Part I - Initial Office Visit You are a nursing student and you have been given the opportunity to shadow Yasmin Gonzalez, a nurse practitioner. Today, Kelly Hunter brings in her 5-month-old son, Tristan, for an exam. Mrs. Hunter is anxious and concerned because she has recently noticed lots of bruises on Tristan and cannot figure out where they are coming from. Ms. Gonzalez looks over Tristan's body and sees visible bruises at different stages of healing along his arms. Upon further inspection, she finds bruises that are the size of half dollars that protrude along his rib cage. You and Ms. Gonzalez are concerned by the bruising and want to discuss this with the mother. Questions 1. What do you think could be causing the bruising? Please list two possible explanations. 2. What are some important questions to ask the parent? After talking with a tearful mom it is revealed that the parents had been trying for several years to become pregnant. Tristan sleeps no more than 20 minutes at a time even throughout the night. Th e mom says the baby's schedule "is tiring, but isn't that normal?" She has noticed the bruising over the past week and the bruises are getting bigger. She thinks they are coming from the excersaucer and jumpers that he plays in, but she is not sure. Tristan does not attend any daycare centers; he stays at home with his mom throughout the day. Th e mom verbalizes and physically shows that she loves her son and is concerned for his wellbeing. Ms. Gonzalez calls a meeting with the medical team, which consists of the pediatrician, a social worker, a nurse, and you. Th e possible diagnoses discussed by the team include child abuse, leukemia, clotting disorders, nutritional deficiencies, and autoimmune diseases. Everyone on the team agrees that due to the location and sizes of the bruises, x-rays need to be taken to rule out broken ribs. X-rays are ordered for Tristan.

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