MN 553 Case Study Part 3:Mr. Smith brings his 4-year-old son to your primary care office.

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Mr. Smith brings his 4-year-old son to the primary care office. The child presents with coughing, sneezing, mild cough, and a low-grade fever of about 100 three days ago. Vital signs are within norma... l limits. The child appears well hydrated, alert, and cooperative. Mildly erythema noted in the throat without exudate, bilateral tympanic membrane mildly pink as well, lungs are clear. The diagnosis for this child is acute upper respiratory tract infection (URTI), more than likely viral in nature. The child goes to a daycare facility exposing him to virus’, he has a low grade fever that does not seem to be worsening and his symptoms appear to be stable and not progressing, as they would with a bacterial infection over time. The absence of exudate as well as adventitious lung sounds also support the diagnosis of acute viral infection. Both ears show mild pink tympanic membrane; respiratory viruses have been shown to account for 40%-70% of acute otitis media. URTI’s can be caused by several different viruses including parainfluenza, respiratory syncytial virus, rhinovirus, coronavirus, and adenovirus. Pharmacologic and nonpharmacologic treatment plan Management of URTI’s includes symptom relief of fever, coughing and nasal congestion. Treatment will consist of nasopharynx treatment such as a nasal spray, and analgesics. There will be no antibiotic prescription necessary for this patient as this is more than likely viral in nature. Using antibiotics for a viral infection can increase the possibility of antimicrobial resistance in secondary bacterial infections in the upper respiratory tract. Some over the counter medications that can be encouraged to minimize the symptoms include: - Children’s Motrin, 7.5ml PO every 6-8 hours as needed for fever. Not to exceed four doses, max 30ml/ 24 hours. Use lowest effective dose, shortest effective treatment duration. Give with food if stomach upset occurs.This study source was downloaded by 100000838987296 from CourseHero.com on 01-29-2023 05:15:16 GMT -06:00 https://www.coursehero.com/file/64999512/MN553-unit-6docx/ - Children’s Acetaminophen 7.5ml PO, every 4-6 hours as needed for fever. Do not exceed 75mg/kg/day - Delsym 12-hour cough 2.5ml, every 12 hours as needed for cough. Not to exceed 5ml’s in 24 hours. Use only if cough is impeding in patients sleep or fluid/food intake. These over the counter medications are age and weight based, so the dosing will need to be adjusted as appropriate, this will be explained into the father during the visit as well. These over the counter medications can be used as needed for nasal congestion, nasal drainage, rhinorrhea, and cough, but the father is encouraged to read the dosing directions as well as the warnings on the boxes as some medications are not to be used in children <6 years. Decongestant over the counter medications have not shown to be effective in treating symptoms of the cold in children. Over the counter nasal spray and a bulb syringe can also help with thinning secretions. This should be done before eating and sleeping to encourage intake and rest. The father should be advised that the child cannot have any aspirin or aspirin containing medications either as this may precipitate Reyes syndrome. Nonpharmacological treatments and supportive therapies include using a humidifier and having the child sleep on more than one pillow at night to assist in the drainage and decrease nighttime cough. Increasing fluids to promote hydration will also be important in decreasing symptoms as well as encouraging rest and relaxation. Honey has also been shows to reduce night-time coughing, possibly due to its antioxidant or antimicrobial effects. This patient is greater than 12 months, so the use of honey is safe. Hand washing within the household will also be encouraged as this will decrease the incidence of passing the virus as well as secondary respiratory and GI infections. Communication plan The communication plan includes educating and explaining the difference between a viral infection and a bacterial infection. It is important to explain to the father why an antibiotic is notThis study source was downloaded by 100000838987296 from CourseHero.com on 01-29-2023 05:15:16 GMT -06:00 https://www.coursehero.com/file/64999512/MN553-unit-6docx/ warranted in this situation. It is also important to educate and explain situations in which an antibiotic is necessary and when he should notify the physicians office. The parent would be educated on symptoms of a secondary bacterial infection. Some symptoms that warrant a call to the physician include: - Persistent upper respiratory symptoms lasting longer than 10 days without any relief or clinical improvement - Congestion that worsens or productive cough that produces green or yellow phlegm - Facial pain, or purulent nasal discharge lasting >3 consecutive days - Fever >102 after three days - Child has difficulty swallowing or refusing to take food or fluids - Any difficulty in breathing, wheezing, or grunting.This study source was downloaded by 100000838987296 from CourseHero.com on 01-29-2023 05:15:16 GMT -06:00 https://www.coursehero.com/file/64999512/MN553-unit-6docx/ Cotton, M., Innes, S., Jaspan, H., Madide, A., & Rabie, H. (2008). Management of upper respiratory tract infections in children. South African family practice : official journal of the South African Academy of Family Practice/Primary Care, 50(2), 6–12. https://doi.org/10.1080/20786204.2008.10873685 Dowell SF, Schwartz B, Phillips WR. Appropriate use of antibiotics for URIs in children: Part I. Otitis media and acute sinusitis. The Pediatric URI Consensus Team. Am Fam Physician. [Show More]

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