Change in the Context of Kotter’s Leading Change Model.

Posted: November 4th, 2022

Change in the Context of Kotter’s Leading Change Model.

Case Study 1
HPI: This is a 3 year old girl with a 2-day history of complaints of dysuria with frequent episodes of enuresis despite potty training about 7 months ago. She is afebrile and denies vomiting.
PMH: Last UTI, 6 months ago.
PE: Dipstick voided urine analysis reveals: specific gravity 1.015, Protein 1+ non-hemolyzed blood, 1+ nitrites, 1+ leukocytes, and glucose-negative.Post an analysis of your assigned case by responding to the following:Change in the Context of Kotter’s Leading Change Model.


What additional questions will you ask?
Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).
What additional examinations or diagnostic tests, if any will you conduct?
What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.
What is your most likely diagnosis and why?
How will you treat this child?
Provide medication treatment and symptomatic care.
Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
Patient Education, Health Promotion & Anticipatory guidance:Change in the Context of Kotter’s Leading Change Model.
Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
Include any socio-cultural barriers that might impact the treatment and management plans.
Health Promotion:
What immunizations should this child have had?
Based on the child’s age, when is the next well visit?
At the next well visit, what are the next set of immunizations?
What additional anticipatory guidance should be provided today?


Case Study Analysis

Additional Question

The additional question that I would ask is if the child has reported any case of diarrhoea and fever. Also, I would enquire whether the UTI was treated well using the right dosage of trimethoprim. Finally, I would enquire from the mother whether she reported any pain either in the perineal or genital areas and if the urine had a strong smell.Change in the Context of Kotter’s Leading Change Model.

Diagnostic Test

I would conduct more tests to get more details about the condition. In particular, I would test for bacteria on microscopy. I would also conduct ultrasonography, renal cortical scan, and radionuclide cystography tests.

Differential Diagnoses

Differential diagnosis needs to be conducted to rule out the condition she is suffering from. The three differential diagnosis that is recommendable in this case is the test for urinary tract infections (UTIs), Occult bacteremia, and urethritis. First, I would test for UTI since the child has a history of the condition. Additionally, some physical examination features in particular dysuria indicate that the child is likely to be suffering from UTI. Finally, a positive nitrite result increases the possibility of UTI. Secondly, I would diagnose her with Occult bacteremia. Occult bacteremia would be suspected due to the positive value in the leukocytes. Finally, I would diagnose the patient with urethritis. This condition is suspected since the child complains of dysuria, which is one of its major symptoms.Change in the Context of Kotter’s Leading Change Model.

The most likely Diagnosis

In this case, the most likely diagnosis is UTI. This condition would be the primary diagnosis since the patient had reported a case of UTI 6 months ago. May be the condition was not well treated thus making it reoccur. Additionally, cases of dysuria in children are mainly associated with UTI. Finally, the Dipstick voided urine analysis indicates positive nitrites value, which indicates the possibility of UTI. According to Stein et al (2015), positive nitrates value indicates the possibility of UTI.
The Treatment

The treatment plan for this child involves both medication and symptomatic care. I would use Trimethoprim 50 mg/5 ml Suspension. Trimethoprim has been effective in treating UTIs (Crellin et al, 2018). The recommended dosage for this patient is 50 mg (5 ml) two times every day.

Patient Education, Health Promotion & Anticipatory guidance

The patient should take precautionary measures to prevent re-occurrence of the condition in the future. The parents of the child should prevent cases of constipation as much as possible. According to Sarvari et al (2017), constipation increases the risk of UTI in children. Therefore, preventing constipation in this child will reduce of chances of subsequent infections in the future. Additionally, the child should be given cranberry juice since it lowers symptomatic UTIs for more than 12-months.Change in the Context of Kotter’s Leading Change Model.

Strategies for Educating Parents

The parents should be educated using approaches that reduce fears that are presented in the case study. First, education should be based on previous cases that were treated successfully. Quoting such cases will minimize the concerns of the parents since they will be assured that the child will be treated. Additionally, the parents should be educated by stating other critical conditions among children. Consequently, their fear will be reduced once they learn about other severe conditions.Change in the Context of Kotter’s Leading Change Model.
Socio-Cultural Barriers that may affect the Treatment and Management Plans

The treatment and management plan is likely to be affected by some socio-cultural barriers. In particular, the plan is likely to be affected by the lack of sufficient family support. According to Soltani et al (2017), the success of treatment among children and people with disability greatly depends on the support offered by the family members. Therefore, failure to give the required family support is likely to interfere with the treatment plan.
What immunizations should this child have had?

This child should have had diphtheria, pertussis (DTaP), and tetanus vaccine. Additionally, she should have had inactivated poliovirus vaccine (IPV) dose for three times. Also, she should have been immunized with doses of Haemophilus influenza type B (Hib) vaccine for three or four times. Finally, a dose of measles, rubella (MMR), and mumps vaccine should have been administered.Change in the Context of Kotter’s Leading Change Model.
The next well Visit

The Next well visit for this child should be at 4 years
Immunizations at the next Visit

At the next visit, the child should be immunized against tetanus, diphtheria, and whooping cough. Additionally, she should be administered with the 4th dose of Polio (IPV). The 2nd dose of mumps, measles, and rubella should also be given during the next visit. Besides, the child should be immunized against influenza annually. Finally, the child will be administered with the 2nd dose of chickenpox in the next visit.Change in the Context of Kotter’s Leading Change Model.
Additional Anticipatory Guidance

The parent should be observant and take the child to a healthcare facility anytime she notices some unusual symptoms. This move will enable the child to get medical attention within the shortest time possible thus preventing the condition from deteriorating. Additionally, the parents should ensure that the child is immunized against any outbreak in the future thus lowering the chances of suffering from the condition.Change in the Context of Kotter’s Leading Change Model.



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