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 low-
grade 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’s includes symptom relief of fever, coughing and nasal congestion.
Treatment will consist of nasopharynx treatment such as a nasal spray, 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:
This study source was downloaded by 100000886105040 from CourseHero.com on 05-20-2024 04:53:19 GMT -05:00
https://www.coursehero.com/file/66150146/MN553-unit-6docx/
, - 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,
rhinorrhea, and cough, but the father is encouraged to read the dosing directions as well as the
warnings on the boxes as some medications are not to be used in children <6 years. Over the
counter decongestant medications have not shown to be effective in treating symptoms of the
common cold in children and per the center for disease control, there is the potential for harm
without benefit for over the counter cough and cold medicine. The father will be educated on
this as well. Over the counter nasal spray and a bulb syringe can also help with thinning
secretions. This should be done before eating and sleeping to encourage intake and rest. The
father should be advised that the child cannot have any aspirin or aspirin containing
medications either as this may precipitate Reyes syndrome.
Nonpharmacological treatments and supportive therapies include using a humidifier and
having the child sleep on more than one pillow at night to assist in the drainage and decrease
This study source was downloaded by 100000886105040 from CourseHero.com on 05-20-2024 04:53:19 GMT -05:00
https://www.coursehero.com/file/66150146/MN553-unit-6docx/
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 low-
grade 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’s includes symptom relief of fever, coughing and nasal congestion.
Treatment will consist of nasopharynx treatment such as a nasal spray, 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:
This study source was downloaded by 100000886105040 from CourseHero.com on 05-20-2024 04:53:19 GMT -05:00
https://www.coursehero.com/file/66150146/MN553-unit-6docx/
, - 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,
rhinorrhea, and cough, but the father is encouraged to read the dosing directions as well as the
warnings on the boxes as some medications are not to be used in children <6 years. Over the
counter decongestant medications have not shown to be effective in treating symptoms of the
common cold in children and per the center for disease control, there is the potential for harm
without benefit for over the counter cough and cold medicine. The father will be educated on
this as well. Over the counter nasal spray and a bulb syringe can also help with thinning
secretions. This should be done before eating and sleeping to encourage intake and rest. The
father should be advised that the child cannot have any aspirin or aspirin containing
medications either as this may precipitate Reyes syndrome.
Nonpharmacological treatments and supportive therapies include using a humidifier and
having the child sleep on more than one pillow at night to assist in the drainage and decrease
This study source was downloaded by 100000886105040 from CourseHero.com on 05-20-2024 04:53:19 GMT -05:00
https://www.coursehero.com/file/66150146/MN553-unit-6docx/
