Peds Week 2 case study

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Northern Kentucky University *

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629

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Nursing

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May 24, 2024

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NUR 629 Case Study One Student’s Name: ____Priyanshi_Shah___ It is early December. Mark, a 7-year-old boy, is in your office this morning with his father after a very restless night; mom is out of town. Dad states that his son was sent home from school 3 days ago after vomiting. Mark awoke the next morning with a fever of 102°F, body aches, a cough, a sore throat, and a runny nose. After 2 days of taking over-the-counter children’s cold medicine, he still had a fever. In your office this morning, you note he is febrile, pale, and shaky; his skin is clammy and sweaty. There are no sick contacts in his home. Dad is not sure if the children have received flu vaccinations this season and your EMR has no flu vaccine documentation (but the immunization could have been received elsewhere). Allergies: sulfa drugs PMH: No ongoing conditions, normal growth and development, no regular medications. No past surgeries or hospitalizations. Last ill visit was in March for strep throat. Vital signs: Temp: 103.4 temporal HR: 92 RR: 24 B/P: 126/86 Wt.: 25 kg General: Pale, limited engagement Ears: TM’s with sharp cone of light, translucent, slightly injected Eyes: Conjunctiva and sclera clear, no eyelid puffiness Nose: Moderate opaque discharge, thin Pharynx: 2+ rosy pink tonsils and soft palate erythema Neck: 2+ anterior cervical and submandibular lymph nodes, bilateral Lungs: Slightly diminished sounds throughout, no rales, rhonchi or wheezing. No increased work of breathing. Abdomen: Soft and flat, non-tender. No organomegaly Skin: Damp and clammy. Good skin turgor

NUR 629 Case Study One List five differential diagnoses that you feel are likely to explain this patient’s presentation List your most likely diagnosis first (“working diagnosis”), followed by 4 other reasonable alternatives. Using the grid below each diagnosis, enter the inclusion or exclusion rationale from the history and the physical examination that support each one. Differential Diagnosis (20 points) Inclusion Rationale Exclusion Rational Working Diagnosis (  ) 1. Influenza Fever, Runny nose, cough, Fatigue, Sore throat, swollen lymph nodes Headache, conjunctivitis, non- sure history of influenza vaccination (Dynamed, 2023). Yes 2.Streptococcal Pharyngitis Temperature greater than 100.4- degree F, swollen tonsils, cough, sore throat, and swollen lymph nodes, nausea, and vomiting. (Dynamed, 2024) Headache, chills, petechiae on soft palate, swollen uvula (Dynamed, 2024). Yes 3. Epstein-Barr Virus-associated Infectious Mononucleosis Fever, Pharyngitis, and Cervical Lymphadenopathy, cough, rihnorrhea Headache, abdominal pain, palatal petechiae (Dynamed, 2024). Yes 4. Tonsillitis With swollen tonsils on inspection, fever, erythema. Dysphagia, palatal petechiae, which may be related to group A beta- hemolytic Streptococcus (Dynamed, 2024) Yes 5. Pneumonia Cough, fatigue, fever. Tachypnea, dyspnea, chest pain, wheezing, elevate respiratory rate (Dynamed, 2024). Less Likely List the components of your evaluation plan, and provide a rationale for each (why are you prescribing this medication or test? How will it help you make the diagnosis?).

NUR 629 Case Study One Pharmacological Plan (6) (if indicated) Medication and Rationale Recommended mg/kg/day Dose Concentratio n (if pertinent) Route/ Frequency 1. Oseltamivir (Tamiflu) considered with confirmed or suspected influenza. (Dynamed, 2024). 60 mg twice a day for patient weighing >23 kg (Dynamed, 2024). 60 mg (2x30 mg capsules) or 10 mL of 6 mg/ml suspensio n orally twice daily (Dynamed , 2024). n/a Capsule or suspension, twice daily. 2. Penicillin V Children less than 27 kgs: 250 mg PO dose is recommended 2-3 times daily for 10 days (Dynamed, 2024). 250 mg 2- 3 times daily for 10 days in children (Dynamed , 2024). n/a Orally 3.Amoxicillin 50 mg/kg/day 50 mg/kg once daily for 10 days, maximum 1 g daily (Dynamed , 2024). n/a Orally Testing: Lab or Radiology (2) (If indicated) Test Rationale 1. Rapid Antigen Detection Test and/or throat swab This will help confirm the diagnosis of group A streptococcal pharyngitis which is most likely diagnosis given the patient information. (American Family Physician, 2013). 2. Rapid Influenza Diagnostic tests (RIDTs) This test will help detect flu viruses in respiratory specimens. (Centers of Disease Control and Prevention, 2023).

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NUR 629 Case Study One 3. Serologic or respiratory testing if Mycoplasma pneumoniae infection is suspected. This will help detect the bacterium that is a common cause of community-acquired pneumonia, typically associated with mild disease with persist cough (Dynamed, 2024). Patient Education (8) 1. Annual immunization is recommended for all individuals 6 months or older without contraindications (Dynamed, 2024). Parents must be educated to make sure their children get immunized yearly. 2. Children should consume regular Vitamin C supplementation as it is shown to have reduce URI incidence and even reduce symptom duration (Dynamed, 2023). 3. It is important to have proper hand hygiene interventions to control any spread of infections which can increase the chances to get acute respiratory illnesses and influenza (Dynamed, 2023). Parents must teach their children proper hand washing hygiene. 4. Educating the parents to finish the full course of prescription medication even when symptoms have improved to prevent relapse of infection and the development of antibiotic resistance (Mayo Foundation for Medical Education and Research, 2024). 5. Educating the parents to avoid giving children raw milk, washing hands before making food and before eating, and cooking food in a safe internal temperature to lower the risk of getting a bacterial infection spread by food (Mayo Foundation for Medical Education and Research, 2024). Follow-Up Plan (4) (May include referrals) (Dynamed, 2024) 1. Following the course of medication, if the child’s symptoms are still concerning it is important to seek care from the child’s pediatrician. 2. If the child develops seizures, fever above 104 degrees F, and worsening of chronic medical condition, the child must be taken to the ER. Total Points _______________________ Number highlighted in red indicate possible points for that question. A maximum of 40 points is possible

NUR 629 Case Study One References Centers for Disease Control and Prevention. (2022, October 3). Diagnosing flu . Centers for Disease Control and Prevention. https://www.cdc.gov/flu/symptoms/testing.htm#:~:text=A %20number%20of%20tests%20are,that%20stimulate%20an%20immune%20response. Dynamed. (2024). https://www.dynamed.com/approach-to/pharyngitis-approach-to-the-patient- 25#GUID-DDDE3E99-39A8-4B86-985C-3E72F9FD2EB8 Dynamed. (2024). https://www.dynamed.com/condition/streptococcal-pharyngitis#GUID- FAC9A0C0-70D0-4E43-A022-64EEF2AB8343 Influenza in Children . Dynamed. (2024). https://www.dynamed.com/condition/influenza-in- children Mayo Foundation for Medical Education and Research. (2024, April 9). Antibiotics: Are you misusing them? . Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/consumer- health/in-depth/antibiotics/art-20045720 Randel, A. (2013, September 1). IDSA updates guideline for managing group A streptococcal pharyngitis . American Family Physician. https://www.aafp.org/pubs/afp/issues/2013/0901/p338.html Upper Respiratory Infection (URI) in Children . Dynamed. (2023). https://www.dynamed.com/condition/community-acquired-pneumonia-in-children#GUID- F1853342-1CAF-42ED-B693-341B99E4346E

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