Clinical Journal Entry

A 21 month old Caucasian baby girl was brought to clinic by her mother with complaint of her baby getting irritable, easy tired during the day and sleeps more than usual after small activities at the day care and now she just noticed her skin is pale especially around her hands and eyelids and her husband also confirmed that she did look pale. So they are here today for a checkup even though she notices no other developmental changes. Mother denies any s/s of GI bleed like tarry stool. She has been current with her immunization and has no other medical or surgical history.

 

Assessment

 

An active toddler, with recent fatigue, has increase in sleeping, mild exercise intolerance.. She is a picky eater, enjoys small chicken, pork, and some vegetables, but loves milk and drinks about   seven bottles of whole milk daily.

 

Family history reveals mother had anemia during her pregnancy. There is no history of splenectomy, gall stones at an early age, or other anemia in the family.

 

Physical Examination:

Vital Signs: Temperature 37.8 degrees C, Blood Pressure 95/50 mmHg, Pulse 144 beats/minute, Respiration 18 breaths/minute , Height 85.5 cm (50th %ile), Weight 13.2 kg (75th %ile). General appearance: He is a pale appearing, active toddler.

Reflect on the patient provided who presented with a hematologic disorder during your Practicum experience. Describe your experience in assessing and managing the patient and his or her family and follow up apt . Include details of your “aha” moment in identifying the patient’s disorder. Then, explain how the experience connected your classroom studies to the real-world clinical setting.

24/7 Nursing Homework Help

Stuck with your nursing assignment? From Essays to Complicated Dissertations? Our accredited nursing paper writers can answer it all!

Get nursing paper writing help