Pediatric Scenarios

University of Phoenix Material

Pediatric Scenarios

1. Vomiting, 6-week-old male

Name: A.P.

Date: 15 July 2011

DOB: 1 June 2011

Gender: Male

Age: 6 weeks

CC: Vomiting for 2 days.

Accompanied by mother. A. has been vomiting for 2 days, mother is concerned that he is getting dehydrated, fewer wet diapers today. No fever. Does not act sick. Crying with vomiting, wants the bottle. Discussed ADLs related to normal activity: Is sleeping well, was voiding about 6 wet diapers a day, today with only 1 wet diaper in early morning. BMs one to two daily/soft. No BM yet today. On Similac Advanced formula. Usually taking 4- to 6-oz. bottle about every 4 to 6 hours. Started with vomiting yesterday. Now had what is described as projectile vomiting only with feedings. Appears very hungry. Wants to eat but only vomits when fed. Mother tried to give smaller amount of formula- 1 oz. but still had vomiting. No allergies, is not on any medications, unremarkable prior history. Last fed about one hour ago with vomiting afterwards. Event started yesterday with morning feeding. No one at home sick. Stays home with mother. Vaccines are up to date. Denies any recent travel or exposure to anyone who is ill. Last well visit at 1 month of age was unremarkable. Lives in home with parents and 3-year-old brother. Mother is coping well at this time. Concerned about dehydration and being unable to feed A.

Birth weight 8 lb 6 oz (50%); one month weight (50%)

Birth history: Unremarkable

1. Constipation, 4-year-old female

Name: C.P.

Date: 15 July 2011

DOB: 15 August 2007

Gender: Female

Age: 4 years 11 months

CC: Here with father. Concerns about Constipation

CP is a 4-year-old female. She will be 5 years old in one month. Concerns of abdominal pain before having BM then feels better, denies soiling underwear. Has had problems with BMs when she started in preschool last year but seemed to resolve with increased fluids. Has been toilet trained since 3 years of age. Was having one soft stool daily to every other day. Now with BMs every 3 to 4 days, hard, large, brown in color. Is voiding well, denies any daytime or nighttime enuresis. Decrease in playtime because it is too hot to go outside. No change in diet. Eats meals with family. Good appetite, about 2 to 3 6-ounce glasses of milk daily, likes cut up fruits and vegetables. Normal ADLs- eating, drinking, sleeping well, voiding 4 to 6 times a day with no problem. Vaccines are up to date. No recent illness. In home are parents and a new 2-month-old baby brother. Stays home with mother. Will start kindergarten in fall. Very social. Likes to be with other children.

Review of growth charts shows weight at 4 year well exam 50%. Today’s weight is 91% (>85%). 24 hour diet recall in office suggests increase in milk intake and eating a lot of cheese.

1. Short Stature, 7-year-old male

Name: B.P.

Date: 15 July 2011

DOB: 01 January 2004

Gender: Male

Age: 7 years 6 months

CC: Well visit today with parental concern about short stature

Here with parents. Parental concerns about B. being the shortest child in class. They are concerned about his height. Denies any PMH of any significant illness. Mother’s height is 64” with menarche onset at 12 years of age. Father’s height is 72”. Father states he was shorter than other children and then he had a rapid growth spurt when he was about 16-years old. Other family members are normal heights per parent’s history. Vaccines are up to date. Denies any recent travel. Lives with parents and older sister, no pets. B. is not concerned about his height at this time. Is going to start 2nd grade in August. Does well in school. Has friends at home and school. No other concerns at this time. Well exam done today. Normal exam and normal development. Denies any medications.

Review of growth chart shows:

• Annual growth >4 cm/year.
• Birth: Ht: 19”
• 6.6 years old: Ht: 44 ½””

Labs/Imaging:

• NB screen at birth normal
• XRay single AP view of the left hand and wrist
• Labs: T4, TSH

1. Obesity, 16-year-old female

Name: D. P.

Date: 15 July 2011

DOB: 10 June 1995

Gender: Female

Age: 16 years

CC: Concerned about D. P’s weight

New patient here with mother today. Concerned about weight. Has not received regular well exams due to lack of insurance. Last well exam was when she was 12-years old. Now has insurance coverage. Vaccines complete except for recommended HPV series. Mother and D. P. would like to start vaccine series today. Denies any allergies, is not taking any medications or OTC products. PMH significant for overweight “all her life.” Menses started at 12 years of age. Has regular menses monthly lasting about 4 to 5 days, no discomfort. Denies being sexually active. Will be starting 11th grade in the fall. Grades usually As and Bs. Just moved to Arizona. Has made a few friends in the neighborhood. Normal developmental milestones per parent history. No known medical problems. ADLs- WNL by history- eating, sleeping well, voiding, normal daily/soft BMs. Not very active, likes to read, hangs out with friends, takes singing lessons, would like to sing professionally. Review of PMH, birth history, social history, surgical/hospitalizations- unremarkable. FMH of obesity with no complications. In home are parents, 2 sisters, and older brother. Family members are also obese per mother and D.P.