CASE: Tenly.

CASE: Tenly is a 6-year-old only child who is in the 1st grade. She is very bright and is meeting her milestones. Her parents have chosen not to immunize Tenly due to the fact that her cousin Grace had an erythema multiforme reaction to the HPV vaccine at the age of 12. Tenly’s teacher called her parents yesterday reporting that she has been choosing to go to the reading corner frequently and taking naps in the middle of the day after lunch. She has been requesting to go to the drinking fountain frequently as well and has appeared pale to the teacher. Tenly attends after hours care from 3pm – 7pm daily and her aftercare attendant reports that she has eaten her dinners well and without issue. Tenly’s mother is a corporate attorney and works 12 hour days. Her father is an investor and work long hours as well. Her grandmother is here at the appointment with her and has full HIPAA access per the chart. Neither parent reports noticing anything different at home, but they only see her in the evening for a bit. She is usually with her grandmother on the weekends. Her grandmother reports enjoying afternoon naps with her granddaughter and states that she has a fabulous appetite.
What questions do you have for Tenly? Tenly’s grandmother?
What tests would you like to order for Tenly?
What is her likely diagnosis? What is high on your list of differentials?
What medications would you prescribe and why?
What are possible barriers to education and care for Tenly?
What do you anticipate for this young girl?
The initial post requires 300 or more words, supported by at least three scholarly references. Your main post must cover the points and questions as noted in the discussion directions. Your discussions will be evaluated on content, participation, writing, and scholarly support. Use Burns, C., Dunn, A.M., Brady, M.A, Barber, S. (2017). Pediatric Primary Care (6th ed). St. Louis, Missouri: Evolve Elsevier. as one of your three references