Reference no: EM133394186

Case: It has been a little over 2 years since you, the registered nurse has seen Julia, now a 36- month old toddler. During this visit to the clinic, Julia is 36 inches tall and weighs 25 pounds. Since her last visit at 12 months old, Julia has been followed up by a physiotherapist and occupational therapist to work with Julia and her mother in meeting Julia's physical, cognitive and psychosocial milestones. To date, Julia can run, hop, walk up and down the stairs with supervision, dress and undress with assistance, and feed herself using her hands and a spoon. She is showing keenness and consistency in going to the bathroom whenever she has the urge to void or have a bowel movement, although her mother reports that she heavily bed wets at nighttime. Julia lives with her parents and an older sibling, Gabriel. Her father is a miner who works 2 weeks off and 2 weeks on at one of the diamond mining areas in NT. Julia's mother stays at home as a housewife. Their house sits on a large plot of land surrounded by woods on one side and a lake on the other. Their closest neighbour is about 1 km away. They also have many pets, two dogs, three cats, and some fish. They have no family close-by; both appear reserved and don't engage much with the other parents and care-givers at the school that Gabriel goes to. Julia does not like the word "No" and is having a tough time adjusting to her mother's attempts to add structure into their unstructured lives. Currently, Julia is speaking up to good amount of words and refers to same by her name. She enjoys watching television shows about fairies and princesses and if given the chance, will spend large amounts of time, sometimes up to twenty minutes. She is able to draw squiggly forms and makes animals sounds. She is able to show a wide range of emotions, and is quick to show observers her happiness, sadness, confusion, frustration or frightfulness. Julia is a child who needed and wanted to be with her mother and would cry or search for her as soon as she leaves her sight. She relies on her baby bottle at night to settle down and usually falls asleep with it in her mouth. Gabriel, 5 year old, on the other hand is independent and would prefer to play on his own. His prefers to climb ladders, cut pictures of airplanes and paste them on his craft wall. He fully dresses and undresses himself. When he plays with Julia, Gabriel is easily frustrated and would take over tasks that Julia is currently doing. He usually dresses up as Spiderman and spits cobwebs with his hands. In the past 6 months, Gabriel has missed school 3 times due to colds and respiratory illnesses. According to their mother, Gabriel usually wakes up screaming and in distress at least 3-4 times a month. Otherwise, she voiced no concerns for her children.

1. How would you compare Julia's development to that of a 36-month-old as per the texts?

Julia Texts

2. How is Gabriel's development (physical, cognitive & psychosocial) compare to the development of a 5-year-old?

Gabriel Texts

3. Consider the NWT Well Child Records specific to Julia and Gabriel, what health promotion 4 areas of priority would you like to discuss with the parents?

4. Which screening tests should a registered nurse perform during this visit

a. for Julia? what is your rationale?

b. For Gabriel? what is your rationale?