Evaluation and Management of HEENT Disorders Essay Paper

Week 4: Evaluation and Management of HEENT Disorders

Discussion Board: Initial Post

Case Study #1

Additional Questions

This case study discloses several important factors as it pertains to the treatment plan of the patient. There are some vague aspects of this patient’s history and physical examination and further questioning will need to be conducted in order to effectively treat the patient. Additional questions that I would ask include:

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· How many days have the symptoms been present?

· Does the child guard any areas or suggest any particular areas cause pain/irritation?

· Were any medications given to relieve symptoms? Were symptoms alleviated with the medications use?

· What made the symptoms better/worse? Evaluation and Management of HEENT Disorders Essay Paper

· Did symptoms worsen at a particular time of day or during any particular activity?

· Has the child been diagnosed with allergies/seasonal allergies in the past?

I believe these questions will better address the LOCATES mnemonic as well as as applying use of the wong baker pain scale. The parents will also need to be questioned if the child has experienced these symptoms in the past and how often. If the child has a history of seasonal allergies, the symptoms may be related to changes in seasons and/or environment. If the child is already on medications for seasonal allergies, the dosage may need increased or other adjustments may be warranted.

Additional Examinations and/or Diagnostic Tests

Since the patient has had a fever, it will be useful to obtain a complete blood count in order to rule out bacterial versus viral infection. If a bacterial infection is present then the patient will need a prescription of antibiotics.

Differential Diagnoses

Differential diagnoses for this patient include:

1. acute sinusitis- this diagnosis should be confirmed in a child who has an acute upper respiratory tract infection with persistent illness, lasting more than 10 days (DeMuri & Wald, 2013). Since the symptoms started sometime at the beginning of this week, this condition does not yet meet the criteria for this condition.

2. allergic rhinitis- the primary symptoms of this condition include cough, nasal discharge, congestion, postnasal drip, and facial pain (Lin, Wang, Lu, Wang, & Koo, 2019). This condition also lasts longer than 10 days so the condition should be considered but cannot be deemed the cause of symptoms at this point.

3. seasonal allergies- this condition is defined as an inflammation of the membrane lining of the nose resulting in congestion, rhinorrhea, sneezing, itching, and/or postnasal drip (Mahr & Sheth, 2005). Although this could have initially been the cause of the potential condition, it does not explain the abnormalities found on otoscopic examination. Evaluation and Management of HEENT Disorders Essay Paper

Primary Diagnosis

The most likely diagnosis for this patient’s condition is acute otitis media as the child exhibits the classic symptoms for the condition. Although the patient may have initially had an exacerbation of an allergen, the symptoms evolved to create an ear infection as described in the otoscopic examination. The anterior cervical adenopathy and the pus/opaque left tympanic membrane will help the provider to diagnose this condition. The diagnosis of acute otitis media occurs after the abrupt onset of signs and symptoms of middle ear inflammation and effusion (ear pain, irritability, otorrhea, and/or fever) (Burns et al., 2017).

Treatment

Treatment for acute otitis media will include an antibiotic such amoxicillin as this is the first-line treatment unless the patient is allergic to the drug (Burns et al., 2017). If the patient has an ear infection that is resistant to this antibiotic, or if the patient is allergic to the drug then other options will need to be explored. The dose of amoxicillin needed for this patient will be based on the 80-90 mg/kg/day recommendation. The child will need to have an accurate weight on file in order to prescribe the appropriate dose. Other medications such as azithromycin, cefdinir, and clindamycin will also relieve acute otitis media (Burns et al., 2017).

Patient Education and Health Promotion

Patient/parent education for this child include explaining to parents the need to finish all antibiotics in full in order to prevent antibiotic resistance. The parents should also be educated on signs and symptoms to report and the need for follow up after the completion of the medication regimen to ensure the otitis media has fully resolved. Health promotion includes encouraging the patient is removed from known allergens and irritants to avoid recurrence of symptoms.

Parents should be made aware that otitis media is a common condition that occurs in young children related to the anatomy of their inner ear and conditions usually improve with age. The parents should understand that symptoms should be reported in order to prevent hearing loss and damage to the tympanic membrane. If ear infections become recurrent then a referral to an ear, nose, and throat doctor should be made to rule out need for surgical intervention and further treatment.

Immunizations the patient should have had by this age include: hepatitis B; rotavirus; diphtheria, tetanus, & acellular pertussis; haemophilis influenza type b; pneumococcal conjugate; influenza; measles, mumps, rubella; varicella; hepatitis A; meningococcal; inactivated poliovirus. Based on the child’s age, the next well visit should occur at 3 years old but no immunizations are due at this time (Centers for disease control and prevention, 2019). The next immunizations will take place at the child’s 4-year-old well visit. The next set of immunization include: diphtheria, tetanus, & acellular pertussis; measles, mumps, and rubella; varicella; and inactivated poliovirus (CDC, 2019).

Summary

The healthcare provider should observe the entire clinical picture before deciding on a diagnosis. Thorough history and physical evaluation are key in concluding the most appropriate diagnosis and treatment. Caregivers should also be apart in the treatment plan as this will help to ensure their compliance. Health promotion and education is crucial to help avoid recurrence of the condition.

Evaluation and Management of HEENT Disorders Essay Paper

References

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017). Pediatric Primary Care (6th ed.). St. Louis, Missouri: Elsevier.

Centers for disease control and prevention. (2019). Immunization Schedules. Retrieved from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

DeMuri, G., & Wald, E. R. (2013, October 1). Acute bacterial sinusitis in children. Peiatrics in review, 34(10). Retrieved from https://pedsinreview.aappublications.org/content/34/10/429

Lin, S., Wang, S., Lu, M., Wang, C., & Koo, M. (2019, February 12). Acute rhinosinusitis among pediatric patients with allergic rhinitis: a nationwide, population-based cohort study. PLOS One, 14(2), 1-8. http://dx.doi.org/10.1371/journal.pone.0211547

Mahr, T. A., & Sheth, K. (2005, August 1). Update on allergic rhinitis. Pediatrics in review, 26(8). Retrieved from https://pedsinreview.aappublications.org/content/26/8/284

Evaluation and Management of HEENT Disorders Essay Paper