A father brings in his fourteen year-old daughter to your cl
A father brings in his fourteen year-old daughter to your clinic… A father brings in his fourteen year-old daughter to your clinic stating that she has been extremely irritable and emotional recently. He states that the teachers have been complaining that she seems to be having difficulty paying attention in class. On further ing, her father states that she is always complaining the house is “too hot”. The child states that she always feels like she is “sweating” and she also complains that she has felt weak and that sometimes feels like her heart is beating “really fast”, even at rest. She also complains that she seems to become “winded” easily when doing exercises in gym class.Immunizations: Up to dateAllergies: NKDAMedications: One Multivitamin QDDevelopment: 5% for weight, 20% for ht. Developmental milestones met at expected ages. Menses started 8 months ago and they have been irregular.Social: Lives with father and mother and three year-old brother. Has done well in school until this year and grades have slipped.Family Medical History: Mother has a history of autoimmune disorders. Father and brother have no known medical problems. Paternal and maternal grandparents’ medical history unknown.Previous hospitalizations: NonePrevious medical problems: None Vital signs: T. 97.8, BP 136/60, P. 124, R. 28 Pertinent physical exam findings include:HEENT: Mild exophthalmos. Slight eyelid lag.SKIN: Slightly moist. Smooth and flushedHEART: Tachycardia, regular rate and rhythm. Grade 2/6 systolic murmur.LUNGS: Breath sounds clear to auscultation throughout with unlabored breathing. Tachypneic.NEURO: Slight hand tremors noted. DTR’s 3+ = bilaterally. 1. You can ask this patient and her father 5 more history s. What 5 s would you ask, with rationale, to gain the most beneficial information to get you to your diagnosis? 2. While there are some abnormal physical exam findings listed here, describe any additional physical exam you might do with rationale. 3. What diagnostic testing should be done at this time, with rationale? 4. List your top three differential diagnoses, with the first one being most likely diagnosis. Health Science Science Nursing NURSING 6200
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