Immunization history and vaccine plan

B.W. is a 16 month old male. He was born at 39 weeks via C-section and has to date been very healthy as far as his mother knows. He lives in an older house with his mother, grandmother and 2 siblings, ages 4 and 6. His mother reports that both she and his grandmother smoke outside. He presents to the clinic today for a well child exam. His last office visit was when he was 6 months old as his mother reports that she “just forgot” to bring him in for others. B.W is not walking yet but is crawling around the floor of the exam room while drinking milk from his bottle. Temp 98.2, RR 24, HR 102, Weight 28lbs 10oz, Length 31.5”, HC 48cm.

  1. Review B.W.’s growth chart and plot his measurements for today. How would you interpret your findings? 20pts
  2. What historical information would you obtain? 10pts
  3. Discuss the assessment of this child. What components would you include? What questions would you ask? (i.e. list the milestones, exam findings to look for, etc). 20pts
  4. Would he need any lab work? If so, what and why?10pts
  5. What anticipatory guidance would be appropriate for this child? 10pts
  6. Review the immunization history and determine which vaccines he would need. Develop a plan for future vaccines (which ones, when he should return, etc). 20pts