|
LUCY
CASE SUMMARY
You are the parent of a 5 year old girl, Lucy. She has always been healthy with the
exception of colds and ear infections. You are talking with her pediatrician at a
scheduled well-child examination. She will be starting school in one week.
You have brought a copy of the child's immunization record which you show to the
doctor. She has been up to date with her immunizations until now, though she needs
her 4-6 year old shots. A nurse has measured the child's height and weight which
are at the 75th and 90th percentiles respectively. The blood pressure is normal.
The nurse screened the child's vision which was 20/30 OU. Hearing is normal.
The doctor has done the physical examination which was normal.
You have two concerns you would like to discuss with the doctor:
The student has been instructed to elicit and discuss at least one of your two concerns.
You may volunteer information if the student's question is open-ended and the information
you volunteer could be considered an appropriate response to that question. For example,
if asked specifically about your concerns regarding Lucy, you may mention both of the above.
When the student asks follow-up questions about either issue you may give details as listed
in the PATIENT DETAILS section. Feel free to expand on those details, i.e. make things up,
as long as the made-up details are consistent with those listed.
LUCY PATIENT DETAILS
The child's last doctor visit occurred one year ago, another well child visit, and
everything was OK. She takes no medications including vitamins and has no known allergies.
While highly variable, her diet consists of a piece of toast and sometimes cheese and
juice in the morning, a hot dog or macaroni at lunch and some of what the family eats at
dinner though, depending on what it is, the child may eat little and then have a bowl of
ice cream later in the evening.
The nine month old sibling is breastfeeding and is a "mellow" baby. He is, of course,
a baby and demands a large amount of your attention. There has been a definite decrease
in the amount of 1:1 attention you have been able to give your daughter. When your husband
comes home from work, you are eager for him to take the baby while you cook dinner. Lucy,
too, is eager for daddy's attention at that time. There are no other adult caregivers.
During the pregnancy, Lucy was excited and talked a lot about her brother or sister to be.
You read her books about the effect a new sibling would have on the family.
Specific behavior problems include defiance, talking-back, leaving clothes and toys strewn
about the house and increased emotional sensitivity and outbursts. You did not notice this
sort of behavior prior to the birth of the sibling or if you did the severity has definitely
increased since the baby's birth.
You work at home.
Your spouse works about 50 hours per week outside the home.
Your child has a huge vocabulary, is very active and coordinated, loves to draw and play with dolls.
She attended a preschool program and liked it, got along with the other kids and occasioned no concerns on the part of the teachers.
She has friends.
She cooperated with the PE.
Family history: Parents well. No history of childhood diseases of significance in family.
Social history:
One set of grandparents live about an hour away and the other set live across the continent.
The closest of the siblings of the parents live 1 1/2 hours away.
Social history:
The closest of the siblings of the parents live 1 1/2 hours away.
LUCY
Lucy is a 5 year 6 month old girl who is here for a well child examination prior to
starting kindergarten. You have completed a physical examination which was entirely
normal. Now you are talking to the parent.
Hgt 115 cm (75th%ile)
Immunization card presented to student (child needs 5th DPT, 4th polio and 2nd MMR)
School requests indication of screening for TB and Pb w/i past 6 months
Please address at least one of the parent's concerns.
You have 15 minutes.
LUCY
CHECKLIST
A. Inquires about dietary history
A. Asks about family situation/impact of birth on family
|
|
Bio-Med 450: The Pediatric Clerkship |