Parents generally require medical help of their children for Eye,Ear, Nose, and Throat (EENT) or contagious disorders. It is fundamental for anadvanced practice nurse to use their expertise to properly diagnose and implementa treatment plan based on the conditions reported. Parents and caregivers are somewhat deprived of the ability toattend work because of their caring for their sick children thus, cause somefinancial burdens to the family (Barber, Ille, Vergison, & Coates, 2014).Also, a major challenge that faces the advanced practice nurse is that mostsigns and symptoms of EENT tend to imitate other respiratory system andgastrointestinal disorders which may cause the patient to be misdiagnosed (Hagan,Shaw, & Duncan, 2008).Reflection on a Patientwith Streptococcus Pharyngitis (Strep throat)J.
T. is an 11-year-old Hispanic female patient that was accompaniedto the clinic by her mother with a chief complaint of a sore throat, painfulswallowing, headache, decreased appetite, nausea, foul smelling breath andfever 102.1 oF. The mother of the J. T. revealed that her daughter reported theonset was four days ago. It started out as fever, painful swallowing and throatpain 6/10 on a pain scale of 0 -10. They decided to seek medical attention whenthe difficulty swallowing became worse where she couldn’t even swallow a sip ofwater.
The bacteria that most often cause pharyngitis and tonsillitis inchildren between the ages of 5 through 15-year-old is GABHS, and it accountsfor approximately 15% to 30% of infections in this age group with a fever andacute sore throat (Burns et al., 2013). If a patient present with symptoms suchas fever, sore throat, headaches, enlarge anterior cervical lymph nodes, tenderand enlarged tonsillar, nausea, malaise, prominent sore throat, dysphagia,strawberry tongue and bad breath, the utmost possible diagnosis will be strepthroat (Burns et al.
, 2013). It is imperative that the advanced practice nurseshould gather information on the history of present illness (HPI) during theprocess of formulating a differential diagnosis of diseases (Hagan, Shaw, , 2008).Experience in Assessment andManagement of Streptococcus Pharyngitis (Strep Throat)I conducted a detailed assessment on J.
T. and consideredStreptococcus pharyngitis (strep throat) as a primary diagnosis from otherdifferential diagnoses such as viral pharyngitis and allergic rhinitis. Theinfectious mononucleosis is the most usual source of viral pharyngitis. The Epstein-Barrvirus was revealed to be the etiologic cause of heterophile-positive infectiousmononucleosis in about 99% of most cases (Cohen, 2000). Burns et al. revealedthat viral pharyngitis would be considered as a differential diagnosis with thepresentation of the symptoms such as fever, fatigue, lymphadenopathy, sorethroat, splenomegaly, and lymphadenopathy (2013). Allergic rhinitis wasconsidered as a differential diagnosis due to the presenting symptoms ofwheezing, itching, stuffy nose, sneezing, and bad breath.
The physicalassessment reveals nasal mucosa was pale, nasal congestion, and rhinitis causesthe 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 andswollen tonsils, sometimes with streaks of pus or with white patches, tenderlymph nodes palpated to the neck (Mayo Clinic, 2015). However, during theassessment of my patient, I auscultated a clear lungs sound, the white patchesnoted to the tonsil, the tonsils is red and swollen, strawberry tongue andsmelled bad breath from the mouth, and tender lymph nodes palpated to the neckarea, the tympanic membrane not visible due to the presence of cerumen. Also,patient report having headaches and painful swallowing.
The thorough assessmentenable me to determine Streptococcus Pharyngitis (Strep throat) as the primarydiagnosis for J. T. However, Streptococcus Pharyngitis (Strep throat) can becaused by either bacterial or viral infections and a common problem or symptomis a sore throat in children (Burns et al., 2013). It is often importantto culture the swab from the throat to determine what organism that isresponsible for the infection.The management and treatment of Streptococcus pharyngitis includethe use of oral penicillin V. 500 mg two to three times a day over a period of10 days. This it is proven to be safe, efficient, low cost, and it is a narrowspectrum.
But if the patient cannot tolerate oral intake, Penicillin Gbenzathine (Bicillin L-A) 1.2millon units intramuscular (IM) times one dose forpatient 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″) BMI19.9. For the children that weight less than 27 kg will be given Penicillin Gbenzathine (Bicillin L-A) 600,000 units alternatively Bicillin C-R 900/300(Penicillin G benzathine penicillin G procaine) IM times one dose (Pichicheroet al.
, 2016). It is imperative to verify that the patient is not allergic topenicillin before ordering the medication otherwise Azithromycin 12mg/kg/doseon the first day, then 6mg/kg/dose orally on the second day through the fifthday (Pichichero et al., 2016). It is significant to educate the patient and parents that shewill feel some pain at the injection site, and the medication may have someside effects such as nausea, vomiting, and diarrhea.
However, if the symptompersists or exacerbate, she should return to the clinic or go to the closestemergency department.The “aha” moment, was observed during the process of educating thepatient and her mother on the importance for the child be compliant and followthrough with the antibiotics regiment, and that in two to three days she willfeel better. However, J. T. can still transmit the infection until completionof 24 -48 hours of antibiotic therapy. To manage the fever by administeringAcetaminophen 10-15mg/kg by mouth every four to six hours as needed for fevergreater than 100.4 degrees Fahrenheit or Ibuprofen 10mg/kg by mouth every sixto eight hours for temperature greater than 100.
4 degrees Fahrenheit(Pichichero et al., 2016).It is important to educate the patient and parents increase fluidintake to improve hydration and do not share drinks from one cup, avoid acidicdrinks such as orange juice and lemonade, and practice proper handwashing. I provided valued resources and websites such as the Centers forDisease Control and Prevention (CDC) and American Academy of Pediatrics (AAP)web page address to the parent and patient. Burns et al., recommend that itobligated healthcare provider should educate the patient, family, and caregiver(2013). How the Experiencecorrelated my Class Studies to the Real-world Clinical Setting The correlation between the experience and myclass work is the knowledge attained to efficiently identify the signs andsymptoms of strep throat amongst children when they visit the clinic.
The formulationof the appropriate diagnoses is brought about by collecting a thorough medicalhistory and performing a complete physical examination on the patient isparamount. This experience which correlates with my class work also relates to myreal-life experiences in the clinic. I gained first-hand knowledge when childrenare seeking medical assistance display signs and symptoms of an upperrespiratory infection, they must be meticulously evaluated to determine if itis a viral or bacterial infection of the contributing organism. ConclusionThe utilization of up-to-date evidenced based care is an importantattribute an advance practice nurse should have to ensure an accurate diagnosisand treatment to combat the patient’s symptoms.
Children are prone to being exposedto others who may be sick with strep throat, at places such as daycare facilitieswhere parents are forced leave their children at, while they are at work. Educatingparents and caregivers to ensure not smoke around children and educating patientson methods to prevent the spread of the organism resulting in the infection isvital. The encouragement of proper hand washing and the avoidance of otherchildren that exhibit the symptoms of strep throat will diminish the probabilityof the infection.