NSG 6020 Emma Ryan iHuman Case study, 2 year old

NSG 6020 Emma Ryan iHuman Case study, 2 year old with chief complaint of runny nose, cough, and fever

Discussion Question 1 Emma Ryan’s iHuman Case

In the iHuman case of 2-year-old Emma Ryan, who had a runny nose, cough, and fever, there were two questions that were accidentally skipped during the discussion. These questions are crucial for understanding the child’s health better.

Firstly, when talking about Emma’s symptoms, I forgot to ask if there was any discharge or bleeding from her ears. This is important because such signs could indicate various issues, like a wound in the ear, a skull fracture, or an infection (Goolsby, Jo, M., Grubbs, Laurie., 2014, p. 127). Knowing this beforehand would have helped in planning the physical examination more effectively.

Secondly, I missed asking about Emma’s flu vaccine. I did ask about her general immunizations, but I didn’t specifically ask about the flu shot. Knowing whether Emma got the flu vaccine is crucial because it helps in preventing flu and reducing pneumonia rates in children (Seasonal influenza vaccine in children, n.d). This kind of information is vital for planning the right care and preventing future health issues.

Emma Ryan iHuman Help

Discussion Question 2: Errors in Physical Exam Performance for Emma Ryan’s iHuman Case

In the iHuman case of 2-year-old Emma Ryan, my physical examination had two notable errors. These errors, although unintentional, are crucial to address for a more accurate assessment of the client.

Firstly, I included a mental state assessment in the vital signs, which turned out to be unnecessary. This was an oversight, considering that Emma, being a 2-year-old, cannot verbally express her mental state. As Goolsby, Jo, M., Grubbs, Laurie note, observing a child’s mental state in this age group is limited to signs of wakefulness and alertness, which can be evident without a specific examination (2014, p. 128). This indicates the importance of tailoring the examination to the developmental stage of the patient.

Secondly, I performed an internal examination of Emma’s nostrils, which, upon reflection, was not required for her chief complaints. Internal examination of the nose is more relevant for individuals with significant nasal symptoms, and it is best done after asking the patient to blow their nose (Goolsby, Jo, M., Grubbs, Laurie., 2014, p. 128). Additionally, this kind of examination may not be suitable or comfortable for a fussy 2-year-old. Recognizing the appropriateness of specific exams for different age groups is crucial for a focused and patient-centered assessment.

Discussion Question 3

Key Finding and Point-of-Care Assessment for Cough and Pharyngeal Erythema

In the iHuman case of 2-year-old Emma Ryan, a significant finding during the physical exam was associated with the complaint of cough and erythema of the pharynx. Emma’s mother reported exhaustion due to staying up all night, attending to Emma’s crying and coughing. To further evaluate this finding at the point of care, a relevant physical exam would be a throat culture.

A throat culture is a valuable diagnostic tool to identify infections such as strep throat and pharyngitis. The Centers for Disease Control and Prevention (2018) notes that strep throat is more common in children aged 5-15 years and rare in those under 3 years old. However, Emma’s exposure to a daycare environment increases the likelihood of contracting streptococcus infections.

Performing a throat culture can aid in confirming or ruling out bacterial infections, providing crucial information for targeted treatment. This point-of-care assessment aligns with the specific symptoms presented by Emma and ensures a more accurate diagnosis, contributing to effective and timely healthcare management.

Discussion Question 4

Select one missed or incorrectly identified category from your ASSESSMENT performance and the expert feedback. Explain the importance of this category in arriving at accurate differential diagnoses for the client using specific references from your text.

Upon reviewing the information gathered from the history collection and physical exam, I incorrectly identified the immune system as the problem category, assuming the presence of an infection. The feedback received highlighted this error, and upon careful reconsideration, I acknowledge that I was not thinking systematically. The correct problem category, as indicated by the erythema and bulging of the tympanic membranes and pharynx, along with other respiratory signs, is the respiratory system. This experience emphasizes the importance of following the process, avoiding hasty conclusions, and thoroughly considering all relevant factors before making assessments.

Discussion Question 5

Discuss one inaccurate or overlooked differential diagnosis in your assessment and utilize specific references from your text to substantiate its relevance for this client.

One overlooked differential diagnosis I omitted was laryngotracheobronchitis or croup. This condition is characterized by a distinctive “barking” cough and labored breathing or stridor. During history collection and physical examination, the mother reported no signs of labored or difficult breathing. Unfortunately, I neglected to explore defining characteristics of the cough, leading to the exclusion of this diagnosis. However, individuals with “croup” exhibit inflammation of the larynx, throat, and upper bronchial tubes, resulting in hoarseness and a cough—symptoms that align with Emma’s presentation. Typically affecting children aged six months to five years, croup is particularly common in two-year-olds (Henningfeld, D. P., 2013). NSG 6020 Emma Ryan iHuman Case study, 2-year-old with a chief complaint of a runny nose, cough, and fever.

Also Read: i-human case study answers


Centers for Disease Control and Prevention (2016).  Group A Streptococcal Disease. Retrieved from:


Goolsby, Jo, M., Grubbs, Laurie. (2014). Advanced Assessment: Interpreting Findings and Formulating

Differential Diagnoses, 3rd Edition. [South University]. Retrieved from https://digitalbookshelf.southuniversity.edu/#/books/9780803645011/

Henningfeld, D. P. (2013). Croup. Magill’S Medical Guide (Online Edition), Seasonal influenza vaccines in children. (n.d).