What are some things you like or dislike?

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Julie is a 4 y/o Hispanic female. Mother states Julie “missed her last immunizations and
needs to catch up.” The Mother wonders when her daughter will stop wetting the bed. States she just
recently started doing it. Keeps putting her hands “down there where she ought not to.” States she is
starting to be very introverted. Cries when her mother is leaving for work. States her boyfriend is very
attentive to her and keeps her on Tuesdays when she doesn’t have other childcare available. Mother
thinks Julie must be nervous or something, so every-once-in-a-while she will give her some of her
Xanax to help her relax. No significant PMH. No known drug allergies. Vital Signs WNL. BMI 30.

Impression/concerns
As I read the details of Julie, I’m immediately suspecting she may have or continuing to be a victim
of sexual abuse in the home. If Julie was not wetting the bed before and it just recently began, this
is a classic red flag of sexual abuse (Mckinney 2022). She is also placing her hands “down there”.
According to the American Academy of Pediatrics, sexual abuse can potentially cause long-term
physical and psychological damage. Julie has predisposing factors of being a victim of sexual abuse.
First, she is a minority child, adopted/stepchild, and lives in a single parent home. I wonder if the
mother would be okay if I talked to Julie alone and if she refuses, this would be considered a “red
flag”. I need to perform a history, physical examination (abnormal genital examination), and some
lab tests. Julie may be at imminent risk of additional harm if sent back to the environment. Child
protective services should be contacted because I must report suspected child abuse and neglect. I
would inform the mother to stop giving Julie Xanax and question what other interventions she has attempted before giving Xanax? Evaluate the child’s overall appearance. Is the child clean and is her
clothes appropriate for season, hygiene, depression, withdrawnness, behavioral compliance? I am
also concerned about Julie’s weight after reflecting on her BMI of 30, which indicates her falling
into the obese category (95th percentile or greater).

Questions for Julie: What are some things you like or dislike? How many people live at
your home? Do you feel safe at home? Describe a typical day- what do you eat, who makes
the food, where do you play, who comes/ leaves the house? Does any place on your body
hurt? Are you afraid of anyone? Is anything bothering you? What happens when you take a
bath? Do you have stomachaches, headaches, difficulty with bowel movements? Where do
you sleep? What happens when you go to sleep? Has anyone touched you in a way you
didn’t like? Have you ever tried to harm yourself? Do you eat breakfast in the morning?

Questions for Ginger: Does Julie have any allergies that you are aware of? Have you
encourage your child to be independent? Does your child increasing independence create
any exhibit or conflict for you? Is your child in preschool or daycare? How many hours or
days? How does your child get along with other children that are the same age? How well
does your child communicate with others? Do you have any concerns about your child
speech? Has your child play become more imaginative? Does your child describe any fears?
What activities do you enjoy together? Where did you obtain the Xanax? Do you have a
prescription for Xanax? When was the last time you gave Julie a Xanax? Do you have
anyone trustworthy to keep Julie while you’re at work? Do you need some assistance
finding resources to aid in caring for Julie? Do you read to Julie? Do you practice counting
numbers and singing ABCs? Does Julie conform two simple rules regarding behavior? Is
Julie able to separate from you, after a short transition time, for at least half a day? Prepare
your child for school. What ways have you been preparing Ginger for school?

 

Sample Solution 

Section I: INTRODUCTION TO THE STUDY Introduction The country is encountering a basic deficiency of medical care suppliers, a lack that is supposed to increment in the following five years, similarly as the biggest populace in our country’s set of experiences arrives at the age when expanded clinical consideration is vital (Pike, 2002). Staffing of emergency clinics, facilities, and nursing homes is more basic than any time in recent memory as the huge quantities of ‘gen X-ers’ start to understand the requirement for more continuous clinical mediation and long haul care. Interest in turning into a medical caretaker has disappeared lately, likely because of the historical backdrop of the extraordinary and requesting instructive cycle, low compensation, firm and extended periods of time, and fast ‘wear out’ of those rehearsing in the calling (Wharrad, 2003).

A complex oversaw care climate in this country is restricting the dollars accessible to be spent on nursing care. Numerous wellbeing callings, particularly nursing, have the standing of ‘eating their young’ as opposed to offering compelling coaching to develop future medical services suppliers. Because of these variables, the quantity of medical attendants has diminished and businesses regard themselves as understaffed and seeking able work force. Before 2001 the decay had been apparent for a considerable length of time (Sadler, 2003). Nursing schools, public pioneers, medical services pioneers and the overall population is impacted by the absence of Registered Nurses (RNs) accessible.

As the populace ages, the assumption is that a rising number of RNs will be required essentially to keep up with the ongoing degree of medical care. Furthermore, the momentum ecological and political worries of expanding pandemic sickness, event of synthetic and catastrophic events, and expanding dangers of war, requires critical expansions in the medical services labor force (Jefferys, 2001). The public nursing lack and factors that increment the interest for expanding the nursing labor force notwithstanding public, state, and nearby debacles make the potential for a general wellbeing emergency. Nursing programs have endeavored to satisfy need for medical attendants by expanding enlistment and campaigning effectively for expansions in program subsidizing by schools and states for understudies.

Tragically, the issue of nursing understudy weakening hampers the best endeavors of nursing programs and irritates the public lack of Registered Nurses in the United States (Ofori, 2002). In 2003, the National League for Nursing revealed a positive vertical pattern in the nursing labor force supply in any case, the American College of Healthcare Executives (2006) detailed that in 2005, 85% of emergency clinic directors decided medical clinics needed more enlisted medical attendants to fulfill patient consideration needs. The United States Bureau of Labor insights showed by 2014, more than 1.2 million new and substitution nursing positions would be expected to meet the public medical services needs (Ramsburg, 2007).

Various broad endeavors to diminish weakening have been made by nursing programs including reinforcing affirmation methods and executing maintenance programs. Unfortunately, the issues of weakening keep on continuing nursing schools the nation over. Admission to a nursing program is serious and numerous potential understudies are denied confirmation every semester. Steady loss from nursing programs influences not just the particular understudy who is acknowledged to a nursing program and ineffective, yet in addition the understudy denied confirmation that might have been effective. Steady loss rates are expensive to understudies, nursing projects, and medical services the same by diminishing the quantity of likely alumni from schools of nursing and adding to the nursing lack. Many examinations feature the a lot higher than wanted whittling down rates for nursing understudies

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