NURS-6541 Primary Care Adolescnt & Child

Week 4 Discussion

Evaluation & Management of HEENT Disorders

In clinical settings, head, eye, ear, nose, and throat (HEENT) disorders account for the majority of pediatric visits. With the prevalence of these disorders, you must be familiar with their signs and symptoms as well as evidence-based practices for assessment and treatment. Although many pediatric patients present with common HEENT disorders such as ear infections, allergies, and strep throat, some patients present with rare disorders requiring specialist care. In your role, making this distinction between when to treat and when to refer is essential. For this Discussion, examine the following case studies and consider potential diagnoses and management strategies.

Discussion board posting assignments are assigned alphabetically by FIRST NAME to ensure all cases are covered and discussed.

Case Study 1: A-F

Case Study 2: G-M

Case Study 3 N-Z

Case Study 1:

HPI: A 14-month-old brought Native American boy by his mom due to cough, low grade fever and runny nose for the past 2 days. This morning, the mother noted that her son was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Mom is worried because her son seems to have a lot of ‘bouts of colds”. Per mom, he oral intake is decreased. He didn’t want to eat this morning.

PE: Smiling, alert Caucasian boy.

VS: Temp of 99.9, pulse 112, resp. 42 reveals the following: respiratory rate is 58 HEENT: There is moderate, thick, clear rhinorrhea and postnasal drip.

CV: Her capillary refill is less than 3 seconds

PULM: lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields.

Case Study 2

HPI: Kevin is a 5-year-old with an intermittent 2-day history of nasal congestion and cough in the early morning. Her mother reports thick, green nasal discharge. She is afebrile, and appetite and sleep are normal.

PMH: A smiling Asian American boy 5-year-old, sitting on mom’s lap.

HEENT: Tympanic membranes pearly gray without fluid in a neutral position, no cervical adenopathy, nasal turbinates are red, and clear rhinorrhea and postnasal drip.

CV: RRR, no murmurs or gallop PULM: clear to auscultation

Case Study 3

HPI: Marcus is an 8-year-old with a 36-hour complaint of headache (frontal), sore throat, fever to 102°F, and nausea. Mom says his appetite is decreased and his breath smells “like a puppy dog’s.”

PMH: A Polish 8-year-old boy, in mild distressed.

HEENT: Tympanic membranes partially obscured by cerumen but in neutral position and transparent, 2+ enlarged and red tonsils with exudate, strawberry tongue, and petechiae on the soft palate enlarged tonsillar and anterior cervical lymph nodes.

CV: RRR

PULM: Clear to auscultation bilaterally

To prepare:

Review “Eye Disorders” and “Ear Disorders” in the Burns et al. text.

Review the three case studies focusing on the case that is assigned to you. Analyze the patient information, including the parent’s perspective.

Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.

Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.

Consider strategies for educating parents on the child’s disorder and reducing any concerns/fears presented in the case study.NURS6541 Week 4 Discussion Nursing Essay

By Day 3

Post an analysis of your assigned case by responding to the following:

What additional questions will you ask?

Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).

What additional examinations or diagnostic tests, if any will you conduct?

What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.

What is your most likely diagnosis and why?

How will you treat this child?

Provide medication treatment and symptomatic care.

Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.

Patient Education, Health Promotion & Anticipatory guidance:

Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.

Include any socio-cultural barriers that might impact the treatment and management plans.

Health Promotion:

What immunizations should this child have had?

Based on the child’s age, when is the next well visit?

At the next well visit, what are the next set of immunizations?

What additional anticipatory guidance should be provided today?

NURS6541 Week 4 Discussion Nursing Essay

 

 

 

MORE INFO 

Evaluation & Management of HEENT Disorders

Introduction

Hearing loss is a common problem that can cause difficulty in communicating and understanding. In addition, it can increase stress levels, impact concentration, limit job performance and interfere with social interaction.

Hearing Loss

Hearing loss is a common, but often overlooked condition. It can be conductive, sensorineural, or mixed. Audiogram testing is used to determine the type and degree of hearing loss. The most common causes of sensorineural hearing loss include aging; noise exposure (such as gun shots); genetics; certain medications; infections like meningitis or otitis media (ear infections).

Rhinitis

Rhinitis is an inflammation of the mucous membranes in the nose. Symptoms include sneezing, runny nose, itchy nose and postnasal drip. Rhinitis may be caused by allergies or viruses such as croup and influenza.

Treatment includes antihistamines such as hydroxyzine (Atarax), loratadine (Claritin) or fexofenadine (Allegra). Decongestants can also be used if needed to relieve congestion.

Sinusitis

Sinusitis is an inflammation of the sinuses, which are air-filled chambers located in the bones of the face above and behind each eye. It can be caused by a virus, bacteria or other irritants. Symptoms include pain, pressure and/or tenderness to touch in one or both eyes; fever; nasal congestion (runny nose); headache; cough due to drainage from swollen sinuses; facial swelling around one or both eyes with redness between eyebrows or upper lip area if there is swelling in front of them.

It’s important to see a doctor right away if you have symptoms like these because they could be signs that your condition has become severe enough that you need treatment right away! If left untreated for too long without proper medical care then infection may spread throughout your body causing more serious injuries including pneumonia which is deadly!

Otitis Media – Acute

Otitis media is an inflammation of the middle ear. It’s usually caused by a viral or bacterial infection, and it can cause fluid to build up in the middle ear. The fluid can also cause pressure, which can damage the eardrum.

If you have otitis media:

• Drink plenty of fluids so that your body has something to drain from its ears when they’re drained of excess fluids by antibiotics.

• Take over-the-counter painkillers like ibuprofen or acetaminophen if you have pain from an earache or sore throat that won’t go away after taking antibiotics (or if they’re not strong enough).

Otitis Media – Recurrent or Chronic

The ear is the body’s hearing organ. It consists of the outer and middle ears, which are separated by a thin layer of tissue called the tympanic membrane.

The middle ear includes two small bones (ossicles) attached to the inner surface of each temporal bone; this arrangement helps transmit sound waves from one side to another. The eardrum separates these bones into three parts—the stapes footplate, malleus hammerhead and incus hook—that vibrate at different frequencies when they’re struck by air passing through them during breathing or speaking activities. Each part has its own function:

Stuffy Nose or Rhinitis (Congestion) After a Cold or Flu (Viral Upper Respiratory Tract Infection) in Children and Adults

Stuffy nose or rhinitis (congestion) is common in children and adults with colds and flu. It may be due to a viral upper respiratory tract infection. Symptoms include nasal congestion, sneezing, runny nose, postnasal drip (bleeding from the back of the throat), sore throat and fever.

In addition to over-the-counter medications such as decongestants and antihistamines that help reduce swelling of mucus membranes in the nose, there are several non-pharmacological treatments that can help relieve symptoms:

• Mucus softening strips inserted into one nostril at bedtime may help loosen phlegm from your nose overnight so it’s easier to breathe through it in the morning; make sure you wash out any tissue after you use them! This method doesn’t work for everyone however so make sure you give yourself time before giving up on this strategy altogether!

Vertigo

Vertigo is the sensation of spinning or whirling in the head, neck and/or body. It can be caused by an imbalance in one or more of the vestibular organs (i.e., semicircular canals), which control balance.

There are different types of vertigo:

• positional vertigo – when you feel like you’re moving side to side but not rotating around your central axis

• nauplius type vertigo – characterized by rapid alternating movements between compensatory and postural responses; this type is related to migraine headaches, multiple sclerosis (MS), Parkinson’s disease (PD) etc.; it often occurs before movement disorders occur

Takeaway:

• The takeaway is that it’s important to evaluate your child’s hearing if they have any of the following symptoms:

• Difficulty understanding speech, especially when the person speaking is close.

• Difficulty understanding soft background noises such as television or music.

• You should also make sure your child doesn’t have any other health concerns that could be causing their hearing problems, like diabetes or high blood pressure.

Conclusion

We hope that you found this article helpful in your quest to determine what is wrong with your HEENT. Remember that a visit to an ENT specialist is always a great idea if you are suffering from any of these issues, but even if they don’t help, it’s important to know what they are so that you can get your symptoms under control!