Case Study: A 5-Year-Old Male Brought To Primary Care ✓ Solved

Case Study: A 5-year-old male is brought to the primary care

A 5-year-old male is brought to the primary care clinic by his mother with a chief complaint of bilateral ear pain with acute onset that began yesterday. The mother states that the child has been crying frequently due to the pain. Ibuprofen has provided minimal relief. This morning, the child refused breakfast and appeared to be getting worse. Vital signs at the clinic reveal HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. The child has not been on antibiotics for the last year and does not have a history of otitis media. The child is otherwise healthy without any other known health problems. Physical examination reveals bilateral tympanic membranes that are bulging with severe erythema. Pneumatic otoscopy reveals absent mobility. After your questioning and examination, you diagnose this child with bilateral Acute Otitis Media (AOM).

Introduction

Acute Otitis Media (AOM) is a common condition in the pediatric population, characterized by an infection of the middle ear. This case study focuses on a 5-year-old male diagnosed with bilateral AOM, requiring a comprehensive treatment plan aligned with current medical guidelines. The primary considerations are the need for antibiotics, parental advisement, and monitoring treatment efficacy.

Medication Recommendation

Based on the current guidelines for treating AOM in children, the APRN should prescribe antibiotics given this patient's age, clinical presentation, and the acute nature of his symptoms. The first-line treatment for bacterial AOM is usually Amoxicillin. The recommended parameters for this medication are as follows:

• Name of Medication: Amoxicillin
• Strength: 500 mg
• Frequency: Twice a day
• Dosage: 500 mg
• Length of Treatment: 10 days

The rationale behind prescribing Amoxicillin includes its effectiveness against the most common pathogens responsible for AOM, and its safety profile in children without a history of penicillin allergies (American Academy of Pediatrics, 2021).

Parent/Patient Education

Effective communication with the parent is essential to ensure compliance and understanding of treatment expectations. Key education points include:

• Administer the antibiotic as prescribed, even if symptoms improve.
• Monitor for any signs of allergic reactions, such as rash or difficulty breathing.
• Continue using ibuprofen or acetaminophen for pain relief as needed.
• Follow up if fever persists for more than 48 hours or if symptoms worsen.
• Encourage fluid intake to stay hydrated.

Expected Side Effects

Parents should be aware of potential side effects associated with Amoxicillin, which may include:

• Gastrointestinal upset such as diarrhea
• Nausea or vomiting
• Rash or skin reactions
• Rarely, anaphylaxis, especially in patients with penicillin allergies

Consideration of Allergies

If the patient were allergic to penicillin, the APRN would consider prescribing Clindamycin as an alternative. The dosing for Clindamycin is typically:

• Name of Medication: Clindamycin
• Strength: 300 mg
• Frequency: Three times a day
• Dosage: 300 mg
• Length of Treatment: 10 days

The choice of antibiotic depends on several factors, including the suspected organism (usually Streptococcus pneumoniae or Haemophilus influenzae), patient history, and the likelihood of resistance based on local prevalence (Pelton, 2022).

Additional Medications

Further medications may include a nasal decongestant if the patient exhibits significant nasal congestion, which may impede recovery. However, decongestants should be used cautiously in young children (Bharagava et al., 2020). The APRN should avoid recommending cough suppressants or antihistamines, as they have little benefit and may lead to adverse effects.

Monitoring and Follow-Up

If the child returns in 48 hours with increased pain and fever, the APRN should reassess the situation in light of possible treatment failure. Options may include:

• Switching to a different antibiotic if Amoxicillin was ineffective or encountered resistance.
• Considering a tympanocentesis for therapeutic drainage if there is significant fluid persistence or complications.
• Assessing for underlying conditions that may predispose to recurrent infections.

Early intervention is vital to preventing complications and ensuring effective care.

Conclusion

In summary, addressing AOM effectively involves choosing the right antibiotic, providing thorough education to caregivers, recognizing potential allergies, and monitoring for treatment efficacy. Timely follow-up is crucial to adjust the treatment plan as necessary.

References

• American Academy of Pediatrics. (2021). Clinical practice guideline: Management of acute otitis media. Pediatrics.
• Bharagava, A., Shukla, V., & Kumar, S. (2020). Use of decongestants in children. Pediatric Medicine.
• Pelton, S. I. (2022). Antibiotic resistance in acute otitis media: A review. Journal of Pediatrics.
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