Assignment task:
A 2-month-old male presents for a well-child visit in Alaska. This is the first time you see this infant. You ask the mother if they have been seen elsewhere for records. She states, "no, Timmy was born in Texas as a home birth and we moved here when he was 3 weeks old." She continues to state, "he seems so small and I don't know if he has gained weight, when I kiss him he tastes salty." You ask about feeding and the mother states that the infant is breastfeeding but gets tired after about 5 minutes. You proceed to get his VS and measurements. VS are 98.4F, RR 66, HR 144, O2 sat 92%. Weight 2.3kg, Height 21 inches, OFC 14 inches. When you plot his measurements on the growth chart he is below the 10th percentile for all measurements. Mom states "he was at the 50th percentage for everything when he was born". Questions What are your 3 priority concerns? List in order of priority and provide the rationale. Upon assessment you find the following: Neuro/development - infant's tone is appropriate, unable to lift head when prone, HEENT - Fontanelles are soft and flat, head symmetric, eyes and ears are symmetrical, eyes track mother as she moves around the room, the nose is midline, no nasal flaring Respiratory - Symmetric chest movements, diffuse wheezing bilaterally, no accessory muscles used. Cardiac - S1, S2 heard, no murmurs, cap refill <3 seconds GI - bowel sounds normoactive, distended abdomen, diaper change found greasy, foul-smelling stool. Musculoskeletal - Full ROM Integumentary - pink, moist, and intact GU - testes present, no rashes, wet diaper What is concerning to you at this point and why? What labs and diagnostic tests do you anticipate will be ordered? What diagnosis do you suspect?