NURS 6541 Week 2 Discussion: Developmental Red Flags
NURS 6541 Week 2 Discussion: Developmental Red Flags
NURS 6541 Week 2 Discussion: Developmental Red Flags – Wellness visits are an important part of pediatric primary care. During these visits, patient growth and development are assessed. As an advanced practice nurse who performs these assessments, you must be able to distinguish between normal and abnormal growth and development to recognize red flags. While some patients may not meet milestones due to differences in rates of development, abnormal development might also be a red flag of an underlying problem. In this Discussion, you examine the following case studies and consider potential developmental red flags:
NURS 6541 Week 2 Discussion: Developmental Red Flags Case Study 1
A mother brings in her 16-month-old, Brittany, for treatment of an acute illness. During the history, the mother reports that her mother-in-law is concerned about the toddler’s development. Further questioning reveals the following:
- Brittany was a term infant born vaginally with no intrapartum complications. Birth weight was 8 pounds 1 ounce and current weight is 26 pounds 9 ounces.
- She was breastfed until 12 months of age and now drinks 24 ounces of whole milk and eats table foods daily.
- Physical milestones are as follows: Rolled front to back at 6 months, developed pincer grasp at 11 months, crawled at 8 months, and began cruising at 10 months. She does not walk independently.
- Social development includes mimicking adult behavior, four-word vocabulary (mama, dada, baba, and no), follows one-step commands, and quiets easily when comforted.
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NURS 6541 Week 2 Discussion: Developmental Red Flags Case Study 2:
You see a 30-month-old named Brian for a well-child visit. His mother reports the following development:
- Physical: Walks independently, runs, able to climb stairs alternating feet, makes a tower of nine cubes, and is able to button his pants.
- Social: Follows one-step commands, uses one-word sentences, and has a vocabulary of approximately six words. He is resistant to nighttime and feeding routines, he has marked temper tantrums, and Mom states he does not calm when she tries to comfort him.
NURS 6541 Week 2 Discussion: Developmental Red Flags Case Study 3
Jose is a 36-month-old who presents for a preschool evaluation. His father reports the following development:
- Physical: Walks, runs, and jumps independently, walks up stairs alternating feet, pedals a three-wheeler, scribbles, copies circles and squares, and is able to balance on one foot for 2 to 3 seconds.
- Social: Recognizes three colors; speech is 75% understandable; uses three- to four-word sentences; talks about friends, favorite activities, and family; frequently engages in imitative play; has an imaginary friend; does stutter on occasion when excited or when intent on getting something said. Will typically repeat the first word in a sentence three to four times, but does not repeat syllables or consonants. This happens three to four times a week.
To prepare FOR NURS 6541 Week 2 Discussion: Developmental Red Flags:
- Review this week’s media presentations, as well as “Developmental Management of Infants” and “Developmental Management of Toddlers and Preschoolers” in the Burns et al. text.
- Think about how physical, social, and cognitive development vary during infancy, toddlerhood, and the preschool years. Reflect on normal versus abnormal growth and development and consider the decision-making process of identifying and managing red flags of abnormal development.
- Select one of the three case studies provided. Reflect on the patient information included in the case study and consider any developmental red flags.
- Reflect on standardized screening tools, clinical guidelines, and management strategies that would be used to assess and manage the patient in your selected case study.
By Day 3 OF NURS 6541 Week 2 Discussion: Developmental Red Flags
Post an explanation of any developmental red flags that presented in the case study you selected based on the stages of normal physical, social, and cognitive development for infants, toddlers, and preschoolers. Explain how you differentiated between normal and abnormal growth and development for this patient and identify which standardized screening tools, clinical guidelines, and management strategies you might use to assess and manage this patient and why.
NURS 6541 Assignment: Practicum – Journal Entry
As a future advanced practice nurse, it is important that you are able to connect your didactic experience to your Practicum experience. By applying the concepts you study in the classroom to clinical settings, you better prepare yourself for your future professional career. Each week, you complete an assignment that prompts you to reflect on your Practicum experiences and relate them to the material presented in the classroom.
To prepare for this course’s Practicum experience, address the following in your Practicum journal:
- Explain what most excites and/or concerns you about pediatric clinical experiences. Include a description of your strengths and weaknesses in terms of working with children and how these strengths and weaknesses might impact your Practicum experience.
- Select and explain a nursing theory to guide your practice with pediatric patients.
- Based on your strengths, weaknesses, and theory of nursing practice, develop goals and objectives for the Practicum experience in this course. Be sure to consider the NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice from this week’s Learning Resources.
- Create a timeline of Practicum activities based on your Practicum requirements.
NAPNAP POSITION STATEMENT
NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice
The National Association of Pediatric Nurse Practi- tioners (NAPNAP) broadly defines the pediatric popula- tion cared for by pediatric nurse practitioners (PNPs) as all children from birth through 21 years of age and, in specific situations based on patient needs, individuals older than 21 years until care can be successfully transi- tioned to adult health care providers (American Acad- emy of Pediatrics [AAP], American Academy of Family Physicians, and American College of Physicians, Transi- tions Clinical Report Authoring Group, 2011). Age pa- rameters for practice are only one criterion for population care and should not be the sole arbiter for optimal, safe, and quality care. ‘‘Circumstances exist in which a patient, by virtue of age, could fall outside the traditionally defined population focus of a PNP but, by virtue of special need, is best served by that PNP. Such patients may be identified as nontraditional patients for that PNP. In these circumstances, the PNP may man- age the patient or provide expert consultation to assure the provision of evidence-based care to those patients’’ (LACE APRN Network, 2012; AAP, 1988).
Adopted by the National Association of Pediatric Nurse
Practitioners’ Executive Board on February 25, 2014. This
document replaces the 2008 NAPNAP Position Statement on Age Parameters for Pediatric Nurse Practitioner Practice.
All regular position statements from the National Association of
Pediatric Nurse Practitioners automatically expire 5 years after
publication unless reaffirmed, revised, or retired at or before that time.
Correspondence: NAPNAP National Office, 5 Hanover Square,
Suite 1401, New York, NY 10004.
J Pediatr Health Care. (2014) 28, 15A-16A.
0891-5245/$36.00
Copyright Q 2014 by the National Association of Pediatric
Nurse Practitioners. Published by Elsevier Inc. All rights
reserved.
http://dx.doi.org/10.1016/j.pedhc.2014.03.001
www.jpedhc.org
PNPs have the education, certification, and licensure to provide comprehensive care to pediatric patients. NAPNAP, partnered with the Association of Faculties of Pediatric Nurse Practitioners, recommend that PNPs be educated and prepared to provide quality health care to children and families. The National Organization of Nurse Practitioner Faculties (NONPF; 2012) established core competencies for all graduates of NP programs. In addition, there are established competencies for PNPs (primary care and acute care) that include essential knowledge and skills for providing health care to chil- dren from birth through young adulthood (National Organization of Nurse Practitioner Faculties, 2013). All of the PNP national certification examinations in- clude items related to the PNP’s role in caring for infants to young adults (American Nurses Credentialing Center, 2013; Pediatric Nursing Certification Board, 2010, 2012). Together, these organizations collaboratively use an evidence-based approach to create congruency among PNP educational programs, national certification stand- ards, and PNP practice. As part of a health care team, PNPs can participate in
prenatal visits (Cohen, 2009). Their consultation with families of well children and those with prenatal diag- noses can foster strong patient-provider relationships. At the time of delivery, term and preterm infants present for care within multiple PNP practice environ- ments. Preterm infants are recognized as a unique population with specialized health care needs (Agency for Healthcare Research and Quality, 2010). Research to improve care delivery for neonates has been a focus among PNP providers (Ahmed, 2010; Cockfield, Garner, Borders, 2012; Wells, Ahmed, & Musser, 2013). The delivery of specialty care for this population should be enhanced through consultation as indicated. Many PNPswork in private practices or school health
settings where some students, particularly children and
July/August 2014 15A
http://dx.doi.org/10.1016/j.pedhc.2014.03.001
http://www.jpedhc.org
youth with special health care needs, or college stu- dents, may be 21 years of age or older. The PNP is edu- cated to meet the psychosocial and physical care needs of these students, participate in health promotion, de- liver preventative care, and provide medical continuity (Keeton, Soleimanpour, & Brindis, 2012) to all children as they become young adults.
The importance of transition planning for adoles- cents to adult health care services has been widely acknowledged (McManus et al., 2013). Education, plan- ning and support are needed for all adolescents pre- paring to transition to adult systems of health care. Adolescents with complex health care needs require additional coordination and guidance to ensure an op- timal care transition (AAP, AmericanAcademyof Family Physicians, & American College of Physicians, Transi- tions Clinical Report Authoring Group, 2011; McManus, 2013). Pediatric health care providers, including PNPs, are qualified to assist patients from birth to age 21 years of age, adolescents and young adults older than 21 years of age with special health care needs, and young adult patients during the transition to adult health care services (NAPNAP & Society of Pediatric Nurses [SPN], in press). Preparing adolescents with strategies to manage their health and negotiate the complexities of the adult health care system, adult health care home, and ancillary health systems empowers them and pro- motes success during the transition while establishing autonomy in an unfamiliar, challenging health care en- vironment (AAP, 2011).
NAPNAP is an organization whose mission is to em- power PNPs and their health care partners to enhance child and family health through practice, leadership, advocacy, education, and research. NAPNAP firmly supports the scope of practice for PNPs to include pre- natal consultations, newborns, infants, children, adoles- cents, and young adults. NAPNAP additionally supports the PNP’s role as a provider of health care for individu- als older than 21 years with unique needs and for young adults during the transition to adult health care pro- viders, especially among those living in communities with limited access to health care (AAP, American Acad- emy of Family Physicians, & American College of Physi- cians, Transitions Clinical Report Authoring Group, 2011). To create exclusive age limits for pediatric pa- tients may unnecessarily create barriers and limit access to health care for this population (LACE APRNNetwork, 2012; NAPNAP & SPN, in press).
The National Association of Pediatric Nurse Practi- tioners would like to acknowledge the contribution of the Professional Issues Committee and the following members for their contribution to this statement: Kristin Hittle, MSN, RN, CPNP-AC, CCRN, Chair, Professional Issues Committee; Beth Bolick, DNP, CPNP-AC, PPCNP-BC, CCRN; Andrea Kline-Tilford, MS, CPNP-
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AC/PC, FCCM; and Heather Keesing, MSN, RN, APRN (NAPNAP Staff).
REFERENCES Agency for Healthcare Research and Quality. (2010). Assessment
and care of the late preterm infant. Evidence-based clinical practice guideline. Retrieved from http://www.guideline.gov/ content.aspx?id=24066
Ahmed, A. H. (2010). Role of the pediatric nurse practitioner in pro- moting breastfeeding for late preterm infants in primary care settings. Journal of Pediatric Health Care, 24(2), 116-122.
American Academy of Pediatrics. (1988). Policy statement: Age limits of pediatrics (reaffirmed October 2011). Pediatrics, 81(5), 736, Retrieved from http://pediatrics.aappublications.org/content/ 129/2/e561.full
American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians, Transitions Clinical Report Authoring Group. (2011). Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics, 128(1), 182-200.
American Nurses Credentialing Center. (2013). Test content outline: Pediatric primary care nurse practitioner board certification ex- amination. Retrieved from http://www.nursecredentialing.org/ Documents/Certification/TestContentOutlines/PediatricNPTCO- Aug2013.pdf
Cockfield, C. M., Garner, G. D., & Borders, J. C. (2012). Follow-up after a failed newborn hearing screen: A quality improvement study. ORL Head and Neck Nursing, 30(3), 9-13.
Cohen, G. J. (2009). The prenatal visit. Pediatrics, 124(4), 1227-1232. Keeton, V., Soleimanpour, S., & Brindis, C. D. (2012). School based
health centers in an era of health care reform: Building on his- tory. Current Problems in Pediatric and Adolescent Health Care, 42(6), 132-156.
LACE APRNNetwork. (2012). Clarifying statement on age parameters for APRNs. Retrieved from http://login.icohere.com/connect/ d_connect_itemframer.cfm?vsDTTitle=Clarifying%20Statement %20on%20Age%20Parameters%20for%20APRNs&dseq= 11071&dtseq=63052&emdisc=2&mkey=public935&vbDTA= 0&viNA=0&vsDTA=&PAN=1&bDTC=0&blog=0&vsSH=A
McManus, M. A., Pollack, L. R., Cooley, W. C., McAllister, J. W., Lot- stein, D., Stickland, B., & Mann, M. Y. (2013). Current status of transition preparation among youth with special need in the United States. Pediatrics, 131(6), 1090-1097.
National Association of Pediatric Nurse Practitioners & Society of Pe- diatric Nurses. (in press). Pediatric nursing: Scope and standards of practice Silver Spring, MD: American Nurses Association.
National Organization of Nurse Practitioner Faculties. (2012). Nurse practitioner core competencies. Retrieved from http://c.ymcdn. com/sites/www.nonpf.org/resource/resmgr/competencies/ npcorecompetenciesfinal2012.pdf
National Organization of Nurse Practitioner Faculties. (2013). Population-focused nurse practitioner competencies. Retrieved from http://c.ymcdn.com/sites/www.nonpf.org/resource/resmgr/ competencies/populationfocusnpcomps2013.pdf
Pediatric Nursing Certification Board. (2010). PNCB acute care PNP detailed content outline. Retrieved from http://www.pncb.org/ ptistore/resource/content/exams/ac/CPNP-AC_ExamContent Outline.pdf
Pediatric Nursing Certification Board. (2012). Primary care pediatric nurse practitioner certification exam. Retrieved from http:// www.pncb.org/ptistore/resource/content/exams/pnp/2012_ CPNP_Content_Outline.pdf
Wells, C., Ahmed, A., & Musser, A. (2013). Strategies for neonatal hyperbilirubinemia: A literature review. The American Journal of Maternal/Child Nursing, 38(6), 377-382.
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