PBL Case Discussion: Initial Visit- Meet the Family Part One (graded) Background and Visit One Background: Field Family: Mother: Kayla-age 37, Father:
... [Show More] Mike-age 39, Daughter: Lily-age 15, Daughter: Jo-age 5, Son: Riley-age 13 months. Maternal Grandmother: Mary-age 55, Paternal Grandfather: Tom-age 62. Setting: Rural U.S. Office: Rural, NP owned, Family Practice Clinic PART 1: Today is a busy day in your rural family practice clinic. You are reviewing the chart of your next appointments and realize that there is very little information and that you are scheduled to do a well-woman and two well-child exams for the same family. Your office schedules 20 minutes each for well exams. Upon entering the room, you note a Latino-looking woman who appears in her 40s who sits focused on paperwork, a male infant on her lap crying and grabbing for her pen, while a preschool-aged appearing female is sitting at your computer pretending to type on the keyboard. As you introduce yourself, the mother tells the infant to “Stop!” smacking his hand and causing him to cry. She states, “I am so sorry. They usually behave. I am Kayla Field, and this is Riley and Jo.” You then inquire as to the reason for their visit. The mother reports they recently moved to the area to live with her parents due to a recent separation from her husband, and she is there to have a physical exams before they lose her husband’s health insurance benefits. She reports that the children are currently healthy and had a pediatrician at their previous home, but she would like to establish care with your clinic moving forward. She also has a teenage daughter that refused to come today because she wanted to ‘hang out with friends’. The mother reports she would really like to get her well exam done today as she will lose her insurance soon as well with the impending divorce. KAYLA HPI: Kayla reports that she is healthy and takes no medication. She has no symptoms that she can think of other than she is currently having trouble falling and staying asleep, but associates this with stress and with sleeping in the same room with her two younger children. She is a 15 year smoker of 1PPD up until 18 months ago when she quit with the pregnancy of Riley. She is concerned about finances today and reports ongoing fatigue. She has not and menses since the birth of her last child. She is not currently sexually active with either men or women and has been abstinent for the last 6 months. PMH: Kayla denies any surgeries or past medical history other than four pregnancies, three births, one pre-term, and two C-sections with the last two births. She had one miscarriage at 10 weeks when she was 16. She also reports that she had PCOS as a teenager and has always had irregular menses. She had gestational diabetes with the last birth and preeclampsia causing the early delivery of Riley. She has no allergies. She is currently taking Advil PM every night to sleep and drinking a glass of wine. She does not routinely exercise. She often skips breakfast and lunch and eats whatever the children eat for dinner, which is often processed, or quick food. [Show Less]