responseee
Hello class, so this week was a successful one as I felt accomplished in being able to comfort a worried mom. The baby came in with a fever as well as a strong cough, she was worried the baby was very sick and had to be sent to the hospital. She was a first-time mom, so she wasn’t sure what was going to happen, and it was her first time her baby was experiencing a fever. So, all of it led to her head having huge paranoia. Thankfully me and my preceptor were there as we both were moms as well and told her her baby was in the best hands and we were going to make sure the baby left the office with a well-rounded plan for her to get better in no time. The mom seemed to be less worried and when the baby was examined and she needed was some antibiotics and to be kept on Tylenol PRN, and baby would be fine in no time. The mother was very thankful and appreciative of us, so it made me feel very fulfilled, she came in the office very scared and left with hope and peace that her baby was going to be fine.
2.) Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
So patient S.M came in with her mother because, there seemed to be a rash on the superficial layers of the skin of the patient. The mother says they were like honey-colored crusts. She states her daughter has also been having weakness, some diarrhea, and a mild fever. When the patient was examined, on her face around the nose and under the mouth there were some papules as well as pustules present. There were also some that were broken and looked like honey-colored crusts as the mother described it. There was also some lymphadenopathy on the patient’s neck, basically meaning there was a bacterium the patient was fighting. Some of the tests that needed to be done was a gram stain/culture to test what type of bacteria is positive to best treat it. Some of the differential diagnosis involves, herpes, varicella as well as scabies. Herpes simplex 1 because; this leaves blisters, and they break and cause painful open sores in the mouth region. Varicella, this can cause a itchy blister like rash in the mouth as well as other parts in the body like impetigo. Scabies is another one because, it causes a intense itching and pimple like skin rash on the skin. The plan of care for the patient involves topical antibiotics since its superficial and localized. If there is no response to the antibiotics within a week of starting them then there needs to be a culture taken to see what else is necessary to treat it. There also needs to be education mostly of the parent on hygienic measures that needs to be taken to avoid passing of bacterium. Child should also not go into daycare until they have been treated for 24 hours. The antibiotic would consist of mupirocin 2% ointment. It needs to be applied to the lesions at least 3 times a day for 3-5 days (Schaefer TJ, 2023).
3.) Mention the health promotion intervention for this patient.
Some of the health promotion strategies for this patient would include, to make sure to cover the lesions and make sure to apply topical antibiotics as ordered for best affect. Mother needs to help the child to practice good body, face and hand hygiene. The towels, linens, as well as clothing of the contagious person need to not be used by anyone else in the house.
4.) What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
What I learned from this week clinical experience is knowing how to treat impetigo. Knowing what to tell the parents on how to help the patient not contaminate other members of the household as well as what topical antibiotic is useful. Since this patients’ lesions were not spread out all over the body she just needs topical ointment if its spread through the body the patient needs oral antibiotic which in this case is amoxicillin/clavulanate 90 mg per kg per day, and it would be divided twice daily for 10 days (Schaefer TJ, 2023).
5.) Support your plan of care with the current peer-reviewed research guideline.
On the scholarly article Interventions for impetigo, it was stated; topical antibiotics (mupirocin, retapamulin, fusidic acid) were found to be more effective than the placebo and preferable to oral antibiotics for limited impetigo. Topical antibiotics were also superior to disinfection methods (Dellavalle R, 2021).
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