The Family Nurse Practitioner

Clinical Case Studies

Leslie Neal-Boylan, Leslie Neal-Boylan

• Publisher: Wiley-Blackwell
• Year: 2020
• ISBN:
  9781119603221
• Edition: 2
• Topic: Medicine
• Subtopic: Nursing

The Family Nurse Practitioner provides essential guidance and information for understanding how to diagnose and manage typical (and some atypical) patient cases. With contributions from noted experts on the topic, this new edition contains updated cases to reflect today's patient-centered approach, and includes the most recent advances in patient care. From neonatal to geriatric, all the cases demonstrate real-life scenarios and present appropriate solutions on a case-by-case basis to reflect the nuance required in practice.

The revised edition emphasizes pharmacological management, with a new section on mental health care and additional cases on chronic conditions. Greater consideration is given to race, gender, ethnicity and their impact on management options.

• Contains more than 70 case studies
• Offers new cases on pelvic pain, substance abuse, food allergies, celiac disease, child abuse, pre-conception planning, and dermatology
• Includes discussion questions to help develop understanding

Written for students and academics of nursing and nurse practitioners, The Family Nurse Practitioner is the ideal text for developing and expanding one's knowledge and comprehension of the diagnosis and management of patient care.

Section 1
The Neonate

Case 1.1	Cardiovascular Screening Exam By Mikki Meadows‐Oliver, PhD, RN, FAAN
Case 1.2	Pulmonary Screening Exam By Mikki Meadows‐Oliver, PhD, RN, FAAN
Case 1.3	Skin Screening Exam By Mikki Meadows‐Oliver, PhD, RN, FAAN
Case 1.4	Oxygenation By Mikki Meadows‐Oliver, PhD, RN, FAAN
Case 1.5	Nutrition and Weight By Mikki Meadows‐Oliver, PhD, RN, FAAN

Case 1.1
Cardiovascular Screening Exam

By Mikki Meadows‐Oliver, PhD, RN, FAAN

SUBJECTIVE

Justin, a 10‐day‐old male, presents in the primary care office for a weight check. He is accompanied by his parents. His mother is concerned about his feeding habits. She believes that he takes awhile to drink his formula—longer than his siblings did; she also thinks that he sweats more than they did, even when he doesn’t feel warm.

Birth history: Significant for a 36‐week gestation. His birth weight was 2600 grams. Because of his premature birth, Justin required hospitalization for the first week of life in the Neonatal Intensive Care Unit (NICU). During his stay in the NICU, he was noted to feed without problems, maintain his temperature without assistance, and gain weight. His weight at discharge from the hospital 3 days ago was 2400 grams. Because of his premature birth status and his decreased weight, the family was told to follow up with their primary care provider in 3 days.

In the office today, his weight is 2490 grams. Further questioning about Justin’s birth history reveals that the mother’s pregnancy was normal. She had no infections, falls, or known exposures to environmental hazards. She did not drink alcohol, take prescription medication (other than prenatal vitamins), use tobacco products, or use illicit drugs. During labor, she experienced a failure to progress, which resulted in her having a cesarean birth. The baby’s Apgar scores were 8 at 1 minute and 9 at 5 minutes.

Social history: Justin was born to a single, 29‐year‐old mother. His father is involved but does not reside in the household. Justin lives in an apartment with his mother and two other siblings (ages 2 and 4 years). The maternal grandmother (MGM) lives nearby and is able to help Justin’s mother provide care. The family receives several governmental subsidies such as the Women, Infants, and Children (WIC) Supplemental Nutrition Program, Temporary Assistance for Needy Families (TANF), and Medicaid. Educationally, Justin’s mother has a high school diploma. She works in a local retail store. Justin’s father works in a manufacturing plant. The family has no pets. The MGM smokes but does not smoke in the home.

Diet: Breastfeeding ad lib with supplementation of a milk‐based formula.

Elimination: 6–8 wet diapers daily with 3–4 yellow, seedy bowel movements.

Sleep: Sleeps between feedings.

Family medical history: PGF (age 54): diabetes mellitus, heart attack at age 50; PGM (age 53): healthy; MGF: deceased from stroke at age 47; MGM (age 54): asthma; mother (age 29): asthma; father (age 31): healthy; Sibling #1 (age 4): asthma; Sibling #2 (age 2): heart murmur.

Medications: Currently taking no prescription, herbal, or OTC medications.

Allergies: No known allergies to food, medications, or environment.

OBJECTIVE

Vital signs: Weight: 2490 grams; length: 44 centimeters; temperature: 37°C (rectal).

General: Alert, well‐nourished, well‐hydrated baby.

Skin: Clear with no lesions noted; no cyanosis of lips, nails, or skin; no diaphoresis noted; skin turgor with elastic recoil.

Head: Normocephalic; anterior fontanel open and flat (2 cm × 3 cm); posterior fontanel open and flat (1 cm × 1 cm).

Eyes: Red reflex present bilaterally; pupils equal, round, and reactive to light; no discharge noted.

Ears: Pinnae normal; tympanic membranes gray bilaterally with positive light reflex.

Nose: Both nostrils patent; no discharge.

Oropharynx: Mucous membranes moist; no teeth present; no lesions.

Neck: Supple; no nodes.

Respiratory: RR = 28; clear in all lobes; no adventitious sounds noted; no retractions; no deformities of the thoracic cage noted.

Cardiac/Peripheral vascular: HR = 120; thrill noted in pulmonic area; continuous, systolic, grade 3 heart murmur noted on exam in the pulmonic area of the chest with both the bell and diaphragm; no radiation of the murmur to the back or axilla; brachial and femoral pulses present and 2+ bilaterally.

Abdomen/Gastrointestinal: Soft, nontender, nondistended, no evidence of hepatosplenomegaly. Umbilical cord is in place with no signs and symptoms of infection.

Genitourinary: Normal male; testes descended bilaterally; circumcision healing well.

Back: Spine straight.

Extremities: Full range of motion of all extremities; warm and well perfused; capillary refill <2 seconds. Negative hip click.

Neurologic: Good ...