, she perceives small dots in her peripheral vision during the headache episodes. Initially, the headaches were daily; however, they have reduced in frequency and are currently occurring about two to five times a week. The longest that a headache last is two to three days. Over-the-counter medications such as Tylenol and Ibuprofen have been mildly effective in managing pain.
14-point-ROS are all negative except those mentioned in the HPI.
Medication: Metformin (Eqv-Glumetza) 1000 mg oral tablet extended-release, take 1 tab once daily
Past Medical History: Unremarkable
Allergies: No known allergy
Family Medical History: There is no significant past medical history to report. However, it is noteworthy that the patient’s paternal uncle has a history of epilepsy.
OBJECTIVE:
Vitals and Growth:
T 98.30’F
HR 57
RR 18
Oxygen Saturation 98 %
Pain 0/10
Wt. 66.4 kg
Ht. 155.0 cm
BMI 27.64 kg/m2
Physical examination:
Our patient is a well-developed, well-nourished infant with a good resting posture.
Head: atraumatic and normocephalic. There are no dysmorphic features.
Neck: supple with no lymphadenopathy or masses.
Lungs: clear to auscultation bilaterally.
Cardiovascular examination: Normal rate and rhythm with no murmurs.
Extremities: No gross deformities. The examination did not reveal unequal leg length.
Skin: warm and moist with no active dermatosis. There are no lesions suggestive of neurocutaneous syndrome.
Neurologic examination: The patient is awake and alert. Her speech is clear and language is fluent.
Cranial nerves: Extraocular movements are full with no nystagmus. There are no visual field cuts on confrontation testing. There is no papilledema on fundoscopy. There is no facial weakness. Her face is symmetric. She has intact gross hearing bilaterally. Tongue is midline on protrusion.
Motor: She has good strength in both upper and lower extremities, proximal and distally. Tone is normal.
Reflexes 2+ in both upper and lower extremities. Tone is normal.
Coordination: There is no ataxia on finger-to-nose testing. Rapid alternating movements were done without problems. There are no tremors.
Gait: She is able to walk on her heels, toes, and tandem walk without difficulty.
ASSESSMENT:
The patient is a 17-year-old female presenting with recurrent headaches over the past four weeks, which are gradually decreasing in frequency. The headaches are predominantly occurring at the back of her head and moving forward, with both throbbing and squeezing quality. She has reported visual disturbances and sensitivity to light and noise during these episodes. These symptoms are partially responsive to over-the-counter pain medications.
G43.119 Migraine with aura, intractable, without status migrainosus
PLAN:
Diagnostics: None
Therapeutics:
Imitrex 25 mg oral tablet. Give 1 tab po prn for moderate to severe q 2 h max of 3 tabs/day
Naproxen 500 mg oral tablet. Give 1 tab po prn for moderate to severe q 12 h with food
We discussed extensively with the patient and her parents about her condition and treatment goals. We suggested the following plan of care:
1. Upscale the management based on severity if her symptoms persist or become more frequent despite current measures. This may include trying different classes of pain relievers, or considering prophylactic medications if her headaches are frequent and debilitating enough to warrant this. We have been prescribed Imitrex and naproxen for abortive therapy.
2. If her headaches persist or if new concerning signs or symptoms develop, consider a brain MRI for further evaluation.
3. Encouragement of lifestyle modifications, including a consistent sleep schedule, staying hydrated, balanced diet, regular physical activity, and avoiding any identified triggers as these changes might be beneficial.
Follow-up: Follow-up appointment in three months or sooner if headaches worsen or become more frequent.
In your response, use at least 4 resources.
Cite the sources using APA format (7th edition).
Follow the rubric.
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