MN553_unit_6.docx

Mr. Smith brings his 4-year-old son to the primary care office. The child presents with coughing,sneezing, mild cough, and a low-grade fever of about 100 three days ago. Vital signs are within normal limits. The child appears well hydrated, alert, and cooperative. Mildly erythema noted in the throat without exudate, bilateral tympanic membrane mildly pink as well, lungs are clear. The diagnosis for this child is acute upper respiratory tract infection (URTI), more than likely viral in nature. The child goes to a daycare facility exposing him to virus’, he has a lowgrade fever that does not seem to be worsening and his symptoms appear to be stable and not progressing, as they would with a bacterial infection over time. The absence of exudate as well as adventitious lung sounds also support the diagnosis of acute viral infection. Both ears show mild pink tympanic membrane; respiratory viruses have been shown to account for 40%-70% of acute otitis media. URTI’s can be caused by several different viruses including parainfluenza, respiratory syncytial virus, rhinovirus, coronavirus, and adenovirus. Pharmacologic and nonpharmacologic treatment plan Management of URTI’sincludessymptom relief of fever, coughing and nasal congestion. Treatment will consist of nasopharynx treatment such as a nasalspray, and analgesics. There will be no antibiotic prescription necessary for this patient as this is more than likely viral in nature. Using antibiotics for a viral infection can increase the possibility of antimicrobial resistance in secondary bacterial infections in the upper respiratory tract. Some over the counter medications that can be encouraged to minimize the symptoms include: / - Children’s Motrin, 7.5ml PO every 6-8 hours as needed for fever. Not to exceed four doses, max 30ml/ 24 hours. Use lowest effective dose, shortest effective treatment duration. Give with food if stomach upset occurs. - Children’s Acetaminophen 7.5ml PO, every 4-6 hours as needed for fever. Do not exceed 75mg/kg/day - Delsym 12-hour cough 2.5ml, every 12 hours as needed for cough. Not to exceed 5ml’s in 24 hours. Use only if cough is impeding in patients sleep or fluid/food intake. Use sparingly. These over the counter medications are age and weight based, so the dosing will need to be adjusted as appropriate, this will be explained into the father during the visit as well. These over the counter medications can be used as needed for nasal congestion, nasal drainage