Management Of Pediatric And Adolescent
Management Of Pediatric And Adolescent
Clinical Case SOAP Note 1. Identify a patient from your pediatric clinicals who provided you with a learning experience. 2. Write a complete SOAP note for the patient encounter. 3. Include the following: • A brief case scenario, including pertinent aspects of the history and physical exam. • Your assessment and plan • The patient’s vaccine status, BMI percentiles, nutrient status, and development status 4. Include a minimum of 2 scholarly peer-reviewed journal articles that support your differential diagnosis and plan. 5. Cite and reference according to 7th edition APA guidelines. 6. References must be from within the last five years. 7. All treatment regimens, diagnosis, medications, diagnostic testing, etc… need to have proper reference citations for each item. 8. Textbook for NRP/543: Burns, C. E., Dunn, A. M., Brady, M. A., Barber Starr, N., Blosser, C. G., & Garzon, D. L. (2017). Pediatric primary care (6th ed.). Elsevier. Grading Criteria Weeks 6: Clinical Case SOAP Note Content: 20 points possible Points Possible Points Earned Provided patient history and physical exam 5 Provided assessment and plan 5 Included the following components in the SOAP note; • patient vaccine status • BMI percentile assessment •Management Of Pediatric And Adolescent Nutrition intake and activity pattern • developmental assessment 10 Office Visit Scenario • A 4-year-old child is seen by the pediatrician for ear pain. His mother reports he was in his usual state of good health until about 5 days ago when he developed an upper respiratory infection (URI) consisting of clear nasal discharge and cough.
ORDER A PLAGIARISM – FREE PAPER NOW
He had been having normal activity and intake until about 48 hours prior when he developed a temperature of 102.1°F (38.9°C) and complaints that his left ear hurts. She denies nausea, vomiting, diarrhea, headache, or change in urine output. She reports that he did not sleep well the previous evening, awakening several times complaining of ear pain, but remains somewhat interested in his toys earlier in the day. • What is the most likely diagnosis? Acute otitis media (AOM) • What is the best therapy? Oral antibiotics • Summary: A preschool child presents with ear pain and fever. Objectives • Be familiar with the epidemiology of otitis media (OM) in children. • Understand the treatment of this condition. • Learn the consequences of severe infection. Considerations • OM is high on the differential diagnosis for this child with URI and ear pain. The diagnosis can be confirmed by pneumatic otoscopy and treatment started. A “telephone diagnosis” should be avoided. Definitions • ACUTE OTITIS MEDIA (AOM): A condition of otalgia (ear pain), fever, and other symptoms along with findings of a red, opaque, poorly moving, bulging tympanic membrane (TM). • MYRINGOTOMY AND PLACEMENT OF PRESSURE EQUALIZATION (PE) TUBES: A surgical procedure involving TM incision and placement of PE tubes (tiny plastic or metal tubes anchored into the TM) to ventilate the middle ear and help prevent reaccumulation of middle ear fluid. • OTITIS MEDIA WITH EFFUSION: A condition in which fluid collects behind the TM but without signs and symptoms of AOM. Sometimes also called serous OM. • PNEUMATIC OTOSCOPY: The process of obtaining a tight ear canal seal with a speculum and then applying slight positive and negative pressure with a rubber bulb to verify TM mobility. • TYMPANOMETRY: An examination that measures the transfer of acoustic energy at varying levels of ear canal pressures, which will reflect TM mobility. • TYMPANOCENTESIS: A minor surgical procedure in which a small incision is made into the TM to drain pus and fluid from the middle ear space. This procedure is rarely done in the primary care office, but rather is done by the specialist. Clinical Approach • Otitis media is a common childhood diagnosis. Common bacterial pathogens include Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis. Other organisms, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa, are seen in neonates and patients with immune deficiencies. Viruses can cause AOM, and in many cases the etiology is unknown. Acute OM is diagnosed in a child with fever (usually <104°F [40°C]), ear pain (often nocturnal, awakening child from sleep), and generalized malaise. Systemic symptoms may include anorexia, nausea, vomiting, diarrhea, and headache. The cornerstone of diagnosis is the physical examination findings on pneumatic otoscopy of a red, bulging TM with middle ear effusion and decreased mobility by either pneumatic otoscopy and/or tympanometry. The TM may be opaque with pus behind it, the middle ear landmarks may be obscured, and, if the TM has ruptured, pus may be seen in the ear canal. • In some situations and in a child older than 6 months with mild symptoms (ie, mild otalgia for <48 hours, temperature <39°C), a “watchful waiting” period of a few days may be indicated because many AOM cases self-resolve. Numerous studies have shown that only about one-third of children with evidence of AOM initially observed for a period of time had persistent or worsening symptoms that required rescue antibiotics. Ensuring close medical follow-up is paramount if the choice is made to withhold antibiotics and to observe children with mild AOM. Management Of Pediatric And Adolescent • Should antibiotics be deemed necessary and depending on a community’s bacterial resistance patterns, amoxicillin at doses up to 80 to 90 mg/kg/d for 7 to 10 days is often the initial treatment. If the child has received amoxicillin in the previous 30 days, has a history of recurrent AOM unresponsive to amoxicillin, or has concurrent purulent conjunctivitis, an antibiotic with β-lactamase coverage is warranted. In the child begun on amoxicillin who demonstrates clinical failure after 3 treatment days, a change to amoxicillin-clavulanate, cefuroxime axetil, cefdinir, azithromycin, ceftriaxone, or tympanocentesis is considered. Adjuvant therapies (analgesics or antipyretics) are often indicated, but other measures (antihistamines, decongestants, and corticosteroids) are ineffective. • After an AOM episode, middle ear fluid can persist for up to several months. If hearing is normal, middle ear effusion often is treated with observation; some practitioners treat with antibiotics. When the fluid does not resolve or recurrent episodes of AOM occur (defined as ≥3 in the previous 6 months or ≥4 in the previous year with 1 in the previous 6 months), especially if hearing loss is noted, myringotomy with PE tubes is often implemented. • Rare but serious AOM complications include mastoiditis, temporal bone osteomyelitis, facial nerve paralysis, epidural and subdural abscess formation, meningitis, lateral sinus thrombosis, and otitic hydrocephalus (evidence of increased intracranial pressure with OM). An AOM patient whose clinical course is unusual or prolonged should be evaluated for one of these conditions. Clinical Pearls • The most common bacterial pathogens causing otitis media (OM) are Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis. • Examination findings of OM include a red, bulging tympanic membrane that does not move well with pneumatic otoscopy, an opaque tympanic membrane with pus behind it, obscured middle-ear landmarks, and, if the tympanic membrane has ruptured, pus in the ear canal. • Initial treatment of OM often includes amoxicillin (depending on local bacterial resistance patterns). If a clinical failure is seen on day 3, a change to amoxicillin-clavulanate, cefuroxime axetil, ceftriaxone, or a tympanocentesis is indicated. • Administration of the pneumococcal and influenza vaccines, tobacco smoke avoidance, and increase in breast-feeding are linked to a reduction in the incidence of AOM. • Complications are rare but include mastoiditis, temporal bone osteomyelitis, facial nerve palsy, epidural and subdural abscess formation, meningitis, lateral sinus thrombosis, and otitic hydrocephalus Management Of Pediatric And Adolescent.
