Case study: Jalin
Growth and Development Parameters and Health Promotion: Jalin
Mr. and Mrs. Wahington bring Jalin, their 6 month old infant boy to the pediatric clinic for a well-child visit. Jalin has been healthy and there are no issues. His last well exam was at 4 months old and he was found to be in good health at that time. He did not receive his Hepatitis B or polio (IPV) vaccine at his four-month visit (the reason is unknown). Otherwise he is up to date on his vaccines. Jalinis still breast feeding and drinks some diluted juice from a sippy cup. His mother has also given him some pureed chicken in the bottle from time to time over the past month because “he always seems so hungry”. He hasn’t started any baby foods yet. His father works as an accountant and his mother stays home to raise Jalin. He is the couple’s first baby. The family owns their own home in Elizabeth, NJ.
The nurse weighs and measures Jalin and continues the assessment.
VS: 99.0 F, 120, 30, 80/50, Pain 0 Flacc
Physical Exam: HEENT: Normocephalic, Anterior fontanel open and flat. PEARLA, + red reflex, TM’s grey, nares patent, mms moist and pink, pharynx pink no exudate.
Neck supple, no lymphadenopathy.
CV: RRR, S1 S2, no murmur, periph pulses +2, cap refill < 2 secs
Lungs: clear bilaterally
Abdo: soft, non-tender, non-distended, + BS X 4. No hepatosplenomegaly, no mass.
GU: intact, testes down X2
Neuro: Cranial nerves intact, DTRs intact +2 bilaterally, awake and alert, Sits supported, grasps feet, rolls from back to abdomen, babbling.
Skin: consistent with black race, intact.
Ext: FROM, no hip click.
Length: 26 inches
Weight: 18lb
HC: 43 cm
1. Plot the measurements on the infant’s growth chart (you can use the one in your book or posted in bb). What percentiles does he fall on for length, weight and head circumference? What conclusions can the nurse make from these findings?
2. What developmental milestones has Jalin achieved? What other developmental milestones would the nurse need to assess at this visit?
3. What anticipatory guidance should the nurse provide to Jalin’s parents?
4. What does the nurse conclude from Jalin’s vital signs and physical assessment?
5. What immunizations does Jalin need at this visit? Consult the 2014 immunization schedule posted under course info in bb.
6. What health teaching should the nurse provide regarding diet, immunizations, and growth and development?
7. When should Jalin’s parents schedule his next visit?