27 Jan Explain strategies

NURS-6541 Primary Care Adolescnt & Child

Week 4 Discussion

Evaluation & Management of HEENT Disorders

In clinical settings, head, eye, ear, nose, and throat (HEENT) disorders account for the majority of pediatric visits. With the prevalence of these disorders, you must be familiar with their signs and symptoms as well as evidence-based practices for assessment and treatment. Although many pediatric patients present with common HEENT disorders such as ear infections, allergies, and strep throat, some patients present with rare disorders requiring specialist care. In your role, making this distinction between when to treat and when to refer is essential. For this Discussion, examine the following case studies and consider potential diagnoses and management strategies.

Discussion board posting assignments are assigned alphabetically by FIRST NAME to ensure all cases are covered and discussed.

Case Study 1: A-F

Case Study 2: G-M

Case Study 3 N-Z

Case Study 1:

HPI: A 14-month-old brought Native American boy by his mom due to cough, low grade fever and runny nose for the past 2 days. This morning, the mother noted that her son was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Mom is worried because her son seems to have a lot of ‘bouts of colds”. Per mom, he oral intake is decreased. He didn’t want to eat this morning.

PE: Smiling, alert Caucasian boy.

VS: Temp of 99.9, pulse 112, resp. 42 reveals the following: respiratory rate is 58 HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip.

CV: Her capillary refill is less than 3 seconds

PULM: lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields.

Case Study 2

HPI: Kevin is a 5-year-old with an intermittent 2-day history of nasal congestion and cough in the early morning. Her mother reports thick, green nasal discharge. She is afebrile, and appetite and sleep are normal.

PMH: A smiling Asian American boy 5-year-old, sitting on mom’s lap.

HEENT: Tympanic membranes pearly gray without fluid in a neutral position, no cervical adenopathy, nasal turbinates are red, and clear rhinorrhea and postnasal drip.

CV: RRR, no murmurs or gallop PULM: clear to auscultation

Case Study 3

HPI: Marcus is an 8-year-old with a 36-hour complaint of headache (frontal), sore throat, fever to 102°F, and nausea. Mom says his appetite is decreased and his breath smells “like a puppy dog’s.”

PMH: A Polish 8-year-old boy, in mild distressed.

HEENT: Tympanic membranes partially obscured by cerumen but in neutral position and transparent, 2+ enlarged and red tonsils with exudate, strawberry tongue, and petechiae on the soft palate enlarged tonsillar and anterior cervical lymph nodes.

CV: RRR

PULM: Clear to auscultation bilaterally

To prepare:

Review “Eye Disorders” and “Ear Disorders” in the Burns et al. text.

Review the three case studies focusing on the case that is assigned to you. Analyze the patient information, including the parent’s perspective.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.

Consider strategies for educating parents on the child’s disorder and reducing any concerns/fears presented in the case study.

By Day 3

Post an analysis of your assigned case by responding to the following:

What additional questions will you ask?

Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).

What additional examinations or diagnostic tests, if any will you conduct?

What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.

What is your most likely diagnosis and why?

How will you treat this child?

Provide medication treatment and symptomatic care.

Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.

Patient Education, Health Promotion & Anticipatory guidance:

Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.

Include any socio-cultural barriers that might impact the treatment and management plans.

Health Promotion:

What immunizations should this child have had?

Based on the child’s age, when is the next well visit?

At the next well visit, what are the next set of immunizations?

What additional anticipatory guidance should be provided today?