Case study 1: Part OneBackground and Visit 1Background:Field Family: Mother: Kayla age 25, Father: Mike age 27, Daughter: Jo age 5, Son: Riley age 18 months.Maternal Grandmother: Mary age 48, Paternal Grandfather: Tom age 52.Se±ng: Rural U.S.O²ce: Rural, NP owned, Family Prac³ce ClinicPART 1: Today is a busy day in your rural family prac³ce clinic. You are reviewing the chart of your nextappointment and realize that there is very li´le informa³on and that you are scheduled to do well-childexams on a male age 18 months and female age 5 years, who appear from last names to be siblings. Youro²ce schedules 20 minutes each for well-child exams. Upon entering the room, you note a Caucasianwoman who appears in her early 30s who sits focused on paperwork, a male toddler climbing on theexam table to reach up and take the otoscope oµ of the wall, while a preschool-aged appearing female issi±ng at your computer pretending to type on the keyboard.As you introduce yourself, the mother stands abruptly and grabs the toddler oµ of the exam table,smacking his hand and causing him to cry, while simultaneously yelling “I told you to stop it!” She states,“I am so sorry. They usually behave. I am Kayla Field, and this is Riley and Jo.” You then inquire as to thereason for their visit, as you always do. The mother reports they recently moved to the area to live withher parents due to a recent separa³on from her husband, and she is there to have a physical exambefore they lose her husband’s health insurance bene¶ts. She reports that the children are currentlyhealthy and have a regular pediatrician back at home.HPI:The mother denies any recent illnesses in either child and reports they are here for their check-up. Shedoes report that since moving in with her parents recently, it has been di²cult to get the children to goto bed at night and stay in bed and expresses extreme frustra³on with this. She reports that they areea³ng three meals per day and two snacks, one at bed³me and one in the a·ernoon between lunch anddinner. They do brush their teeth twice a day, ride in car seats in the car, and play vigorously both indoorsand outdoors at home. She also verbalizes extreme concern of their impending loss of health insurance.PMH:Jo: Full-term gesta³on, born cesarean sec³on, weight. 7lb 4 oz. There were no complica³ons inpregnancy, but the mother did smoke 1 PPD throughout pregnancy. There were no hospitaliza³ons—NKDA. The daily medica³on was chewable children’s mul³vitamin with iron.Riley: Born at 34 weeks gesta³on via cesarean sec³on, weight. 5lb 1 oz. The mother developedpreeclampsia and gesta³onal diabetes. The mother quit smoking when she found out she was pregnant.
