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Questions: Examine and discuss your nursing assessment and priorities. What risk factors can you identify? What are the nursing problems? What nursing interventions will you put into place? Answers: Introduction The case scenario describes the clinical condition of a three years old male child (Elias) exhibiting the clinical history of delayed motor development, irritability and malaise. The patient appears emotionally dependent of his parents and influenced with vitamin D deficiency. The child is affected with the pattern of impetigo as evidenced by the appearance of crusty yellow sores over his nose and mouth. Delay in patients motor development might relate to an abnormality of congenital origin that might have affected his walking capacity (Malak, Kostiukow, Krawczyk-Wasielewska, Mojs, Samborski, 2015). The developmental motor delay is also related to the pattern of neuronal degeneration leading to the over-expression of peroxidase coding genes. Delayed motor development remains highly prevalent in children with a history of periventricular brain injury and pre-term birth (Campbell, et al., 2012). Delay in childs motor development adversely influences his cognitive and adaptive abilitie s during childhood (Ghassabian, et al., 2016). The timely acquisition of motor milestones is highly significant for the normal physiological development of the growing child. The timely identification of the pattern of developmental delays in children is necessarily warranted with the objective of configuring remedial as well as rehabilitative interventions for the systematic enhancement of the developmental outcomes (Gupta, Kalaivani, Gupta, Rai, Nongkynrih, 2016). Irritability in children is clinically manifested in terms of the outcomes including grouchy and sulky mood as well as inadequate temper outbursts. The defects in the developmental trajectory of the growing children contribute to the pattern of their anger predisposition across the community environment (Leibenluft, 2017). Patients malaise leads to the experience of uneasiness and discomfort requiring assessment by the nurse professional in the clinical setting (NIH, 2017). Patients vitamin D deficiency increases his pr edisposition towards the development of symptoms including fatigue, muscle weakness and pain and disturbed thought processes (Weyder, 2014). The cases of vitamin D deficiency appear subclinical in the growing children (Michie, 2010). Vitamin D deficiency is highly prevalent across the children population. Accordingly, the affected children remain highly predisposed towards the development of immune system disorders and associated manifestations (Weyder, 2014). The pattern of impetigo experienced by the patient warrants the requirement of undertaking diagnostic interventions for evaluating the extent of Staphylococcus aureus colonization in the patients skin (Pereira, 2014). This research paper evidentially discusses the assessment strategies, medical management approaches, nursing interventions and care plan warranted for improving the health outcomes of Elias across the community environment. Assessment Strategies The clinical requires utilizing HINT (Harris Infant Neuromotor Test) diagnostic tool with the objective of assessing the pattern and intensity of childs delayed motor development (Harris, 2016). The HINT intervention considers the circumference of patients head for analysing the development of microcephaly in patients affected with developmental delays. The pattern of childs movement and play activities, supine position and passive range of motion, resting extremity posture and visual following as well as existence of stereotypical behaviour requires analysis through HINT tool for evidentially tracking the level of delayed motor development and associated clinical manifestations (Harris, 2016). The clinical requires assessing the level of patients communication in the context of clinically correlating the same with the progression of his delayed motor development. The reciprocal delay in patients communication (if tracked) evidentially correlates with the delay in his motor developme nt and walking capacity (Bhat, Galloway, Landa, 2012). The pattern of patients irritability warrants the requirement of investigating the development of DMDD (disruptive mood dysregulation disorder) or SMD (severe mood dysregulation) by the attending clinician and nurse professional (Krieger, Leibenluft, Stringaris, Polanczyk, 2013). The pattern of patients SMD (if diagnosed) would reveal his elevated inclination towards negative stimuli reflected through abrupt behaviour. The nurse professional might also observe distractibility, pressured speech, agitation and insomnia (in the patient) that might emanate under the influence of SMD (Krieger, Leibenluft, Stringaris, Polanczyk, 2013). The pattern of patients irritability could also relate with the elevated frequency of his temper outburst that proves to be inconsistent with the level of his physiological development. Such a pattern is indicative of the development of DMDD in the affected child (Krieger, Leibenluft, Stringaris, Po lanczyk, 2013). Patients known pattern of vitamin D deficiency requires the utilization of the laboratory evaluation of the active concentration of calcidiol in accordance with the standard prescribed by the Institute of Medicine (Lee, So, Thackray, 2013). Severe deficiency of vitamin D is affirmed with the serum calcidiol concentration of less than 5ng/mL. However, mild to moderate insufficiency is indicated by the findings of 4-15ng/mL (Lee, So, Thackray, 2013). In the presented clinical scenario, patients mother requires the increased consumption of vitamin D (i.e. 4000-6400 units/day) in the context of improving the level of vitamin D in the affected patient. The enhancement of vitamin D in breast milk reciprocally elevates its level in the developing child through breast feeding intervention (Lee, So, Thackray, 2013). The mother of the breastfeeding child also requires consuming the food items with vitamin D content in the context of accomplishing his vitamin D deficiency. T hese food items could include cows milk, egg yolk, cod liver oil, shrimp, swiss cheese, fresh mushrooms, cereal fortified, butter, yogurt, swiss cheese and raw Atlantic herring (Lee, So, Thackray, 2013). The clinician as well as the nurse professional requires evaluating the type of childs impetigo (i.e. bullous or non-bullous) for its effective treatment (Hartman-Adams, Banvard, Juckett , 2014). The physical examination of patients integumentary system assists in finding out the pattern of non-bullous of bullous impetigo in the affected patient. The appearance of yellowish of honey coloured or crusty yellow sores on the face of the child is indicative of the development of non-bullous impetigo manifested by Staphylococcus aureus (Hartman-Adams, Banvard, Juckett , 2014). Medical Management The medical interventions warranted for effectively treating the manifestations of patients delayed motor development attribute to the administration of AAC (augmentative and alternative communication) approaches, motor based behavioural interventions, electromagnetic brain stimulation treatment and RIT (reciprocal imitation training) (McCleery, Elliott, Sampanis, Stefanidou, 2013). These interventions facilitate the systematic improvement in patients behaviour, language, play activities, walking and communication as well as socialization skills. AAC technique utilizes sign language approaches to facilitate the pattern of speech in developmentally delayed children (McCleery, Elliott, Sampanis, Stefanidou, 2013). This intervention also uses picture exchange methods for improving the level of patients communication. The motor based behavioural remediation strategy assists in the systematic manipulation of patients anatomical structures associated with the production of sound (McCleer y, Elliott, Sampanis, Stefanidou, 2013). This manipulation is materialized by the clinicians through the administration of various play activities. Electromagnetic brain stimulation technique transmits low intensity intracranial current to the patients cerebral cortex with the objective of enhancing brain functionality (McCleery, Elliott, Sampanis, Stefanidou, 2013). RIT is a gesture-based intervention that helps in engaging the children in various learning activities for the systematic enhancement of their overall mental and behavioural functionality (McCleery, Elliott, Sampanis, Stefanidou, 2013). pharmacotherapeutic management of paediatric irritability warrants the utilization of drugs in accordance with the associated aetiology and psychosocial manifestations. These drugs could include clomipramine, fluvoxamine, fluoxetine, sertraline, citalopram, escitalopram, venlafaxine, trazodone, mirtazapine, haloperidol, pimozide, clozapine, risperidone, olanzapine, quetiapine, ziprasi done, aripiprazole, paliperidone, methylpnenidate, atomoxetine, clonidine, guanfacine or memantine (Doyle, 2012). The medical management of paediatric malaise is entirely based on its existing aetiology. The best recommended therapy for malaise management attributes to the systematic administration of cognitive behavioural intervention for effectively enhancing the energy level of the treated patient (Jason, Barker, Brown, 2012). Cognitive rehabilitation not only improves the level of patients socialization but also elevates his mental health outcomes across the community environment. Evidence-based clinical literature advocates the requirement of administering vitamin D supplements to the paediatric patient in the context of treating the pattern of his vitamin D deficiency (Harijan, Khan, Hussain, 2013). However, low dosages of vitamin D supplements do not evidentially enhance the bone mineral density of the treated patient. Regular sunlight exposure is another treatment of choic e that could facilitate the production of vitamin D in the treated patient. The paediatric patient requires the topical administration of antibiotic creams containing fusidic acid mupirocin for effectively treating his impetigo lesions (PubMed_Health, 2015). Oral administration of erythromycin is another treatment option available for decreasing the intensity of crusty yellowish impetigo sores. Orally administered erythromycin exhibits superior action potential in comparison to the topical antibiotics (PubMed_Health, 2015). Nursing Interventions (Including Care Plan) Nursing Diagnosis Risk Factors Nursing Assessment and Interventions Rationale Treatment and Care Outcomes Delayed Motor Development Patients risk factors related to the delayed motor development include his nutritional mismanagement, economic constraints and underprivileged status, a state of neglect, lack of normal physiological development and defective sanitation mechanism (Ali, 2013). The nurse professional requires require evaluating the daily activities of the child while effectively coordinating with the family members. Nurse will also administer periodic education sessions to the parents of the paediatric patient and make them understand their roles and responsibilities for improving the coping skills and motor activities of the treated child. The nurse professional will configure the pattern of a therapeutic relationship with the patient as well as his family members in the context of improving his communication ability (Roberts, Fenton, Barnard, 2015). Nutritional management of the treated patient is highly required by the nurse professional in the clinical setting. The nurse professional requires emphasizing the requirement of adequate sleep and educate the parents in relation to establishing a well-defined sleep schedule for the treated child. The nurse professional would engage patient family members in the context of organizing various play activities f or the paediatric patient. The regular monitoring of patients daily activities, dietary consumption as well as the pattern of breast-feeding will assist the nurse professional in terms of monitoring the pattern of his physiological development (Gantschnig, Fisher, Page, Meichtry, Nilsson, 2015). The regular assessment of patients psychosocial functioning is necessarily required with the objective of improving his psychosocial development as well as motor skills. The administration of dietary interventions would enhance the energy level, coping skills and the growth curve of the treated child (IOM, 2011). The establishment of a sleep schedule would improve the overall wellness of the child across the community environment (Buxton, et al., 2015). The organization of various play activities would systematically improve the cardiovascular and musculoskeletal systems of the treated patient (Alves, et al., 2016). This would also facilitate his mental and social development across the community environment. The child will exhibit considerable development in the pattern of his motor development. He will also acquire coping skills and effectively socialize with other children of similar age groups. The parental involvement in childs daily activities will elevate their understanding of the developmental requirements. Parents will also remain motivated in the context of regularly administering person-centred and holistic interventions while understanding the social, emotional and physical requirements of their treated child. Irritability Treated paediatric patient experiences elevated risk of encountering falls, trauma, infection and aspiration under the influence of his pattern of irritability. The nurse professional requires engaging the family members of the treated patient with the objective of configuring a protective environment for eliminating the sources of patients irritability. The culturally appropriate as well as family-centred approaches require administration by the nurse professional for effectively improving the behavioural outcomes of the treated child. The nurse professional should understand the refugee status of patients family and provide them regular reassurance as well as moral and social support for enhancing their level of trust and compliance to the recommended treatment interventions. The configuration of a safe environment improves the level of patients comfort that effectively reduces his irritability and associated adverse behavioural outcomes(LEIBENLUFT STODDARD, 2013). The pattern of reassurance and psychosocial assistance to the family members of the treated patients would systematically restore the pattern of their dignity and confidence. They will resultantly engage themselves in the process of medical-decision making with the objective of elevating the treatment outcomes(Miller, 2009). Patient will exhibit positive change in behaviour as well as reduced level of irritability. Vitamin D Deficiency Patients ethnicity, underprivileged status as well as socioeconomic constrains prove to be the risk factors of his vitamin D deficiency in the presented clinical scenario. The nurse professional must evaluate the cultural conventions practiced by patients family members and logically motivate them in terms of administering vitamin D supplementation (in dosage of 400 IU) on daily basis while concomitantly undertaking partial breast feeding(Carbonare, Valenti, Forno, Caneva, Pietrobelli, 2017). The administration of additional vitamin D supplement in concordance with breast feeding will normalize the level of vitamin D in the treated paediatric patient(Carbonare, Valenti, Forno, Caneva, Pietrobelli, 2017). The patient will evidently exhibit an improvement in the pattern of his vitamin D deficiency. Conclusion The nursing management of the paediatric patient warrants the systematic administration of evidence-based holistic and family-centred approaches to restoring the pattern of his physiological development and wellness outcomes across the community environment. The critical analysis of this case study assisted in identifying a range of comprehensive nursing approaches requiring implementation for the systematic enhancement of the prospective professional clinical practice. Thorough knowledge of various pharmacotherapeutic interventions is necessarily required by the nurse professional in the context of reducing the scope of medication errors associated with paediatric adversities. However, the insight and knowledge of various multidisciplinary paediatric healthcare interventions prove to be the essence of nursing practice in the healthcare setting. 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