Parents her mother with a chief complaint of

Parents generally require medical help of their children for Eye,
Ear, Nose, and Throat (EENT) or contagious disorders. It is fundamental for an
advanced practice nurse to use their expertise to properly diagnose and implement
a treatment plan based on the conditions reported. Parents and caregivers are somewhat deprived of the ability to
attend work because of their caring for their sick children thus, cause some
financial burdens to the family (Barber, Ille, Vergison, & Coates, 2014).

Also, a major challenge that faces the advanced practice nurse is that most
signs and symptoms of EENT tend to imitate other respiratory system and
gastrointestinal disorders which may cause the patient to be misdiagnosed (Hagan,
Shaw, & Duncan, 2008).

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Reflection on a Patient
with Streptococcus Pharyngitis (Strep throat)

J. T. is an 11-year-old Hispanic female patient that was accompanied
to the clinic by her mother with a chief complaint of a sore throat, painful
swallowing, headache, decreased appetite, nausea, foul smelling breath and
fever 102.1 oF. The mother of the J. T. revealed that her daughter reported the
onset was four days ago. It started out as fever, painful swallowing and throat
pain 6/10 on a pain scale of 0 -10. They decided to seek medical attention when
the difficulty swallowing became worse where she couldn’t even swallow a sip of
water. The bacteria that most often cause pharyngitis and tonsillitis in
children between the ages of 5 through 15-year-old is GABHS, and it accounts
for approximately 15% to 30% of infections in this age group with a fever and
acute sore throat (Burns et al., 2013). If a patient present with symptoms such
as fever, sore throat, headaches, enlarge anterior cervical lymph nodes, tender
and enlarged tonsillar, nausea, malaise, prominent sore throat, dysphagia,
strawberry tongue and bad breath, the utmost possible diagnosis will be strep
throat (Burns et al., 2013). It is imperative that the advanced practice nurse
should gather information on the history of present illness (HPI) during the
process of formulating a differential diagnosis of diseases (Hagan, Shaw, &
Duncan, 2008).

Experience in Assessment and
Management of Streptococcus Pharyngitis (Strep Throat)

I conducted a detailed assessment on J. T. and considered
Streptococcus pharyngitis (strep throat) as a primary diagnosis from other
differential diagnoses such as viral pharyngitis and allergic rhinitis. The
infectious mononucleosis is the most usual source of viral pharyngitis. The Epstein-Barr
virus was revealed to be the etiologic cause of heterophile-positive infectious
mononucleosis in about 99% of most cases (Cohen, 2000). Burns et al. revealed
that viral pharyngitis would be considered as a differential diagnosis with the
presentation of the symptoms such as fever, fatigue, lymphadenopathy, sore
throat, splenomegaly, and lymphadenopathy (2013). Allergic rhinitis was
considered as a differential diagnosis due to the presenting symptoms of
wheezing, itching, stuffy nose, sneezing, and bad breath. The physical
assessment reveals nasal mucosa was pale, nasal congestion, and rhinitis causes
the child to breathe through the mouth breather thus resulting in halitosis
(Hagan et al., 2008). In regards to Streptococcus Pharyngitis (Strep Throat),
is with the clinical presentation of throat pain that manifest rapidly, fever,
painful swallowing, sudden frontal headache, generalized body aches, red and
swollen tonsils, sometimes with streaks of pus or with white patches, tender
lymph nodes palpated to the neck (Mayo Clinic, 2015). However, during the
assessment of my patient, I auscultated a clear lungs sound, the white patches
noted to the tonsil, the tonsils is red and swollen, strawberry tongue and
smelled bad breath from the mouth, and tender lymph nodes palpated to the neck
area, the tympanic membrane not visible due to the presence of cerumen. Also,
patient report having headaches and painful swallowing. The thorough assessment
enable me to determine Streptococcus Pharyngitis (Strep throat) as the primary
diagnosis for J. T. However, Streptococcus Pharyngitis (Strep throat) can be
caused by either bacterial or viral infections and a common problem or symptom
is a sore throat in children (Burns et al., 2013).  It is often important
to culture the swab from the throat to determine what organism that is
responsible for the infection.

The management and treatment of Streptococcus pharyngitis include
the use of oral penicillin V. 500 mg two to three times a day over a period of
10 days. This it is proven to be safe, efficient, low cost, and it is a narrow
spectrum. But if the patient cannot tolerate oral intake, Penicillin G
benzathine (Bicillin L-A) 1.2millon units intramuscular (IM) times one dose for
patient that weight over 27 kg (Pichichero, Sexton, Edwards, & Baron,
2016). J. Ts’ recorded weight is 41.8 kg (92 lbs.) and height 150 cm (4’9″) BMI
19.9. For the children that weight less than 27 kg will be given Penicillin G
benzathine (Bicillin L-A) 600,000 units alternatively Bicillin C-R 900/300
(Penicillin G benzathine penicillin G procaine) IM times one dose (Pichichero
et al., 2016). It is imperative to verify that the patient is not allergic to
penicillin before ordering the medication otherwise Azithromycin 12mg/kg/dose
on the first day, then 6mg/kg/dose orally on the second day through the fifth
day (Pichichero et al., 2016). 

 It is significant to educate the patient and parents that she
will feel some pain at the injection site, and the medication may have some
side effects such as nausea, vomiting, and diarrhea. However, if the symptom
persists or exacerbate, she should return to the clinic or go to the closest
emergency department.

The “aha” moment, was observed during the process of educating the
patient and her mother on the importance for the child be compliant and follow
through with the antibiotics regiment, and that in two to three days she will
feel better. However, J. T. can still transmit the infection until completion
of 24 -48 hours of antibiotic therapy. To manage the fever by administering
Acetaminophen 10-15mg/kg by mouth every four to six hours as needed for fever
greater than 100.4 degrees Fahrenheit or Ibuprofen 10mg/kg by mouth every six
to eight hours for temperature greater than 100.4 degrees Fahrenheit
(Pichichero et al., 2016).

It is important to educate the patient and parents increase fluid
intake to improve hydration and do not share drinks from one cup, avoid acidic
drinks such as orange juice and lemonade, and practice proper hand
washing.  I provided valued resources and websites such as the Centers for
Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP)
web page address to the parent and patient. Burns et al., recommend that it
obligated healthcare provider should educate the patient, family, and caregiver


How the Experience
correlated my Class Studies to the Real-world Clinical Setting

    The correlation between the experience and my
class work is the knowledge attained to efficiently identify the signs and
symptoms of strep throat amongst children when they visit the clinic. The formulation
of the appropriate diagnoses is brought about by collecting a thorough medical
history and performing a complete physical examination on the patient is
paramount. This experience which correlates with my class work also relates to my
real-life experiences in the clinic. I gained first-hand knowledge when children
are seeking medical assistance display signs and symptoms of an upper
respiratory infection, they must be meticulously evaluated to determine if it
is a viral or bacterial infection of the contributing organism. 



The utilization of up-to-date evidenced based care is an important
attribute an advance practice nurse should have to ensure an accurate diagnosis
and treatment to combat the patient’s symptoms. Children are prone to being exposed
to others who may be sick with strep throat, at places such as daycare facilities
where parents are forced leave their children at, while they are at work. Educating
parents and caregivers to ensure not smoke around children and educating patients
on methods to prevent the spread of the organism resulting in the infection is
vital. The encouragement of proper hand washing and the avoidance of other
children that exhibit the symptoms of strep throat will diminish the probability
of the infection. 



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