Six Month baby's well-being assessment

You are writing for MASTER level online FNP nurse practitioner program. Discussion Boards are utilized to encourage student-to-student interactions.These assignments will focus on assessment and evidence-based health promotion activities’ u responding to Faryal Sahibzada post which in orange color.

I have provided my initial post (below in black ink)

Your responses should be clear, accurate and in complete sentences.

When offering an opinion, please support it with specific references and evidence, when possible. Evidence is supporting information from course readings, an outside resource,

research (1 book, 1 website scolerly article.) or specific real-life application from your work experience or prior coursework.

Please do not just rewrite the post that your class meat wrote, put your opinion can agree or disagree with evidence please…please ….

 Text Book name

Pediatric Physical Examination - E-Book: An Illustrated Handbook (3rd Edition)

Required Textbook Readings

1.Duderstadt - Chapt. 10: Head and Neck Assessment – (MO 1,2,3)

2.Duderstadt - Chapt. 11: Lymphatic System – (MO 1,2,3)

3. Duderstadt - Chapt. 12: Eyes – (MO 1,2,3)

4. Duderstadt - Chapt. 13: Ears – (MO 1,2,3)

5.Duderstadt - Chapt. 14: Nose, Mouth, and Throat – (MO 1,2,3)

1.    Some questions to be aske  Has solid food been introduced? If yes, what type of food and did the child have any reaction?Solids are introduced around 6 months of age with iron-fortified cereal or purred meat (Gavin, 2022).

a.    How much sleep is she getting?

  My initial post

Specific QuestionsAt 6 months old, I would ask the mother for the newborn screening results, whether there is any swelling in the neck area, how the child is managing head control, whether the child has ahistory of neonatal or maternal infection, quality of strength and muscle tone, and whether the child is achieving her developmental milestones (Duderstadt, 2017: p.287). This would allow me to gather information for the head and neck assessment. I would additionally ask the mother whether the child has a history of respiratory infection or fever or any exposure to them and whether the child has poor growth or is failing to thrive (Duderstadt, 2017: p.309). This additional information would help me gather information for lymphatic system assessment. Moreover, I would ask the mother when the child started to visually follow her, if the child reacts or blinks to bright light, whether there is any rapid involuntary eye movement, if there is a persistent tearing or discharge on either or both eyes, whether the mother has any concern concerning visual development, whether there was significant jaundice during the neonatal period, if there was an occurrence of neonatal meningitis, and whether there is any abusive head trauma history. This would allow me to gather information for eye assessment.

I would also ask the mother if the child reacts to sound with activity change or startle response, whether the infant turns her body or head towards the sound, whether the child makes babbling or cooing noises, if the child is breastfed, if the child experience frequent colds, whether there is a history of a ruptured tympanic membrane or frequent ear infections, if there is an occurrence of ear drainage, if the mother has any concern about the verbalizing and hearing of the infant, whether the child turns her head towards her when her name is called, and whether there is any concern about the motor development of the child (Duderstadt, 2017: p.371). This would help me gather information for ear assessment. Finally, I would ask the mother if there are any nasal discharges, any sucking difficulty, feeding, whether the mother has introduced solid food to the child, whether there are any sores, moth bleeding, or white patches, and if the child has any erupted teeth, whether the mother gives the child some juice in the bottle, whether the child is water fluoridated or is on fluoride supplement, her weaning plans from bottle or breast, if the child has the habit of putting objects in the mouth, if the child sucks her fingers or thumb, or uses a pacifier, and if so, the frequency of the habit (Duderstadt, 2017: pp.413-4). This would help me gather assessing information for the nose, mouth, and throat.  

Immunizations/Tests

  i. The child might receive a Haemophilus Influenzae Type B (Hib) vaccine (Duderstadt, 2017: p.433).

   ii. Diphtheria, Tetanus, Acellular Pertussis (DTaP)

  iii.Polio Vaccine (IPV)

  iv.Pneumococcal Conjugate Vaccine (PCV)

   v.Rotavirus (RV)

   vi. Hepatitis B (HBV)

  vii. Influenza (Flu)

Specific Aspects

The child’s head control ought to be examined. There should be no lag when pulling the child to a sitting position. The size and shape of the head should be assessed while noting any masses or misshapen skull, nodules, scalp, or lesions. There should be fontanels palpation for size, tenseness level, depression, or pulsations. The neck should be inspected for symmetry, mobility, and shape. It should also be palpated for any masses, nodules, or swelling. Any nodules and masses noted on the scalp or in the neck area need diagnostic evaluation (Duderstadt, 2017: p.300). Young children are often very uncomfortable and fearful, or ticklish, and tend to move their shoulders upward during palpation on the head and neck region. I would therefore ensure that this examination follows the 'quieter' examination parts. It would also be important to inspect and palpate lymph glands regionally while noting ominous signs such as tenderness, warmth, and immobility that indicate abscess or infection, as well as visible lymph gland swelling that needs further diagnostic evaluation (Duderstadt, 2017: p.310). Examiners often miss the occipital nodes because of very low palpation. I will ensure that I aim for the area above the hairline. During the eye examination, the symmetry should be noted, and the shape and size of the periorbital cavity. Ocular alignment can also be evaluated using the cover-uncover test (Duderstadt, 2017: pp.341-2). Red light reflex or retinal light reflex can be used to determine clarity, receptivity, and sensitivity (Duderstadt, 2017: pp.345-6). During ear inspection, the auricles should be inspected for shape, size, deformity, placement, symmetry, color, and discharge. The tympanic membrane ought to also be assessed for bony landmarks while noting its quality and movement (Duderstadt, 2017: p.378). I will not focus on tympanic membrane color like pink or red color may be due to irritation, fever, or crying. The child should also be inspected for patency of nares using an otoscope with halogen light while noting any narrowing of nares or flaring with breathing. The mouth should be checked for the presence of sores, and the lips for sucking blisters (Duderstadt, 2017: p.422). Moreover, the hard palate should be inspected for lesions or patency. Since children tend to cry and be uncomfortable during the nose-mouth-throat assessment, I would only perform the examination after the quiet parts and the ear exam.

Anticipatory Guidance

   i. Alternate the child's head position from left to the right occipital area while asleep, and provide short supervised periods of tummy time when the child is awake (Duderstadt, 2017: p.289). This i meant to prevent and correct most position-related head deformities.

  ii. Hold the child in a sitting position while feeding.

   iii.Tooth eruption may begin if not yet starting with the lower incisors.   iv.        Avoid putting the child to sleep with a bottle containing added or natural sugars (Duderstadt, 2017: p.427).

      v.Introduce solid foods

     vi.Observe choking

     vii.Expose the child to various sights and sounds, provide toys, and socialize.

 References

Duderstadt, K. (2017). Pediatric Physical Examination-E-Book: An Illustrated Handbook. 3^rd Edition. St. Louis, Missouri: Elsevier.

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