Wellness visits are an important part of pediatric primary care. During these visits, patient growth and development are assessed. As an advanced practice nurse who performs these assessments, you must be able to distinguish between normal and abnormal growth and development to recognize red flags. While some patients may not meet milestones due to differences in rates of development, abnormal development might also be a red flag of an underlying problem. In this Discussion, you examine the following case studies and consider potential developmental red flags.
Case Study 3
Jose is a 36-month-old who presents for a preschool evaluation. His father reports the following development:
Physical: Walks, runs, and jumps independently, walks up stairs alternating feet, pedals a three-wheeler, scribbles, copies circles and squares, and is able to balance on one foot for 2 to 3 seconds.
Social: Recognizes three colors; speech is 75% understandable; uses three- to four-word sentences; talks about friends, favorite activities, and family; frequently engages in imitative play; has an imaginary friend; does stutter on occasion when excited or when intent on getting something said. Will typically repeat the first word in a sentence three to four times, but does not repeat syllables or consonants. This happens three to four times a week.
To prepare:
Think about how physical, social, and cognitive development vary during infancy, toddlerhood, and the preschool years. Reflect on normal versus abnormal growth and development and consider the decision-making process of identifying and managing red flags of abnormal development.
Select one of the three case studies provided. Reflect on the patient information included in the case study and consider any developmental red flags.
Reflect on standardized screening tools, clinical guidelines, and management strategies that would be used to assess and manage the patient in your selected case study.
By Day 3
Post an explanation of the following:
- Developmental red flags that presented on the stages of normal physical, social, and cognitive development for infants, toddlers, and preschoolers. Based on the red flags identified within the physical, social, and cognitive what additional questions should you ask? What additional examinations will you conduct?
- Explain how you differentiated between normal and abnormal growth and development for this patient.
- Identify which standardized screening tools, clinical guidelines, and management strategies you might use to assess and manage this patient and why.
- Health, promotion and anticipatory guidance:
- Based on the child’s age, discuss which immunizations this child should have received by now?
- When are the next set of immunizations?
- Which ones should be given?
- When should this child return to clinic?
Sample Solution
