SHOULD BE A TOTAL OF 2 SEPERATE REPLIES WITH ONE SCHOLARLY SOURCE PER REPLY . ha

SHOULD BE A TOTAL OF 2 SEPERATE REPLIES WITH ONE SCHOLARLY SOURCE PER REPLY .
half a page peer reply per topic
TOPIC 1
FARIBA
The questions I would ask:
What specific behaviors prompted your visit today?
When did you first notice these signs in your child? Have others noticed signs?
Have these behaviors been continuous or occasional?
Does your child have any other symptoms that might seem unrelated to autism spectrum disorder, such as stomach problems?
Does anything seem to improve your child’s symptoms?
What, if anything, appears to worsen symptoms?
When did your child first crawl? Walk? Say his or her first word?
What are some of your child’s favorite activities?
How does your child interact with you, siblings and other children? Does your child show interest in others, make eye contact, smile or want to play with others?
Does your child have a family history of autism spectrum disorder, language delay, Rett syndrome, obsessive-compulsive disorder, or anxiety or other mood disorders?
What is your child’s education plan? What services does he or she receive through school?
Subjective:
Chief Complaint (CC): An 18-month-old, you notice that he is playing with the window blinds, pushing them slightly, and then watching them sway back and forth. He avoids eye contact, flaps his hands in excitement, and only says a few words.
Allergy: The patient has no known allergies.
Past Med. Hx (PMH): He was born preterm.
Past Surgical History: No past surgical history.
Immunizations: Up to date
Family history: Mother: obsessive-compulsive disorder. Cousin: autism. Mother age at birth: 43 years old, father age at birth: 51 years old.
Objective:
Vital Signs: HR:82 T:98.2 O2sat:98% Ht: 30 Weight: 22 IIb
General: The patient is awake, No eye contact, only 3 few words.
Assessment:
Working Diagnoses: Autism spectrum disorder (ASD)
Referral: Developmental pediatrician
Autism spectrum disorder (ASD) is a developmental disability caused by differences in the brain. People with ASD often have problems with social communication and interaction, and restricted or repetitive behaviors or interests. People with ASD may also have different ways of learning, moving, or paying attention. It is important to note that some people without ASD might also have some of these symptoms. But for people with ASD, these characteristics can make life very challenging. A child or adult with autism spectrum disorder may have problems with social interaction and communication skills, such as : avoids or does not keep eye contact, does not respond to name by 9 months of age, does not share interests with others by 15 months of age, does not point to show you something interesting by 18 months of age, fails to respond to his or her name or appears not to hear you at times, doesn’t speak or has delayed speech. People with ASD have behaviors or interests that can seem unusual. These behaviors or interests set ASD apart from conditions defined by problems with social communication and interaction only, for example: performs repetitive movements, such as rocking, spinning or hand flapping. Most people with ASD have other related characteristics such as: delayed language skills, delayed movement skills, delayed cognitive or learning skills, and Hyperactive, impulsive, and/or inattentive behavior (Centers for Disease Control and Prevention,2022).
Risk factors:
There is not just one cause of ASD. There are many different factors that have been identified that may make a child more likely to have ASD, including environmental, biologic, and genetic factors. Autism spectrum disorder affects children of all races and nationalities, but certain factors increase a child’s risk. These may include (Mayo Clinic,2018):
Sex: Boys are about four times more likely to develop autism spectrum disorder than girls are.
Family history: Families who have one child with autism spectrum disorder have an increased risk of having another child with the disorder. It’s also not uncommon for parents or relatives of a child with autism spectrum disorder to have minor problems with social or communication skills themselves or to engage in certain behaviors typical of the disorder.
Other disorders. Children with certain medical conditions have a higher-than-normal risk of autism spectrum disorder or autism-like symptoms. Examples include fragile X syndrome, an inherited disorder that causes intellectual problems; tuberous sclerosis, a condition in which benign tumors develop in the brain; and Rett syndrome, a genetic condition occurring almost exclusively in girls, which causes slowing of head growth, intellectual disability, and loss of purposeful hand use.
Extremely preterm babies. Babies born before 26 weeks of gestation may have a greater risk of autism spectrum disorder.
Parents’ ages. There may be a connection between children born to older parents and autism spectrum disorder.
Screening and Diagnosis of Autism Spectrum Disorder
Diagnosing autism spectrum disorder (ASD) can be difficult because there is no medical test, like a blood test, to diagnose the disorder. Health care providers diagnose ASD by evaluating a person’s behavior and development. ASD can usually be reliably diagnosed by age 2. Diagnosis in young children is often a two-stage process (National Institute of Mental Health,2023):
Stage 1: General developmental screening during well-child checkups:
Every child should receive well-child check-ups with a pediatrician or an early childhood health care provider. The American Academy of Pediatrics recommends that all children receive screening for developmental delays at their 9-, 18-, and 24- or 30-month well-child visits, with specific autism screenings at their 18- and 24-month well-child visits. A child may receive additional screening if they have a higher likelihood of ASD or developmental problems. Children with a higher likelihood of ASD include those who have a family member with ASD, show some behaviors that are typical of ASD, have older parents, have certain genetic conditions, or who had a very low birth weight (National Institute of Mental Health,2023).
Stage 2: Additional diagnostic evaluation
A team of health care providers who have experience diagnosing ASD will conduct the diagnostic evaluation. This team may include child neurologists, developmental pediatricians, speech-language pathologists, child psychologists and psychiatrists, educational specialists, and occupational therapists. The diagnostic evaluation is likely to include (National Institute of Mental Health,2023):
Medical and neurological examinations
Assessment of the child’s cognitive abilities
Assessment of the child’s language abilities
Observation of the child’s behavior
An in-depth conversation with the child’s caregivers about the child’s behavior and development
Assessment of age-appropriate skills needed to complete daily activities independently, such as eating, dressing, and toileting.
Because ASD is a complex disorder that sometimes occurs with other illnesses or learning disorders, the comprehensive evaluation may include (National Institute of Mental Health,2023):
Blood tests
Hearing test
The evaluation may lead to a formal diagnosis and recommendations for treatment.
Treatment and Intervention Services for Autism Spectrum Disorder
Current treatments for autism spectrum disorder (ASD) seek to reduce symptoms that interfere with daily functioning and quality of life. Treatments can be given in education, health, community, or home settings, or a combination of settings. There are many types of treatments available. These treatments generally can be broken down into the following categories, although some treatments involve more than one approach (Centers for Disease Control and Prevention,2022):
Behavioral: Behavioral approaches focus on changing behaviors by understanding what happens before and after the behavior. Behavioral approaches have the most evidence for treating symptoms of ASD. A notable behavioral treatment for people with ASD is called Applied Behavior Analysis (ABA). ABA encourages desired behaviors and discourages undesired behaviors to improve a variety of skills. Progress is tracked and measured. Two ABA teaching styles are Discrete Trial Training (DTT) and Pivotal Response Training (PRT).
Developmental: Developmental approaches focus on improving specific developmental skills, such as language skills or physical skills, or a broader range of interconnected developmental abilities. The most common developmental therapy for people with ASD is Speech and Language Therapy. Speech and Language Therapy helps to improve the person’s understanding and use of speech and language. Occupational Therapy teaches skills that help the person live as independently as possible. Skills may include dressing, eating, bathing, and relating to people.
Educational: Educational treatments are given in a classroom setting. One type of educational approach is the Treatment and Education of Autistic and Related Communication-Handicapped Children (TEACCH) approach. TEACCH is based on the idea that people with autism thrive on consistency and visual learning.
Social-Relational: Social-relational treatments focus on improving social skills and building emotional bonds. Some social-relational approaches involve parents or peer mentors.
Pharmacological: There are no medications that treat the core symptoms of ASD. Some medications treat co-occurring symptoms that can help people with ASD function better. For example, medication might help manage high energy levels, inability to focus, or self-harming behavior, such as head banging or hand biting.
Psychological: Psychological approaches can help people with ASD cope with anxiety, depression, and other mental health issues. Cognitive-Behavior Therapy (CBT) is one psychological approach that focuses on learning the connections between thoughts, feelings, and behaviors.
Complementary and Alternative: Complementary and alternative treatments are often used to supplement more traditional approaches. They might include special diets, herbal supplements, chiropractic care, animal therapy, arts therapy, mindfulness, or relaxation therapies.
TOPIC 2 JADA
Case Study #3: A 16-year-old mother has brought in her 5-day-old infant to the clinic with bilateral purulent eye discharge. The infant is breastfeeding well and has had 6 yellow seedy stools within the past 24 hours.
What more should you know about this infant and mother?
How should you manage this infant’s condition?
SUBJECTIVE
CC: Bilateral purulent eye discharge; 6 yellow seedy stools within the past 24 hours
HPI: A 16-year-old mother has brought in her 5-day-old infant to the clinic with bilateral purulent eye discharge. The infant is breastfeeding well and has had 6 yellow seedy stools within the past 24 hours.
PMH:
Chronic medical problems: NA
Surgical hx: NA
Social hx: Raised by his 16-year-old mother in SoCal. Father is not present; mother is dating a new guy. Only child.
Family hx: Both parents are alive and healthy
Hospitalizations: NA
Immunizations: Up to date with all immunizations for his age
Allergies: NA
Meds: Mother continues to take her prenatal vitamins.
What more should you know about this infant and mother?
There may be a maternal history of vaginal infection during pregnancy or current sexually transmitted infection (STI).
General medical history including birth weight; pertinent prenatal, perinatal, and postnatal factors (e.g., prematurity, infections); past hospitalizations and surgery; general health and development
Family medical history of ocular problems (including eye surgeries) such as glaucoma, blindness, poor vision, difficulty walking in dim light, photophobia, use of thick glasses, lazy eye, strabismus, nystagmus, leukokoria, retinoblastoma, congenital cataracts
Presence of allergies and specific allergens
(Maaks, Starr, & Brady, 2020)
OBJECTIVE
VS: BP, HR, RR, Weight, Height, BMI = all within normal limits
Physical Exam:
Physical exam should evaluate for periorbital edema and adenopathy (Makker, Nassar, & Kaufman, 2022). Examine both eyes/eyelids for swelling and edema, check conjunctiva for injection (congestion of blood vessels) and chemosis (conjunctival swelling). Check for ulcerations and the presence of red reflex. A purulent discharge, edema and erythema of the lids, as well as injection of the conjunctiva, are suggestive of bacterial conjunctivitis (Makker, Nassar, & Kaufman, 2022).
ASSESSMENT
Working Diagnosis: P391 Neonatal conjunctivitis
Neonatal eye discharge is usually due to congenital nasolacrimal duct obstruction or either chemical or infectious conjunctivitis (Makker, Nassar, & Kaufman, 2022). Neonatal conjunctivitis, also called ophthalmia neonatorum, typically presents during the first four weeks of life. The infection is usually acquired during delivery and is the most common ocular disease in neonates. Typical symptoms are persistent tearing and a mucoid discharge in the inner corner of the eye (Makker, Nassar, & Kaufman, 2022).
Differential Diagnosis: Dacrocysitis, Nasolacrimal duct obstruction
PLAN
Diagnostic studies: Culture (ELISA, PCR), Gram stain, R/O N. gonorrhoeae, Chlamydia (Maaks, Starr, & Brady, 2020).
Swabs and scrapings must be done. Gram and Giemsa staining, direct immunofluorescent monoclonal antibody staining, cultures, enzyme-linked immunosorbent assay (ELISA), or polymerase chain reaction (PCR) testing can be used (Maaks, Starr, & Brady, 2020). Any infant younger than 2 weeks with ophthalmia neonatorum should be tested for gonorrhea. A culture for gonorrhea (on chocolate agar or Thayer-Martin medium) or aggressive scraping for a Gram stain is used for diagnosis. Culturing purulent discharge is not sufficient. If gonorrhea is suspected, also check for C. trachomatis (Maaks, Starr, & Brady, 2020).
Referral: NA
Treatment: How should you manage this infant’s condition?
Saline irrigation to eyes until exudate gone; follow with erythromycin ointment
Based off diagnostic studies:
For N. gonorrhoeae: ceftriaxone or IM (25-50 mg/kg, not to exceed 125 mg)
For nongonococcal conjunctivitis: topical erythromycin 0.5% ointment (eyes should be cleansed with water or saline applied with cotton balls before instilling the ointment not the lower conjunctival sac)
For chlamydia: erythromycin (50 mg/kg/day in four divided doses for 14 days) or possibly azithromycin (20 mg/kg for 3 days)
Mothers and their sexual partners should receive treatment if gonococcal and/or chlamydial infections occur in their newborns.
Reassure mother that with breast feeding, it can cause her baby’s stools to be yellow and seedy.

Need help Working on This or a Similar Assignment?

We specialize in custom-written, original papers. No prewritten essays here—order your plagiarism-free and AI-free paper today for guaranteed originality.


Posted

in