Differential Diagnosis
Janet, a 20 year-old college student, is experiencing a five-week history of itchy eyes and nasal congestion with watery nasal discharge. She also complains of a “tickling” cough, especially at night, and she has had episodes of repetitive sneezing. Janet gets frequent “colds” every spring and fall.
Physical Examination
Vital Signs: Temp, 98.8; BP 110/68; Pulse 72; Respirations 18
Skin: Flaking erythematous rash on the flexor surfaces of both arms
Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx slightly erythematous, with clear postnasal drainage
Lungs: Clear to auscultation and percussion
Discussion Questions:
1. Provide three differential diagnoses based on Janet’s subjective and objective data and discuss your reasoning for each.
2. What additional history questions would be useful in your evaluation of Janet?
3. Discuss the pathophysiological process of your primary diagnosis.
4. Differentiate the types of hypersensitivity mechanisms.
5. As per your analysis, what type of hypersensitivity reaction is Janet experiencing?
Kathryn E. Barnard was the person who developed the parent-child interaction model
in 1978. This model emerged as a result of Barnard’s scholarly and practical performance. In
other words, this scholar had strong credentials in the field of early child development.
Specifically, Barnard has received her master’s degree in nursing along with the certificate of
Advanced Graduate Specialization in Nursing Education (Masters, 2015).This was the first
THE PARENT-CHILD INTERACTION MODEL !4
step to becoming a teacher of nursing. After graduation, Barnard became a teacher of
maternal healthcare. To be more precise, she specialized in child and mother healthcare.
The parent-child interaction model suggests the three planes: a child, a mother, and
the environment; beginning from the woman’s pregnancy, these three fields overlap and
influence one another. In order to ensure successful interaction within these overlapping
circles, mother needs to modify constantly her mentality to meet and cope with the changes
and challenges of the other planes. The same refers to a child: the process of development
means the need for constant adjustment and re-adjustment (adaptation) to external stimuli.
Simultaneously with the development of a child’s psyche, it is necessary to adjust his or her
internal stimuli to the external factors. However, this process is ongoing and highly volatile
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