As this week comes to an end, I am actually a little sad.  I have enjoyed my time with pediatric patients and their parents.  I have learned that I could easily return to a pediatric setting and feel comfortable due to my time with my preceptor.  I have learned so much in our short time together and I know that I will continue to learn throughout my career as a nurse practitioner, just as she does!  I cannot state how much of an impact that my preceptor has had one me during this clinical rotation.
Assessment of a patient
           Initially, this 7-year-old boy presented to the clinic for a physical examination.  However, when asked if the parent had any concerns.  The mother expressed that she noted that the patient would scratch his head when he was stressed.  She stated that she noted some abrasions on his scalp and was concerned that he may be injuring himself and wanted to know what could be done.  Upon inspections of the hair and scalp, several abrasions were noted to the top of the head, where the child had indicated that he itched the most.  The hair distribution was thick and healthy. However, upon deeper inspection, a live louse was discovered as well as several nits.  A diagnosis of pediculosis was formed and the patient was prescribed Spinosad 0.9%.  This was chosen over permethrin due to its ovicidal activity and the likelihood of only one treatment thus increasing compliance, despite the increased cost of the medication (Leung et al., 2022).
           Differential diagnoses for this patient include dandruff, eczema, and dermatillomania. Dandruff is typically easy to remove from hair.  A light brush of the hand can usually dislodge any dandruff, however, a nit on a hair strand will typically be well bonded.  Eczema can cause itching and dry patches on the scale.  The patient may be uncomfortable and itch frequently. With dermatillomania, the patient will compulsively pick or scratch at the skin. This condition can be aggravated by stress and anxiety.  Since a live louse was found on inspection, treatment for pediculosis will take place first, however, once the patient is free of head lice, it is important to reassess the patient to ensure that the behaviors are not continuing.  If so, it may be necessary to refer the patient to psychology for further evaluation.
Health Promotion
           The patient will be instructed on the proper use of medication.  They will be advised not to wash their hair with shampoo or conditioner after it has been thoroughly washed with warm water from the scalp as it could reduce effectiveness (Fu et al., 2022).  All bedding, clothing, and personal care items should be washed in hot water and dried in a dryer when possible.  However, items such as combs and brushes can be submerged in a dilute bleach or rubbing alcohol solution for 24 hours or replaced. Items that cannot be washed or soaked can placed in a plastic bag for several days to prevent reinfection.  The patient will be taught to avoid sharing brushes, combs, and hats, and to avoid contact with the heads of other people (Leung et al., 2022).
Clinical Experience
           As stated earlier, I have learned a lot from my preceptor.  In the future, I hope I can be as positive and well-loved by my patients as my preceptor is.  It is truly inspiring to see someone embody what I hope to become in my own practice. Someone who listens to their patients acknowledges their needs and is recommended and appreciated for this as I believe it shows that not only does the practitioner care but they also work with their patients to achieve their health goals.