NUR 471 Family Nurse Practitioner I
Spring 2012
Case study: The Restless Pupil
CC: Emily is a 7-year-old girl. Mother brings her because “she’s not doing well in school.”
HPI: Is disruptive in class, has trouble with both reading and math. Teachers believe the problem is behavioral, “could do better if she wanted to.”. Inconsistent performance; some days her work is outstanding, other days she just doesn’t seem to care. Behavior at home reported by mother "Emily and I fight with each other all the time. I think she has some kind of a problem. She's just like my brother. He needed to take pills to calm him down when he was her age.”
Medications: none Allergies: none
PMH: Born at 35 weeks, 4 lbs. & 5 oz. No other hospitalizations, no surgery. Audiometry was normal at age 5. Last dental exam 6 months ago-no caries. Her growth and development have been normal.
SH: Lives with mother, father and brother in apartment. 1st grade. Not exposed to tobacco. Wears seatbelt, bicycle helmet and sunscreen.
FH: Positive for her maternal uncle “was ADD”, maternal grandfather “a heavy drinker."
PE: Slightly obese. Sad facial expression. Difficulty to engage in conversation. Full neurological exam and vision testing, normal. Interrupts conversation with mother several times during the exam. Repeatedly and excessively inflates blood pressure, able to redirect this activity with considerable effort.
1. What is your differential diagnosis for Emily’s school problems?
2. What evaluations should be done?
3. What is your follow-up plan?
4. What recommendation (educational, psychological, medical) would you make to Emily’s mother?
5. If pharmacological therapy is needed, how will you evaluate the success of this treatment?
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