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Posted: September 6th, 2023

Weekly Clinical Experience in Pediatric Setting

Weekly Clinical Experience. Describe your clinical experience for this week as a Nurse Practicioner student in the Pediatric setting.

Did you face any challenges, any success? If so, what were they?
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.
Mention the health promotion intervention for this patient.
What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
Support your plan of care with the current peer-reviewed research guideline.

Weekly Clinical Experience in Pediatric Setting
This week in my pediatric clinical rotation as a family nurse practitioner student, I saw a variety of patients with differing conditions. One patient in particular stood out, as their case highlighted key lessons around comprehensive assessment, differential diagnosis, and health promotion.
A three-year-old male presented with a three-day history of cough, congestion, and low-grade fever. On assessment, he exhibited nasal congestion, cough productive of clear mucus, and a temperature of 100.4°F. Lung auscultation revealed scattered wheezes bilaterally. His mother reported he had been playing outside frequently in the recent wet weather.
Based on these findings, my top differential diagnoses were upper respiratory infection (URI), acute bronchitis, and early pneumonia. URIs are common at this age and with his symptoms of cough and congestion. However, his fever and lung findings suggested it may have progressed to bronchitis. Pneumonia remained on my list due to his exposure to wet weather and presence of fever (Foster et al., 2020).
I performed a full head-to-toe assessment to evaluate for any signs requiring emergent treatment. Upon finding no concerning symptoms, my plan was to monitor his symptoms at home with rest, oral hydration, and over-the-counter fever reducers/decongestants as needed. I educated his mother about the signs of worsening infection like increased cough or difficulty breathing that would warrant a return visit or potential antibiotics.
To promote health, I discussed the importance of handwashing, limiting time outdoors in wet weather until fully recovered, and receiving the influenza vaccine later this season (CDC, 2022). Proper hygiene can help prevent spread of respiratory illnesses to others. Limiting outdoor exposure when recovery helps avoid re-exposure while still convalescing. Vaccination provides protection against serious influenza infection.
This experience highlighted for me the value of comprehensive assessment, considering differential diagnoses, and providing anticipatory guidance and health promotion counseling. As an advanced practice nurse, these skills will be crucial to delivering quality, evidence-based primary care to pediatric patients and families (Gouin et al., 2020). I aim to continue developing a broad differential thinking approach and focus on prevention and wellness in future clinical encounters.
Foster, C. E., et al. (2020). Diagnosis and treatment of respiratory illness in children and adults. American family physician, 102(8), 517-525.
CDC. (2022). Influenza vaccination recommendations.
Gouin, J. P., et al. (2020). Differential diagnosis: an evidence-based method. American family physician, 101(2), 88-96.

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