| Course | NUR 636 Primary Care of Infants, Children and Adolescents |
|---|---|
| Module | Module 9 |
| Paper type | comprehensive care plan for a toddler with anemia and speech delay |
| Length | About 1,300 words, 7 pages |
| Format | APA 7 student paper |
| School | Southern New Hampshire University |
| Program | MSN |
| Updated | September 2026 |
Free sample paper for NUR 636 Module 9
Final Project: Comprehensive Primary Care Plan for a Two-Year-Old with Iron Deficiency Anemia and Expressive Language Delay
[Student Name]
Southern New Hampshire University
NUR 636: Primary Care of Infants, Children and Adolescents
Module Nine Final Project
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
Final Project: Comprehensive Primary Care Plan for a Two-Year-Old with Iron Deficiency Anemia and Expressive Language Delay
The two-year visit is a checkpoint for growth, nutrition and development, and problems in one of these areas often travel with problems in another. Iron deficiency remains the most common nutritional deficiency in young children in the United States, and its peak in toddlers overlaps with the period of fastest brain development. Excess cow's milk is a leading cause, and the same bottle habit that crowds out iron-rich food can be part of a household routine in which a toddler hears and uses less language. This final project presents a comprehensive primary care plan for a two-year-old with iron deficiency anemia and expressive language delay. It argues that treating the anemia, screening for lead, evaluating hearing and referring early for speech support, with a family-centered plan the parents can follow, gives the child the best chance of catching up.
Case Summary
Noah is a twenty-four-month-old boy brought by his mother and grandmother for his two-year well visit. His mother reports that he is "a picky eater" who drinks five or six 8-ounce bottles of whole milk a day, including one at bedtime, and eats small amounts of crackers, bananas and yogurt. He refuses meat and most vegetables. He says about ten words, including "mama," "ball" and "more," but does not combine words. He understands simple directions, points to request things, brings toys to show his mother and pretends to feed a doll. His family lives in an apartment built in 1962 that was recently repainted. His mother works nights and his grandmother cares for him during the day, mostly with the television on. He had one ear infection at fifteen months. His growth has been steady at the 60th percentile for weight and 40th for length.
On examination he is active and playful, with pale conjunctivae and palms and a soft systolic flow murmur. There is no hepatosplenomegaly, lymphadenopathy or bruising. Tympanic membranes are normal. His M-CHAT-R/F score is 1, which is low risk for autism.
Problem One: Iron Deficiency Anemia
The AAP recommends universal screening for anemia at about twelve months, with assessment of risk factors throughout early childhood, and defines anemia in children aged one to three years as a hemoglobin below 11.0 g/dL (Baker & Greer, 2010). Noah had not been screened at his one-year visit because he missed it. His hemoglobin is 9.2 g/dL, MCV 62 fL and red cell distribution width 17.8%, a microcytic anemia with variable cell size. His serum ferritin is 6 ng/mL with a normal C-reactive protein, which matters because ferritin rises with inflammation and a normal CRP makes the low value reliable. His Mentzer index, the MCV divided by the red cell count, is 15, favoring iron deficiency over thalassemia trait.
The cause is clear from the history: about 40 ounces of cow's milk a day, which is low in iron, displaces iron-rich foods and can cause small intestinal blood loss in some toddlers. Baker and Greer note that iron deficiency, even before anemia appears, has been associated with poorer neurodevelopmental outcomes that may not fully reverse, which is why they emphasize prevention and early treatment. This concern links the anemia to Noah's development.
Problem Two: Lead Exposure Risk
Because Noah lives in housing built before 1978 that was recently repainted and has anemia, a blood lead level was drawn. Iron deficiency increases lead absorption, so the two conditions often coexist. In 2021 the CDC moved its blood lead reference value down to 3.5 micrograms per deciliter, from the earlier 5, the level above which children are in the top 2.5% of exposure and need follow-up (Ruckart et al., 2021). Noah's venous level is 2.1 micrograms per deciliter, below the reference value. No lead treatment is needed, but the family was taught to wet-wipe window sills and floors, wash his hands before meals and ask the landlord whether the repainting followed lead-safe practices. His level will be rechecked at his next visit because his risk factors continue.
Problem Three: Expressive Language Delay
In 2022 the CDC and AAP revised their developmental milestones so that every listed skill is one three in four children or more have already reached at that birthday, making a missed milestone a clearer signal for action rather than a reason to wait (Zubler et al., 2022). At twenty-four months, the revised checklist expects a child to say at least two words together, such as "more milk." Noah has about ten words and no combinations, so he has missed this milestone. His receptive language, pointing, shared attention and pretend play are age-appropriate, and his M-CHAT-R/F is low risk, which points to an isolated expressive language delay rather than autism or a global delay.
Possible contributors include limited conversational exposure during long daytime television hours, a past ear infection that might have affected hearing and possibly the effects of iron deficiency. Hearing loss must be excluded in any child with a speech delay, even when the ears look normal today.
Integrated Plan
Iron therapy: ferrous sulfate drops at 3 mg/kg/day of elemental iron, given once daily between meals with water or a small amount of juice, not with milk. For his weight of 13 kg that is 39 mg a day, rounded to 40 mg. The family was warned that iron can darken stools and cause constipation and that iron is dangerous in overdose, so the bottle must be stored out of reach.
Nutrition: reduce cow's milk to about 16 ounces a day served in an open cup at meals, stop the bedtime bottle and offer iron-rich foods he accepts, such as iron-fortified cereal, beans, eggs and ground meat mixed into familiar foods, paired with fruit rich in vitamin C. A referral to WIC nutrition counseling was offered and accepted.
Development: referral to the state Early Intervention program under Part C of IDEA for a speech and language evaluation, which is free and does not require a diagnosis, and a formal audiology evaluation. His grandmother was shown simple ways to build language during the day: naming objects, narrating routines, reading picture books for fifteen minutes and pausing to let Noah respond, with the television off during play.
Family-Centered Care
The plan was built with both caregivers because the grandmother provides most daytime care and the mother gives the night bottle. Neither caregiver wanted Noah to go hungry, and both feared that less milk would mean less food. They were told that most toddlers eat more solids once milk is reduced and that the change can be made over two weeks. The mother's night shifts were accommodated by scheduling follow-up visits in the late afternoon, and the practice's care coordinator will help with the Early Intervention intake call.
Follow-Up and Evaluation
Hemoglobin will be repeated at four weeks; an increase of 1 g/dL or more confirms iron deficiency and adherence. If it does not rise, adherence, ongoing milk intake, blood loss and other causes will be reviewed. Iron will continue for about three months after the hemoglobin normalizes to replenish stores. Lead will be retested in six months. The Early Intervention evaluation should occur within the program's 45-day timeline, and audiology results will be reviewed as soon as they arrive. At the thirty-month visit, the goals are a normal hemoglobin, milk intake under 20 ounces a day, no bottle, a vocabulary of at least fifty words and regular two-word phrases.
Conclusion
Noah's anemia, lead risk and language delay share roots in his diet and daily routine. Treating the iron deficiency, confirming a safe lead level, excluding hearing loss and referring early for speech support, all in a plan his mother and grandmother helped shape, gives him a strong chance of catching up by the time he starts preschool.
References
Baker, R. D., & Greer, F. R. (2010). Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics, 126(5), 1040-1050. https://doi.org/10.1542/peds.2010-2576
Ruckart, P. Z., Jones, R. L., Courtney, J. G., LeBlanc, T. T., Jackson, W., Karwowski, M. P., Cheng, P.-Y., Allwood, P., Svendsen, E. R., & Breysse, P. N. (2021). Update of the blood lead reference value: United States, 2021. MMWR. Morbidity and Mortality Weekly Report, 70(43), 1509-1512. https://doi.org/10.15585/mmwr.mm7043a4
Zubler, J. M., Wiggins, L. D., Macias, M. M., Whitaker, T. M., Shaw, J. S., Squires, J. K., Pajek, J. A., Wolf, R. B., Slaughter, K. S., Broughton, A. S., Gerndt, K. L., Mlodoch, B. J., & Lipkin, P. H. (2022). Evidence-informed milestones for developmental surveillance tools. Pediatrics, 149(3), Article e2021052138. https://doi.org/10.1542/peds.2021-052138
What the NUR 636 Module 9 instructions ask for
The NUR 636 Final Project usually asks for a comprehensive primary care plan for one child that brings together the course's major areas: health history, growth, development, nutrition, screening, diagnosis, treatment, family education and follow-up. Many versions expect more than one problem, handled in an integrated way. Plan on eight to ten pages in APA 7 with current guidelines. Present the case in enough detail to justify every decision, interpret each test against a named threshold, show how the problems connect, give exact doses and referrals and end with measurable goals for each problem, including what you will do if the plan does not work. Name who at home will carry out each step.
How this NUR 636 Module 9 final project example is built
This project presents a composite two-year-old who drinks about 40 ounces of milk a day and says about ten words. The anemia section applies the Baker and Greer thresholds, interprets ferritin alongside CRP and uses the Mentzer index. The lead section compares his result with the Ruckart 3.5 microgram reference value. The development section applies the Zubler 75th-percentile milestones to separate an isolated expressive delay from autism. The integrated plan gives iron at 3 mg/kg/day, milk reduction and bottle weaning, audiology and an Early Intervention referral, and follow-up sets goals such as a 1 g/dL hemoglobin rise in four weeks. Both caregivers shape the plan, and visits fit the mother's night shifts.
Where the NUR 636 Module 9 rubric puts the points
Final projects in NUR 636 are commonly scored on the completeness of the history and examination, correct use of screening and diagnostic criteria, an integrated evidence-based plan, family-centered care, follow-up with measurable outcomes and APA 7 writing. Strong papers interpret every result against a named threshold and explain what it means for this child. Graders reward projects that show how the problems interact, such as iron deficiency raising lead absorption, rather than treating each in isolation. Plans that give exact doses, safety teaching, free referral routes and goals with dates tend to land in the top band. Addressing who actually provides care at home is often scored separately. Timelines for referrals help, too.
NUR 636 Module 9 help: the mistakes that cost points
Final projects lose points when test results are listed without thresholds, when problems are managed in separate silos, when doses lack weight-based calculation or when development is judged by overall impression rather than named milestones. Another gap is a plan the family cannot follow because the real caregiver was never included. Interpret each result, connect the problems, calculate doses, apply current milestones, exclude hearing loss in any speech delay and set measurable goals with a backup plan. If your project features a different child, such as failure to thrive, obesity or asthma, share the case and your NUR 636 guidelines so the plan follows the right evidence. Add a backup plan for each goal.
Get NUR 636 Module 9 written to your instructions
Send the NUR 636 capstone child's details, your course guidelines and the grading rubric. The project you receive will interpret each result against a named threshold, integrate the problems, calculate doses and set measurable follow-up goals, within 24 to 48 hours, free the first time. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
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NUR 636 Module 9 questions, answered
Where can I find a free NUR 636 Module 9 Final Project sample?
The full project is on this page: a two-year-old with iron deficiency anemia and expressive language delay, lead screening, iron dosing, milk reduction and an Early Intervention referral.
What hemoglobin level defines anemia in toddlers?
The AAP defines anemia in children aged one to three years as a hemoglobin below 11.0 g/dL, with universal screening at about twelve months.
How is iron deficiency anemia treated in toddlers?
Oral elemental iron at about 3 mg/kg/day, less cow's milk and more iron-rich foods, with a hemoglobin recheck in about four weeks to confirm an increase of 1 g/dL or more.
What is the CDC blood lead reference value?
In 2021 the CDC set it at 3.5 micrograms per deciliter, down from 5, the level that identifies children with the highest exposures who need follow-up.
Should a two-year-old who does not combine words be referred?
Yes. The revised milestones expect two-word phrases by twenty-four months, so a hearing test and an Early Intervention evaluation are appropriate.