NURS 610 Assignment 7.1 Health Promotion Pediatric Wellness

• NURS 610 Assignment 7.1 Health Promotion Pediatric Wellness

Physical Exam Findings

1. Jai is following his growth curve
2. Jai is up to date with his shots except for the Hepatitis B: Birth, 2, and 6 months

Rotavirus: 2, 4, 6 months

Pentacel (diphtheria, Haemophilus influenzae type B, pertussis, polio, and tetanus): 2, 4, 6, and 15 months

Prevnar 13 (pneumococcal 13-valent): 2, 4, 6, and 12 months Influenza: yearly

Varicella: 15 months

Hepatitis A: 15 months

3. Jai does not say anything during the
4. Jai will not look at you directly or at what you point at, even though you have one of his favorite toys.

You also notice he does not seem to look at his mother for any cues.

5. Jai is walking just fine and has good hand-eye coordination and
6. Jai’s teeth are coming in with no signs of decay, although you do see some white spot

You try to varnish his teeth, but he becomes very upset, and his mom has a really hard time consoling him.

Evaluation

List three developmental delays present in Jai, describe their importance, and develop a plan to address each.

DevelopmentalDelay1

Delay in Social Communication and Reciprocal Interaction Description of the Delay: Jai demonstrates a profound delay in the fundamental building blocks of social engagement. He never responds to his name, an important initial social signal. Throughout the visit, he does not make eye contact with the physician, even with the encouragement of a motivating toy, and he does not show interest in seeking his mother as a source of social cues or reassurance. This social non-rewarding goes on to emotional interactions; his mother remarks that the only sure way of getting a smile is through a screen, not actual human interaction, such as a game of peekaboo or a shared smile.

Such missing behaviors as joint attention, social referencing, and reciprocal enjoyment are the main warning signs that indicate an essential lack of social communication, which is a symptom of Autism Spectrum Disorder (ASD). Plan to Address: There are two main plans to deal with this delay in social development: formal assessment and intervention by parents. To begin with, the statewide Early Intervention program has to be referred to at once to complete the developmental assessment.

At the same time, a formal report of the level of concern should be done through a validated, autism-specific screening tool such as the M-CHAT-R. Second, it has to be about coaching the parents of Jai. They may be addressed to treatments like the Early Start Denver Model (ESDM) that enables the parents to establish social opportunities in daily practices (Ilyka et al., 2021). Through teaching some skills on how to engage in eye contact, turn-taking, and mutual enjoyment by sharing his interests (such as his alphabet letters), his parents can be active participants in assisting Jai to develop these essential social relationships.

DevelopmentalDelay2

2. Delay in Speech, Language, and Communication Description of the Delay: The delay in communication in Jai is not just in his limited use of 2-3 words only; it is more fundamentally described as the total lack of non-verbal communication skills, which normally compensate and come before speech. By the age of 18 months, a child should be pointing to things of interest, requesting, and sharing experiences using gestures. Jai does not do any of this. Moreover, he lacks adherence to a point or gaze, which means that he lacks receptive communication and comprehension of this primary social signal.
   The combination of this, the absence of verbal and non-verbal communication, seriously affects his capacity to communicate his needs and wants, and thus is directly connected to the extreme frustration and temper tantrums that his mother cites when his needs are not handled. Plan to Address: To deal with this communication delay, the skills of a speech-language pathologist (SLP) obtained via the Early Intervention system are needed. The aim of the SLP will be to give Jai a functional method of communicating, thus alleviating his frustration (Cui et al., 2023).
   The treatment regimen will probably be aimed at pre- linguistic capabilities, and that is to teach him to apply gestures, such as pointing or reaching. It can also incorporate formal systems such as sign language of key words or the Picture Exchange Communication System (PECS), where he gives a partner a picture and makes a request. By giving him a reliable tool to express himself, the therapy will directly target

DevelopmentalDelay3

3. Existence of Restricted and Repetitive Patterns of Behavior Description of the Delay: Jai has distinct patterns of restricted and repetitive behavior that extend past the usual toddler behavior. This insistence on sameness is seen when he is so angry when his alphabet letters are not in order, and requires predictable and routine play. He is also very much sensory sensitized, and most notably, auditory over-reactivity is observed, as shown by his extreme hours-long distress towards hearing the sound of a vacuum cleaner, a reaction so severe as to shape family habits. Also, his constant toe-walking is a motor mannerism that is frequently related to this group of behaviors.
   These actions are the essential characteristics of ASD and seriously affect everyday functioning, restricting his ability to be more flexible and reducing his sensory agony. Plan to Address: This approach to dealing with these behaviors will focus on an assessment by an occupational therapist (OT) using Early Intervention. The OT will evaluate the sensory processing differences in Jai and will come up with a sensory diet, a special set of activities that will enable his nervous system to better manage input. This may involve exercises that give him deep pressure or rhythmic movements to relax him. In his case of auditory sensitivity, the OT can direct him through a step-by-step desensitization. Moreover, a behavioral therapist can collaborate with the family to establish plans to implement small, manageable changes to his routines to build flexibility and minimize distress, and make his environment as safe and predictable as possible to him (Nimbley et al., 2022).

List two primary or preventative recommendations and two secondary or screening recommendations that you would address at this visit. (Refer to BrightFutures)

Detect potential issues at an early stage. General Developmental Screening: Both Bright Futures and the AAP recommend that all children be screened with a validated tool of developmental screening at the age of 18 months. Since issues with the language and social development of Jai have been raised, it is necessary to resort to a tool such as the Ages & Stages Questionnaire (ASQ) or Parents’ Evaluation of Developmental Status (PEDS) to have a standardized evaluation. Autism-Specific Screening: The AACP and Bright Futures suggest screenings of autism spectrum disorder at the age of 18 months.

The lack of response to his name, poor eye contact, the absence of pointing, the alignment of toys, etc., of Jai are strong indicators of the necessity to use a validated instrument such as the Modified Checklist for Autism in Toddlers (M-CHAT). Important Visit Notes To complete 18-month visit: You need to also incorporate other Bright Futures priorities: Address Parental Concerns with Empathy: The primary focus of this visit is on how Priya expresses her concerns about vaccinating Jai against the MMR virus and what she fears about the development of the child. Recognize her fears and give well-structured, evidence-based information. Official Screening: It is important to use clinical observation as the sole approach. It is advisable to use validated screening tools in order to objectively detect developmental delays. Consider a Referral: A referral to a formal assessment by Early Intervention services could be the most critical step with Jai, based on your findings and the results of the screening.

Review the Bright Futures anticipatory guidance for 18-month-old children. What are three things appropriate to discuss during this visit? Explain why?

Discussion Topic 1

1. Social-Emotional and Behavioral Development One of the key issues to be discussed during this visit is the social-emotional and behavioral development of Jai. The advice includes the focus on the discussion of the toddler’s emotions and tantrums, and the social interaction origin. This is of paramount relevance in the case of Jai since the transcript indicates that there are serious issues in this area. In particular, his mother reports that he has severe temper tantrums which are hard to calm and that he does not point, smile back socially, and respond to his name.
2. This discussion enables the provider to package these observations as not single issues, but as a group of symptoms that ultimately indicate the possibility of a developmental disorder such as Autism Spectrum Disorder (ASD). These behaviors are best discussed with the anticipatory guidance, as it gives an ideal point of entry and evaluates red flags and the importance of a formal developmental screening, which will eventually result in a referral to early intervention services which are highly critical at this age.

Discussion Topic 2

2. Communication and Language Development Bright Futures emphasizes the need to measure communication milestones that include pointing, use of multiple words and following simple instructions. To Jai, this is a most important issue. His mother has come out squarely to say that he only says two or three words and he is uninterested in speaking. In addition, the clinical findings reveal that there is an important delay in both expressive and receptive communication, as he is unable to point to request something or track a point, as well as to echo words.
   Addressing this topic allows the provider to validate the mother’s concerns and explain that communication is more than just words; it includes these critical non-verbal gestures. This discussion in turn results in a suggestion of a standardized screening tool and a referral to a speech-language evaluation, which places these steps as a preemptive and supportive step to help Jai develop the background skills he requires to express himself and alleviate his frustration.

Discussion Topic 3

3. Oral Health Discussing oral health is the 18-month Bright Futures guidance standard, which includes such topics as brushing with fluoride toothpaste and avoiding sugary drinks. This area is especially pertinent to Jai since the clinical encounter note states that he had white spot lesions on his teeth, the initial symptoms of enamel demineralization and possible tooth decay. Raising this, the provider can stop giving general advice and providing specific actionable suggestions specific to the needs of Jai.
   These involve showing the right size of toothpaste of fluoride (a smear that is as big as a grain of rice), talking about the need to brush twice a day, and examining his diet to determine whether or not he has some hidden sugars. To prevent the further development of the white spots into cavities, it is an important preventative step to address it now so that his overall health and well-being are supported by the health of his teeth and further complications and surgical interventions can be avoided in the future.

Reference

Cui, M., Ni, Q., & Wang, Q. (2023). PeerJ, 11, e15735–e15735. https://doi.org/10.7717/peerj.15735

Nimbley, E., Golds, L., Sharpe, H., Gillespie‐Smith, K., & Duffy, F. (2022). European Eating Disorders Review, 30(5), 538–559. https://doi.org/10.1002/erv.2920