Otitis Media Treatment and Management case study

Otitis Media Treatment and Management Submitted by Shannon Delite Leake The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of Advanced Pharmacology N5334 Mary Davis, DNP, MSN, RN, APN-BC, CRNP, ADM-BC September, 27, 2017 1 Osteoarthritis and Gut Microbiota Otitis Media Treatment and Manament CASE SUMMARY: A 16-month-old male, Seth, presents to clinic with acute onset of symptoms per mom’s report; child has had a decreased appetite and playfulness, and difficulty sleeping. Mom reports he has been tugging at his right ear and has had an increased temperature of 39.5 C. She has been giving him 100mg of ibuprofen every 12 hours for two doses. He was treated symptomatically about a month ago for bronchiolitis, and about two weeks ago with Amoxicillin high dose for Acute Otitis Media. Base on examination of both ears with both tympanic membranes (TM) erythematous, the right TM bulging, and with signs of Middle Ear Effusion (MEE). Focus of care will be on the acute onset of symptoms. An appropriate antibacterial medication will be prescribed, a referral to an ear, nose, and throat specialist to evaluate further appropriate treatment of MEE, education to give Seth all the antibiotic unless otherwise instructed, continue to give ibuprofen for pain and fever, and to bring Seth back in after 72 hours if symptoms do not improve (Burcham & Rosenthal, 2016). 5334 CASE SUMMARY TABLE 1. Symptoms: List two pertinent signs and symptoms Tugging at right ear Fever 39.5 Celsius (103 degrees Fahrenheit) Decreased appetite 2 Osteoarthritis and Gut Microbiota Decreased playfulness Difficulty sleeping 2. Recommended Drugs: **Drug of choice – list at least 3 recommended drugs List recommended drugs as indicated for this diagnosis  Amoxicillin 40-45mg/kg two times a day for five to 10 days considering patient age and severity of the patient’s illness (Burcham & Rosenthal, 2016).  Augmentin ES – Amoxicillin 45mg/kg/clavulanate 3.2mg/kg 2 times a day by mouth 7 days (Burcham & Rosenthal, 2016). Davis’s drug recommends children 40lbs with recurrent or persistent Otitis Media receive, as an ES formulation only, 80-90mg/kg/day in divided doses every 12 hours for 10 days (Vallerand, Deglin, &Sanoski, 2017).  Cefdinir 14mg/kg/day in one or two divided doses (Burcham & Rosenthal, 2016).  Azithromycin (Zithromax) 10mg/kg day one then 5mg/kg/day days two thru five (Burcham & Rosenthal, 2016).  Cipro HC (Ciprofloxacin 0.2%/hydrocortisone 1%) (Vallerand, Deglin, & Sanoskin, 2017) ear drops 3 times a day (Burcham & Rosenthal, 2016). (Vallerand, Deglin, & Sanoskin, 2017). 3 Osteoarthritis and Gut Microbiota  Advil (Ibuprofen) (Vallerand, Deglin, & Sanoski, 2017). 3. Drug Categories and Subcategories: Identify the category of each recommended drug.  Amoxicillin is classified therapeutically as an anti-infective and anti-ulcer treatment and pharmacologically as an aminopenicillin. It is categorized as a pregnancy category B drug (Vallerand, Deglin, & Sanoski, 2017).  Augmentin ES is therapeutically classified as an anti-infective and pharmacologically as aminopenicillin/beta lactase inhibitor and categorized as a pregnancy category B (Vallerand, Deglin, & Sanoski, 2017).  Cefdinir (Cephalosporin—Third Generation) is classified therapeutically as an anti-infective and pharmacologically as a third-generation cephalosporin and categorized as a pregnancy B medication (Vallerand, Deglin, & Sanoski, 2017).  Azithromycin (Zithromax) is therapeutically classified as an anti-infective and as an agent for atypical mycobacterium and pharmacologically as a macrolide. It is categorized as pregnancy category b medication (Vallerand, Deglin, & Sanoski, 2017).  Cipro HC (ciprofloxacin 0.2%/hydrocortisone 0.1%) Ciprofloxacin a fluoroquinolone is classified as an anti-infective therapeutically and is 4 Osteoarthritis and Gut Microbiota categorized as a pregnancy category C medication, Hydrocortisone is pharmacologically classified as a corticosteroid with the therapeutic classification as a anti-inflammatory and is categorized as a pregnancy category C medication (Vallerand, Deglin, & Sanoski, 2017).  Advil (Ibuprofen) a non-steroidal anti-inflammatory medication it’s other therapeutic classifications include anti-pyretic, non-opioid analgesic, antirheumatic and pharmacologically classified as a non-opioid analgesic with is a pregnancy C drug up to the 30th week of pregnancy and a category D from 30 weeks (Vallerand, Deglin, & Sanoski, 2017). 4. Drug(s) of Choice: FOR THE MAIN DIAGNOSIS ONLY, provide the chosen drug(s) of choice for treatment. 5. Rationale: Provide rationale, clinical guidelines, or evidence for the selected drug of choice  Patient requires anti-infective treatment due to sudden onset of symptoms which include an elevated temperature, Augmentin ES is the drug of choice due to treatment two weeks ago with a high dose of Amoxicillin alone. (Burcham & Rosenthal, 2016).  Ibuprofen should be given to reduce fever and control pain. 6. Contraindications and or Risks, as appropriate: Identify contraindications and risks as appropriate  Augmentin ES should not be given to individuals who have had an allergic reaction penicillin or cephalosporin in the past, a history of cholecystic jaundice associated with amoxicillin/clavulanate, and should be used with caution in children with structural abnormalities or other heart problems as sudden deaths have occurred, use 5 Osteoarthritis and Gut Microbiota cautiously in renal insufficiency and decrease dose given, with infectious mononucleosis as it increases the risk of rash, in hepatic impairment use caution with dosing and monitor liver function, (Vallerand, Deglin, & Sanoski, 2017). 7. What Patients Must Understand: Identify at least 3 appropriate teaching points for the patient and/or family (HINT: 3 teaching points is rarely adequate for good patient care)  Signs and symptoms to report immediately rash, severe itching, wheezing or other signs of difficulty breathing (Vallerand, Deglin, & Sanoski, 2017).  It is important to measure all does given accurately. Use the syringe provided by the pharmacy rather than a spoon, or other household device to administer this medication. (Vallerand, Deglin, & Sanoski, 2017).  This medication may cause yeast infections, inform the office if you notice a furry coating to the child’s tongue, or reddened, inflamed genital area (Vallerand, Deglin, & Sanoski, 2017).  Report any diarrhea, loose, or foul-smelling stool as this may indicate a disruption in the body’s normal flora and as well indicate a superinfection. Do not administer an anti-diarrhea medication without consulting office first (Vallerand, Deglin, & Sanoski, 2017).  Administer with food and report back if nausea or diarrhea persist (Vallerand, Deglin, & Sanoski, 2017).  Take this medication every 12 hours as prescribed and complete all medication (Vallerand, Deglin, & Sanoski, 2017).  Continue giving Ibuprofen for pain and fever as directed. 8. The Prescription(s)