| Course | D119 Pediatric Primary Care for the Advanced Practice Nurse |
|---|---|
| Task | Task 1 |
| Paper type | Pediatric case analysis |
| Length | About 800 words, 4 pages |
| Format | APA 7 |
| School | Western Governors University (WGU) |
| Program | MSN Family Nurse Practitioner |
| Updated | September 2026 |
Free sample paper for D119 Task 1
Pediatric Case Analysis: A Barking Cough and Noisy Breathing Overnight in a 26-Month-Old Boy
Student Name
Leavitt School of Health, Western Governors University
D119: Pediatric Primary Care for the Advanced Practice Nurse, Task 1
Course Instructor
Month Day, Year
Pediatric Case Analysis: A Barking Cough and Noisy Breathing Overnight in a 26-Month-Old Boy
Identifying Data and Sources of History
The patient is a composite 26-month-old boy brought to a pediatric primary care clinic on a same-day appointment by his father, who gives the history. The child is too young to describe his symptoms, so all history is caregiver report, and observations made in the room are recorded separately.
Growth, Development and Immunizations
Weight 12.6 kg (about the 50th percentile for age), length 88 cm (about the 50th percentile), weight-for-length near the 50th percentile, tracking along the same curves as his 18- and 24-month visits. Development: walks and runs well, climbs, uses about 50 words and some two-word phrases, follows two-step commands; no concerns at his 24-month screen. Immunizations are complete for age according to the state registry, including all three doses of Haemophilus influenzae type b vaccine and the diphtheria, tetanus and pertussis series (Centers for Disease Control and Prevention [CDC], 2025).
History of Present Illness
The father reports two days of runny nose and a mild cough. Last night at about 11 p.m. the child woke with a loud cough that 'sounded like a seal' and a high-pitched noise when he breathed in while crying. The father took him into the bathroom with a hot shower running, and he settled after about 20 minutes. He slept the rest of the night with occasional coughing. Temperature this morning was 38.2 C. He is drinking milk and water, ate some toast and has had three wet diapers since midnight. No drooling, trouble swallowing, choking episode, known foreign body, rash, hives, facial swelling or new foods. No previous episodes. His older sister had a cold last week. No one at home smokes.
Examination
Temperature 38.1 C; heart rate 128 (normal range for age about 80 to 130); respiratory rate 32 (upper normal range for age about 24 to 40); oxygen saturation 98% on room air. Alert, playful on his father's lap, and interested in the otoscope light. Intermittent barking cough during the visit. No stridor at rest; soft inspiratory stridor heard only when he cries during the ear examination. No suprasternal or intercostal retractions at rest; no nasal flaring. Air entry good in both lungs, no wheezes or crackles. Voice hoarse when he protests. Pharynx mildly red without exudate; no drooling; handles secretions normally. Clear rhinorrhea. Tympanic membranes gray and mobile. Skin warm, pink, no rash or cyanosis; capillary refill under 2 seconds; moist mucous membranes. His Westley croup score is 1: one point for stridor with agitation, and zero each for level of consciousness, cyanosis, air entry and retractions. A score of 2 or less places him in the mild category (Bjornson & Johnson, 2013).
Analysis
The presentation is typical of viral croup (laryngotracheobronchitis): a child between 6 months and 3 years with a few days of cold symptoms, then sudden onset at night of a barking cough, hoarse voice and inspiratory stridor, improving with time and calm (Bjornson & Johnson, 2013). Swelling of the subglottic airway, the narrowest part of a toddler's airway, explains why a small amount of inflammation produces noisy breathing, and why crying, which increases airflow turbulence, makes it louder.
Differential diagnosis, in order: (1) viral croup, supported by every feature above; (2) spasmodic croup, a recurrent, nighttime, less febrile variant, less likely because this is his first episode and he has fever and cold symptoms; (3) airway foreign body, important in a toddler, but there was no choking episode, onset followed a cold and the lungs are clear and symmetric; (4) bacterial tracheitis, dangerous, but he is not toxic appearing and is improving rather than worsening; (5) epiglottitis, rare in a child fully immunized against Haemophilus influenzae type b, and not supported given the absence of drooling, dysphagia, toxic appearance or a tripod posture; (6) allergic reaction with airway swelling, not supported without hives, facial swelling or exposure.
Diagnostic Findings
Croup is a clinical diagnosis, and no laboratory tests or neck radiographs are needed in a child with a typical presentation and mild severity (Bjornson & Johnson, 2013). Oxygen saturation is normal. Imaging would be considered only if the course were atypical, such as suspicion of a foreign body or failure to improve.
Hydration and Risk Assessment
He is well hydrated, with three wet diapers since midnight, moist mucous membranes and quick capillary refill. There are no signs of respiratory distress at rest, and his father is attentive, has a car and lives 10 minutes from the nearest emergency department. He can be managed at home after treatment in the clinic.
Working Diagnosis
Mild viral croup in a well-hydrated, fully immunized 26-month-old boy weighing 12.6 kg, with stridor only when agitated and no signs of a dangerous airway condition. Glucocorticoid treatment reduces croup symptoms and return visits (Gates et al., 2018), and the treatment plan will use the weight recorded here for every dose.
References
Bjornson, C. L., & Johnson, D. W. (2013). Croup in children. Canadian Medical Association Journal, 185(15), 1317-1323. https://doi.org/10.1503/cmaj.121645
Centers for Disease Control and Prevention. (2025). Child and adolescent immunization schedule by age, United States, 2025. https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html
Gates, A., Gates, M., Vandermeer, B., Johnson, C., Hartling, L., Johnson, D. W., & Klassen, T. P. (2018). Glucocorticoids for croup in children. Cochrane Database of Systematic Reviews, 2018(8), CD001955. https://doi.org/10.1002/14651858.CD001955.pub4
What the D119 Task 1 instructions ask
The first D119 task asks you to analyze a pediatric case with attention to the child's age. Most versions ask for identifying data and sources of history, growth, development and immunizations, the history of present illness, examination findings compared with age-specific norms, analysis of the presentation, diagnostic decisions and a working diagnosis. Evaluators look for norms drawn from recognized pediatric references, reasoning that considers conditions common and dangerous at this age, and a severity assessment that determines where care happens. Writing about a child as a small adult, without growth or developmental context, misses the point of the course. Many versions also ask how you will involve the caregiver.
How this D119 Task 1 example is built
The analysis opens by naming the historian, because pediatric histories come from caregivers. Growth, development and immunizations are documented before the illness, since they shape the differential. The history of present illness follows the timeline from cold symptoms to nighttime stridor. The examination compares each vital sign with the normal range for age. The analysis explains why the picture fits croup and considers serious alternatives such as epiglottitis and foreign body. The diagnostic section explains that croup is a clinical diagnosis. The severity and hydration assessment leads to a working diagnosis stated with weight and immunization status, ready for weight-based treatment in Task 2. Norms are cited beside each vital sign, so the reader never has to look up the ranges.
Where the D119 Task 1 rubric puts the marks
D119 Task 1 aspects are rated competent, approaching competence or not evident. A history aspect checks for sources and relevant detail. Growth, development and immunization aspects look for age-appropriate assessment with references. An examination aspect wants findings compared with norms for age. An analysis aspect rewards reasoning about likely and dangerous conditions. Diagnostic and severity aspects ask whether tests and setting of care are justified. Evaluators expect pediatric references for norms and check that the working diagnosis is consistent with the data. Evaluators notice when growth percentiles and immunization status are recorded even though the complaint is acute, since those details change the differential and later treatment. A severity score with its components listed makes the setting of care easy to justify.
D119 Task 1 help: what sends it back
Pediatric analyses are returned most often when vital signs are interpreted with adult ranges. Use age-specific norms and cite them. Second, growth and development are skipped. Include percentiles and milestones even when the complaint is acute. Third, dangerous conditions are not addressed. For stridor, explain why epiglottitis, bacterial tracheitis and foreign body are unlikely. Fourth, severity is not scored, which leaves the setting of care unclear. Use a recognized tool such as the Westley score. Finally, record who gave the history. Caregiver reports shape reliability, and evaluators notice when the source is missing. List the historian's relationship to the child.
Get a D119 Task 1 example written to your instructions
Send the D119 Task 1 instructions and the rubric aspects as your course of study lists them, plus the age, presentation or case you were given. We write a custom example to those aspects, with growth, development and age-specific reasoning carried through the analysis, and return it in 24-48h. The first custom sample is free.
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D119 Task 1 questions, answered
What age should I pick if the case is open?
Pick an age where the developmental reasoning has somewhere to go. Infants under a year, toddlers and early adolescents all force real age-specific judgement about growth, milestones, immunizations and safety. A school-age child with a minor complaint can produce an analysis that reads like a small adult, which is exactly what the developmental aspect is designed to catch.
Which references should the age-specific norms come from?
Named pediatric sources rather than memory. Growth charts from a recognized body, the current immunization schedule, a standard developmental screening reference and current pediatric clinical guidance all carry weight, and each should be cited where it is used. Check your instructions for any requirement about publication currency, since some versions set one explicitly.
Do I have to write about a child I actually saw?
Read your own instructions first, but a composite child is normally acceptable and easier to build the required elements into. Anything documenting a real child you saw stays with you, including hour logs and preceptor evaluations, and none of it is drafted here. Nothing on this page is offered as guidance for treating any actual patient.
Which references should D119 age-specific norms come from?
Recognized pediatric sources, such as growth charts from national agencies and published vital sign ranges. The sample compares each finding with the normal range for a 26-month-old.
Where can I find a free D119 Task 1 sample paper?
Every part of the croup analysis, from growth charts to the Westley score, is above with comments. Share the D119 task and your case; the first tailored analysis costs nothing.