NR 546 Week 7 Case Study- child and adolescent questions and detailed answers all question upgraded /newest version[grade a+]

NR 546 Week 7 Case Study-
ss ss ss ss ss



child and adolescent
ss ss ss ss



questions and detailed
ss ss ss



answers all question
ss ss ss



upgraded /newest
ss ss



version[grade a+]
ss ss



Subjective Objective

The ssclient ssis ssa ss6-year-old ssmale ssaccompanied ssby Physical ssExamination:
sshissmother ssand ss10-year-old ssbrother.
Physical ssExamination ss(Obtained ssby ssPediatrician ss2 ssDays ssEarlier)

s eight ss48″, ssweight: ss65 sslb, ssBMI: ss23.9
H
Client’s ssChief ssComplaints:

“My ssson ssis ssgetting ssin sstrouble ssat ssschool. ssHe Vital sssigns: ssB/P, ss100/60; ssP, ss78; ssR, ss16; ssT, ss98.4
sshas ssendless ssenergy, sshe sscan’t sssit ssstill. ssWhen
General: ssWell-nourished ss7-year-old ssmale
sshe ssplays, sshesis sstoo ssrough sswith ssother sskids.”

HEENT: ssPERRLA, ssEOMI, ssvision ssis ss20/20, ssand sshearing ssacuity ssis
sunremarkable.
History ssof ssPresent ssIllness
Neck: ssNo ssmasses
The ssmother sspresents sswith ssthe ssclient ssdue ssto
ssacademic ssand ssbehavioral ssconcerns. ssThe Pulmonary: ssNo sswheezing, ssrhonchi, ssor
ssmother sspresents ssa ssschool ssreport ssthat ssstates

ssthat sshe sscannot ssstay ssseated, ssfrequently sscalls
ralesC
ss s ardiac: ssS1, ssS2


ssout ssin ssclass, ssis ssdisorganized, sscannot sscomplete
Abdomen: ssNo ssdistension, ssbowel sssounds ss× ss4 ssquadrants, ssno
sshis ssassignments, ssandshas ssbeen ssknown ssto ssbe
ssmassessor sshernias
ssdisrespectful ssto ssadults.

According ssto sshis ssmother, sshe ssis ssvery Lymph ssnodes: ssNo ssswelling
ssimpatient,sdistractable ssand ssimpulsive

ss Extremities: ss2+ sspulses

Past sspsychiatric sshistory: ss. ssAt ssage ss4, ssthe sschild bilaterallySs kin: ssNo sslesions ssor
ss


sswas ssin ssa ssHead ssStart ssProgram, ssand ssit sswas
ss edema ssNeuro: ssCN ssII-XII
ssnoted ssthat sshe sswassdemonstrating ssextreme

sshyperactivity, sspoor ssimpulsescontrol, ssand ss intact
ssdifficulty sssustaining ssfocus. ssPeer ssinteractions

sswere ssmarked ssby ssaggression sssuch ssas sskicking

ssand ssbiting ssothers. ssWhen sstold ss“no,” sshe sswould

shave ssextreme sstemper sstantrums, sswhere sshe

sswould sscry, ssscream, ssand ssdestroy ssproperty.

ssSuch ssbehaviors ssresulted ssin ssbeing sspermanently

ssexpelled ssfrom ssthe ssprogram. ssAt ssage ss5, sshe sswas

ssevaluated ssand ssdiagnosedswith ssADHD, sscombined

sstype. ssMedication sswas ssnot ssprescribed ssat ssthat

sstime ssdue ssto ssage.

, Past ss Medical ss History: ss healthy Mental ssstatus ssexam:

Perinatal sshistory: s s full ssterm Appearance: sswell-nourished ss6-year-old ssmale sswho ssappears
ss pregnancy, ss uneventful. ssNSVD. ssstated ssage. ssHe ssis sscasually ssattired ssin ssa ssstriped sscollared

ssBreastfed ssx ss 5 ssmonths. ssshirt, ssjeans, ssand sssneakers, ssappropriate ssfor ssage ssand ssweather.

ssHygiene ssand ssgroomingsare ssgood.
Developmental: ssmother ssreports ssclient
ssdemonstrates ssage-appropriate ssgross ssand ssfine Alertness ssand ssOrientation: ssfully ssoriented
ssmotorsskills. ssHe ssis ssable ssto ssdress ssand ssundress, sstosperson‚ ssplace‚ sstime‚ ssand sssituation,

sscan sstie sshis ssshoes, sscolors sswithin ssthe sslines; sshe ssAlert

sscan ssbalance sson ssone ssfoot, sscatch ssa sstennis ssball,
Behavior: ssHe ssseparates sseasily ssfrom sshis ssmother ssand ssbrother
ssand ssride ssa ssbicycle sswithstraining sswheels.
ssto ss come sswith ssinterviewer. ssWhen sshe ssenters ssthe ssoffice, sshe sssits

Family ssHistory ssdown ssinsthe sschair, ssputs sshis sshands sson ssthe ssdesk ssand ssstates,

ss“Let’s ssget ssto sswork.” ssInitially, sshe ssstays ssseated sswith ssgood
• Father ssis ssalive ssand sswell.
ssposture, ssbut ssafter ssseveral ssminutes, sshe ssbecomes sshyperactive
• Mother ssis ssalive, sshas ssanxiety
ssand sscannot ssstay ssseated.sBoundaries ssare sspoor, ssand sshe ssoften
• One ssbrother ssage ss10, ssalive ssand sswell ssgrabs ssobjects ssoff ssthe ssdesk. ssHe ssfrequently ssinterrupts.


Social ssHistory
Speech: ssSpeech ssis ssspontaneous. ssAt sstimes, sstone ssis ssloud.
• Lives sswith ssparents ssand ssbrother ssRate ssis sfast, ssand sshe sstalks ssexcessively. ssHe sshas ssa ssmild sslisp
• 1st ssgrader ssat sslocal sspublic ssschool ssand sssome ssage-sappropriate ssarticulation sserrors.


• does ssnot sshave ssany ssfriends Mood: ss“happy”
Trauma sshistory: ssno ssreports ssof sstrauma
ss Affect:
Review ssof ssSystems
constricted
ss


• appetite ssgood, ssweight ssstable
Impulse sscontrol: ssPoor. ssTouching ssitems sson ssprovider’s ssdesk
• sleeps ss5-7 sshours ssat ssnight,
ssdespitesmultiple ssreprimands ssfrom sshis ssmother.
ssdifficulty sfalling ssasleep

Thought sscontent: ssSuicidal ssand/or sshomicidal ssideations: ssCannot
Allergies: s s NKDA
ssbeselicited sswhen ssquestioned



Perceptions: ssNo ssevidence ssof sspsychosis, ssnot ssresponding ssto
ssinternalsstimuli, ssreports ssauditory sshallucinations.



Memory: ssRemote ssmemory ssappears ssfair. ssHe ssis ssable ssto ssrepeat
ssthreesobjects ssimmediately ssbut ssnot ssafter ss5 ssminutes.



Concentration: ssWhen ssfocused, sshe ssis ssable ssto sssing ssthe ssABC’s
ssand sscount ssto ss99. ssOtherwise, sshe sshas ssa ssvery ssshort ssattention

ssspan ssand ssissdistracted.



Attention ssand ssobserved ssintellectual ssfunctioning:
ssIntelligencesappears ssto ssbe ssaverage.



Fund ssof ssknowledge: ssGood ssgeneral ssfund ssof ssknowledge ssand
svocabulary



Musculoskeletal: ssnormal ssgait ssand ssstation
Diagnosis: ss(F90.2) ssAttention-Deficit/Hyperactivity ssDisorder, ssCombined ssPresentation