FNP Perspective Peer Response

Please respond to at least 2 of your peer’s posts. To ensure that your responses are substantive, use at least two of these prompts:
Do you agree with your peers’ assessment?
Take an opposing view to a peer and present a logical argument supporting an alternate opinion.
Share your thoughts on how you support their opinion and explain why.
Present new references that support your opinions.
Please be sure to validate your opinions and ideas with citations and references in APA format. Substantive means that you add something new to the discussion, you aren’t just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion and should be correlated to the literature.Be sure to review your APA errors in your reference list, specifically you have capitalization errors in some words of the titles. Also, be sure you are italicizing titles of online sources.
Samantha’s Post:
Question #1-
What comprehensive physical, social, emotional, information will you gather from parents of a three-year-old who is straining to stool, complaining of abdominal pain, but refusing to use the toilet for bowel movements? What treatment recommendations will you detail in your plan of care? What time frame for a follow-up visit will you expect to establish? What information will you obtain from the parents?
Constipation is one of the most common chronic disorders of childhood, affecting 1% to 30% of children worldwide (Nurko, & Zimmerman, 2014). Constipation is responsible for 3% of all primary care visits for children and 10% to 25% of pediatric gastroenterology visits (Nurko, & Zimmerman, 2014). Stool toileting refusal is present when a child demonstrates a pattern of successfully using the toilet to urinate, but refuses to use the toilet for bowel movements, this is a commo yet not well documented causative agent for constipation in the pediatric population (Burns, et al., 2017). It will be important to identify this from other causes of primary encopresis.
History
When obtaining the it is important to assess the current condition and possible associated factors including social and psychological (AAP, 2017). Key points of history taking include, reports of stained underwear, must differentiate between leakage and hygiene issue, report of fewer than three bowel movements per week, difficult or painful defecation, large-caliber or hard stool, child suddenly becoming still during play, attempting to hide when urge to defecate is felt, child attempting to retain, reports of a bloated sensation, abdominal pain, or both, odor of stool from leakage into underwear, streaks of bright blood on toilet paper or underwear, child attempting to retain urine, enuresis, nocturnal or diurnal, UTIs, anorexia, avoiding using the toilet at school or other public places (Burns, et al., 2017). Key findings associated with stool toilet refusal include bladder control but refusal to defecate on the toilet, a regular or irregular pattern of bowel movements, consistent signs from child that a bowel movement is imminent, may have a history of hiding when defecating, either before or after toilet training begins (Burns, et al., 2017). Additionally, the medical history should include the family’s definition of constipation and a careful review of the frequency, consistency, and size of stools; age at onset of symptoms; timing of meconium passage after birth; recent stressors; previous and active therapies; presence of withholding behaviors, and systemic symptoms (Nurko, & Zimmerman, 2014). The presence of withholding behaviors supports the diagnosis of functional constipation (Nurko, & Zimmerman, 2014). Further evaluation may be warranted in children with red flags that might suggest an organic etiology (Nurko, & Zimmerman, 2014).
Physical Exam
The physical examination should include an assessment for overflow soiling, abdominal distention, abdominal tenderness on palpation, a mass felt at the midline in the suprapubic area, anal fissures, sacral dimple or hair tuft, and neurologic signs including absent or diminished abdominal, cremasteric, anal wink reflexes, and deep tendon reflexes in lower extremities may indicate a neurologic cause (Burns, et al., 2017). Additionally, the physical examination should include a review of growth parameters, an abdominal examination, an external examination of the perineum and perianal area, and an evaluation of the thyroid and spine (Nurko, & Zimmerman, 2014). A digital examination of the anorectum is recommended to assess for perianal sensation, anal tone, rectum size, anal wink, and amount and consistency of stool in the rectum (Nurko, & Zimmerman, 2014). However, in children with normal neonatal courses or clear withholding behaviors, or in whom trauma is suspected, the rectal examination may be deferred (Nurko, & Zimmerman, 2014). A test for oc