Please respond to at least 2 of your peer’s posts, from an FNP perspective. To ensure that your responses are substantive, use at least two of these prompts:

• Do you agree with your peers’ assessment?
• Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
• Share your thoughts on how you support their opinion and explain why.
• Present new references that support your opinions.

Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.

Eric Question and Response

1. You have just finished seeing an 8-month-old girl in urgent care due to a 4-day refusal to bear weight on her left leg. Father reports infant was in the care of mom and her significant other until this morning. Father brought the baby to urgent care when he saw her not wanting to put her foot down. Father denies any reported history of injury or falls. The x-ray result indicates an oblique diaphyseal fracture of the lower tibia. There are corner fractures of both wrists and two posterior rib fractures all in various stages of healing. What is your approach to this situation? What concern, if any, do you have at this time and what is your plan of care? Describe your role as a mandatory reporter and how you reached the determination of whether or not a referral to CPS is indicated.

Infant Abuse

Having worked in the Emergency Room I have seen numerous cases of child abuse, it is not uncommon and we have always been taught to treat injuries as possible abuse until proven otherwise, it can be difficult with children because its not uncommon for them to have scattered bruising of various stages on their legs or arms, I know that both of my children are bruise factories. In my pediatric clinicals, my preceptor always performs a head to toe on his patients no matter their complaint to assess for potential abuse or other issues. I have seen abuse from child care facilities, family members, baby sitters and from immediate family, no one is above suspicion when it comes to abuse.

Obviously this child is loaded with signs of child abuse, the top being the corner fractures which are considered to be completely non-accidental to children under the age of two; a corner fracture is an injury to the metaphysis or growth plate at either ends of the long bones such as the femur or tibia; they are commonly referred to as bucket-handle fractures due to their appearance in x-rays (Martindale, Swenson, Coffman, Newton, & Lindberg, 2014). The spiral fracture of the leg is also a tell tell sign of abuse in infants and children, the fractured ribs in an 8 moth old would only because caused by abuse or potentially neglect or unsafe environment.

In this situation it is essential that you do not allow the father to leave with the child, child protective services should be notified immediately and they will assume care of the child until an investigation has been performed. Although it is the father bringing the child in he should not be allowed to leave with the child, it should never be assumed that the person brining in the child is innocent or that the child will be safe with them, furthermore this child should be brought to an emergency room and an orthopedist consulted to see what must be done in regards to the fractures.

References

Martindale, J., Swenson, A., Coffman, J., Newton, A. W., & Lindberg, D. M. (2014). Recurrent concerns for child abuse: Repeated consultations by a subspecialty child abuse team. Child Abuse & Neglect,38(7), 1259-1266. doi:10.1016/j.chiabu.2014.03.007

Kshawnda’s question and response

1. As a primary care provider, you are managing the care of a toddler who has been diagnosed with febrile seizures. What are your treatment recommendations for the parents? What frequency will you see the child? The parents want to know when he will outgrow this condition. How would you as the primary care provider respond to the parents?

Febrile seizures are seizures or convulsions that occur in young children and are triggered by fever (National, 2019) In many cases the fever will reach up to 100.4 or higher. Young children between the ages of about 6 months and 5 years old are the most likely to experience febrile seizures; this risk peaks during the second year of life (National, 2019). The fever may accompany common childhood illnesses such as a cold, the flu, or an ear infection. The best treatment options are giving the child acetaminophen or Motrin for to treat the child’s fevers. I understand that some parents may feel that more should be done. However, experts recommend that children who have experienced a febrile seizure not take any anti-seizure medication to prevent future seizures, as the side effects of these daily medications outweigh any benefits (National, 2019). Medication such as diazepam, may lower the risk of having another febrile seizure. Although it’s tolerated well, it occasionally can cause drowsiness, a lack of coordination, or hyperactivity. Changing the child’s way of life. As the primary care provider, I would only prescribe the patient anti-seizure medication if the patient has experience 2 to 3 episodes and the episodes last more the 5 minutes. Multiple or prolonged seizures are a risk factor for epilepsy but most children who experience febrile seizures do not go on to develop the reoccurring seizures that are characteristic of epilepsy. Although these seizures can be scary it’s important the we educated the parents about the prevention of injury and when to call 911 / Doctor.

Reference
National Institute of Neurological Disorders and Stroke (2019). Febrile seizures retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregi…

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