Posted: January 28th, 2024

A 5-year-old male is brought to the primary care clinic

Case Study:
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. Weight is 40.5 lbs. The mother reports no known allergies. The child has not been on antibiotics for the last year. The child does not have history of OM. The child is otherwise healthy without any other known health problems.
Physical examination reveals: Vital signsl HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. Weight is 40.5 lbs. Bilateral TMs are bulging with severe erythematous. Pneumatic otoscopy reveals absent mobility. Ear canals are nomal.
After your questioning and examination, you diagnose this child with bilateral Acute Otitis Media.
According to the current guidelines on medications for a 5 year old with Acute Otits Media (AOM), address the following:

Questions If No, explain why If you decide to recommend/ prescribe medication provide a brief rationale. Give name of medication along with strength, frequency, dosage, and length of treatment. (provide citations) What Parent/Patient Education is essential? (you may use bullet format) What side effects might be expected? (you may use bullet format)
Should the APRN prescribe an antibiotic?

What would the APRN prescribe if this child was allergic to penicillin?

What determines the choice of an antibiotic ?
Will you recommend or prescribe any other medications?
The child returns in 48 hours with increased pain and fever.
What changes will the APRN make in treatment plan?

This assignment requires a current, evidence based practice guideline that is specific to the child in the following scenario. This assignment will require analysis and evaluation of the treatment guideline along with basic knowledge of pharmacotherapeutics. You will be given a case study involving a 5-year-old child with an acute illness presenting in primary care and be expected to answer a selected number of questions. This assignment includes a prepared table to help categorize the requested information.

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. Weight is 40.5 lbs. The mother reports no known allergies. The child has not been on antibiotics for the last year. The child does not have history of OM. The child is otherwise healthy without any other known health problems.

Physical examination reveals: Vital signs HR 110 bpm, 28 respiratory rate, and tympanic temperature of 103.2 degrees F. Weight is 40.5 lbs. Bilateral TMs are bulging with severe erythematous. Pneumatic otoscopy reveals absent mobility. Ear canals are normal.

After your questioning and examination, you diagnose this child with bilateral Acute Otitis Media.

According to the current guidelines on medications for a 5-year-old with Acute Otits Media (AOM), address the following the criteria by downloading and completing the assigned template.

I need help writing my essay – research paper include 3-5 references and use provided template.

Questions If No, explain why If you decide to recommend/ prescribe medication provide a brief rationale. Give name of medication along with strength, frequency, dosage, and length of treatment. (provide citations) What Parent/Patient Education is essential? (you may use bullet format) What side effects might be expected? (you may use bullet format)
Should the APRN prescribe an antibiotic? No, the child meets the criteria for acute otitis media based on symptoms and physical exam findings. Guidelines recommend prescribing antibiotics for children ages 2 months to 12 years with AOM. (Shulman et al., 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap) Amoxicillin 80-90 mg/kg/day in 2 divided doses for 10 days. Amoxicillin is considered first line treatment for AOM according to guidelines due to efficacy and safety. (Lieberthal et al., 2013)
Signs of improvement and worsening to watch for
Importance of completing full course of antibiotics
Alternate fever reducers as needed for pain/fever
Return if no improvement in 48-72 hours
Nausea, diarrhea, rash
What would the APRN prescribe if this child was allergic to penicillin? For children with penicillin allergy, guidelines recommend high dose amoxicillin-clavulanate (Augmentin) 90mg/kg/day in 2 divided doses or ceftriaxone 50mg/kg IM as a single dose. (Lieberthal et al., 2013) Amoxicillin-clavulanate (Augmentin) 90mg/kg/day in 2 divided doses for 10 days. Same as above Same as above plus diarrhea, vomiting, rash
What determines the choice of an antibiotic ? Factors such as efficacy, safety, cost, resistance patterns, formulation, and compliance influence antibiotic selection. Guidelines recommend high dose amoxicillin as first line due to efficacy. (Lieberthal et al., 2013)
Will you recommend or prescribe any other medications? Yes, acetaminophen or ibuprofen for fever reduction and pain relief as needed. (Lieberthal et al., 2013) Acetaminophen 15 mg/kg every 4-6 hours as needed for fever >101F or pain, not to exceed 75 mg/kg/day or ibuprofen 10 mg/kg every 6-8 hours as needed for fever >101F or pain, not to exceed 40 mg/kg/day. Same as above Same as above
The child returns in 48 hours with increased pain and fever.
What changes will the APRN make in treatment plan? The APRN would likely switch the antibiotic to amoxicillin-clavulanate (Augmentin) based on lack of improvement and persistent fever, as some studies show better efficacy. (Lieberthal et al., 2013) Other options include high dose amoxicillin or ceftriaxone. Close follow up would be arranged. Amoxicillin-clavulanate (Augmentin) 90mg/kg/day in 2 divided doses for 10 days. Importance of completing full course.
Return precautions discussed. Same as above
References:
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., et al. (2013). The diagnosis and management of acute otitis media. Pediatrics, 131(3), e964–e999. https://doi.org/10.1542/peds.2014: 2024 – Essay Writing Service. Custom Essay Services Cheap-3488
Shulman, S. T., Bisno, A. L., Clegg, H. W., et al. (2014: 2024 – Essay Writing Service. Custom Essay Services Cheap). Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2014: 2024 – Essay Writing Service. Custom Essay Services Cheap update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 55(10), e86–e102. https://doi.org/10.1093/cid/cis629

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