meet the Brown Family- Discussion Part One (graded)

Brown Family:

Mary: 44 mother; Patrick: 42 father, Michael: 9 son; MaryKate: 7 daughter; Paddy: 4; Tommy: 4 son (fraternal twins). Also living with the family are Mary's parents Katie: 65 maternal grandmother and John: 75 maternal grandfather.

Setting: large urban city

Family practice Clinic which employs physicians and nurse practitioners.

Part 1: Today is a busy Monday in your family practice clinic. Your first patients of the morning are a mother and daughter who are both clients of the clinic. The entire family has been coming to the clinic for years. You review the chart before entering the room to familiarize yourself with these patients. Both present today with complaints of pink eye.  

When you enter the room you note a Caucasian woman who appears to be about 40 years old. She is well groomed and appropriately dressed for the weather. There is a young girl standing near her mother reading the eye chart out loud to her mother.  The girl is dressed in clean clothes and appears well groomed. Both smile in response to your greeting.  You introduce yourself and state you are the nurse practitioner who will see them today for their visit. You begin your interaction as always by asking what brings them in today for the visit.  Mom states "MaryKate has had a red eye for two days now. It started in her left eye and then I noticed it spread to her right eye this morning.  She's been complaining of it itching and burning.  This morning I had to all this goop in my eye when I woke up and I noticed my eye looks red too. My four year old twins always have pink eye at their preschool so we came in to be checked. "

 HPI: Mom describes herself and MaryKate as healthy. Denies recent illness for herself but states MaryKate is "getting over a cold" that last about a week.  No one else has been sick at home.

PMH:

Mary: denied past illness or injuries. Hospitalized x 2 for childbirth, no surgeries. NKDA. Drinks alcohol socially, denies tobacco or illicit drug use. Sleeps 6-7 hours/night. No current medications. Takes a daily multivitamin and a B complex vitamin.  

MaryKate:  Have had cold symptoms of a runny nose and nasal congestion for almost a week and seems to be improving. Was given OTC cold medications for congestion which seemed to help. "She did not miss school because she did not have a fever:.

Social : Mary is a high school graduate and works  full time at a local business in the ordering department.  MaryKate is a second grader at the local parochial school and is considered a good student. 

Social history : Mary and MaryKate  live with Patrick her husband, an electrical engineer, and Paddy and Tommy the four year old twins who attend a local preschool 5 days a week.  Mary's parents Katie and John also live in the home. Both are retired and help with childcare and household needs since both parents work full time.  Patrick and John both smoke "but not in the house".  Mary has 2 siblings who are in good health. Patrick is an only child whose parents died of old age in their 70s.  Katie and John emigrated from Ireland in their 20s and have always lived in this area.  Katie has a history of HTN and hyperlipidemia. John has a history of tobacco use since age 10, HTN and hyperlipidemia. They share their home with 2 dogs and a cat.

Discussion Part One: Please answer the questions separately for each patient.

What further questions do you have for Mary at this visit?? 

Use OLDCARTS to guide your questions. Link the questions to your differential diagnoses.

What is your differential diagnosis list for this visit thus far with rationale?

Each differential diagnosis should include a one sentence pathophysiology statement supported by the scholarly literature, not the textbook. Link the patient's presenting symptoms with your differential diagnoses along with rationale.

Based on your differential diagnoses list, what focused PE would you perform? What labs or diagnostic tests, if any, would you order?

What further questions do you have for MaryKate at this visit?? 

Use your OLDCARTS to guide your questions. Link the questions to your differential diagnoses.

What is your differential diagnosis list for this visit thus far with rationale?

Each differential diagnosis should include a one sentence pathophysiology statement supported by the scholarly literature, not the textbook. . Link the patient's presenting symptoms with your differential diagnoses along with rationale.

Based on your differential diagnoses list, what focused PE wo

Acronym for OLDCART

O –Onset

L –Location

D – Duration

C – Characteristics

A – Aggravating Factors

R- Relieving factors

T - Treatment