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Question
You are an FNP in a community health clinic. You assess Billy, an 8-year-old patient who was brought to the clinic for a routine examination by his mother, who is recently divorced. You review Billy's medical records and notice that he has not been examined since age 5, before starting kindergarten. The mother states that Billy has been well and had no need for a physical examination. You note that Billy is 10 pounds under the expected weight for his age. Billy has fetid breath and sores over both arms. He is easily distracted and hesitates before answering questions. Billy tells you that he doesn't like to go to the new school because he has no friends and wishes that his mother would move back to live with his dad. According to the current recommendations for childhood immunizations, which vaccinations will you give Billy on this clinic visit? Based on the above, what diagnoses would you be concerned about and what follow-up would you plan - include what screenings you would do. What clinical manifestations of depression would you evaluate Billy for? What age specific anticipatory guidance topics will you discuss with Billy's mother?
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