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Marquez - Case Study 4

1. A 3-year-old girl named C.E. presents to the emergency department with a 2-day low-grade fever, ear pain, and sore throat. She has a history of recurrent ear infections and her mother reports she attends daycare where her father smokes outside and there is a family history of allergies. 2. The nurse obtains information on risk factors for ear infections including exposure to tobacco smoke, attendance at daycare, and family history of allergies. C.E. is diagnosed with bilateral otitis media and strep throat. She is prescribed antibiotics but is allergic to penicillin so the prescription is changed. 3. After a tons

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643 views4 pages

Marquez - Case Study 4

1. A 3-year-old girl named C.E. presents to the emergency department with a 2-day low-grade fever, ear pain, and sore throat. She has a history of recurrent ear infections and her mother reports she attends daycare where her father smokes outside and there is a family history of allergies. 2. The nurse obtains information on risk factors for ear infections including exposure to tobacco smoke, attendance at daycare, and family history of allergies. C.E. is diagnosed with bilateral otitis media and strep throat. She is prescribed antibiotics but is allergic to penicillin so the prescription is changed. 3. After a tons

Uploaded by

Caren Marquez
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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CASE SIMULATION IN PEDIATRIC NURSING

Case Study 4
Name: Marquez, Caren Joy B. Class/Group: BSN 2B (Group 6)
INSTRUCTIONS:
All questions apply to this case study. Your responses should be brief and to the point. When
asked to provide several answers, list them in order of priority or significance. Do not assume
information that is not provided.
SCENARIO
Three-year-old C.E. is admitted to the emergency department fast track clinic. Her mother tells
the nurse that C.E. has had a low-grade fever for 2 days and is complaining of ear pain and a
sore throat. Mrs. E. states that C.E.’s appetite has been ‘off’, but she has been drinking and
using bathroom as usual.
1. As you get C.E. settled in the exam room, what routine information regarding risk factors
for otitis media (OM) would you want to obtain from Mrs. E.?
 Tobacco smoke in household
 Pacifier use
 Sleep position
 Family history of otitis media or allergies
 Age (Otitis media is most common in the first 24 months of life and again when children enter
school (ages 5 to 6). Otitis media occurs infrequently after age 7.)
 Exposure to large numbers of children (day care)
 There is a lower incidence of otitis media in infants who are breastfed (possibly due to
the presence of immunoglobulin A [IgA] in breast milk), which protects against infection.
 Incidence is higher in the winter and spring months.
 Cleft lip and/or cleft palate.
 Noncompliance with childhood vaccinations
 Down syndrome

2. Mrs. E. asks, “Why does C. keep getting ear infections? Is there something I should do?”
Explain the etiology of ear infections.
Otitis media is usually triggered by a bacterial infection (Streptococcus pneumoniae,
Haemophilus influenzae, Moraxella catarrhalis), a viral infection (respiratory syncytial virus or
influenza), allergies, or enlarged adenoids. Otitis media with recurrent occurrences could be a
risk factor. Tobacco use should be limited.
3. What will you include in your physical examination, and why?
 Redness and inflammation of the ear
 Chronic issue
 Daycare
 Tobacco use
 Family history of allergies have predisposed C.E. to ear infections
 Allergy to penicillin

CASE STUDY PROGRESS


As you continue to get a history from Mrs. E., you learn that C.E. has had “ear problems” and
throat infections since she was a baby. She is in daycare each weekday, Dad smokes outside of
the house, and there is a family history of seasonal allergies. C.E. is allergic to penicillin. Her
weight is 14 kg. The PCP diagnoses C.E. with bilateral otitis media and strep pharyngitis. C.E. is
given a prescription for Augmentin 600 mg bid PO ×7 days. She is to be discharged to home
with instructions to follow-up with the ENT (ear, nose, and throat) specialist.
4. You review the order before completing discharge teaching. What is your first action?
Notify the provider that the patient is allergic to penicillin and will require a different
prescription.

CASE STUDY PROGRESS


Mrs. E. is given a new prescription for azithromycin (Zithromax) PO 160 mg qd × 5 days.

5. Azithromycin is dispensed 200 mg/5 mL. Calculate the dosage for Mrs. E. to administer to
C.E.
160mg/200mg x 5mL = 4mg
6. You are providing Mrs. E. with information on medication administration. Which of these
statements by Mrs. E. indicates need for further teaching? (Select all that apply.)
a. “I will place the correct amount of antibiotic in the ear canal once a day.”
b. “I will monitor for vomiting, diarrhea, or stomachaches because this might be a side
effect of the medication.”
c. “If C. refuses to take her medication, I will tell her it tastes like the candy we get at the
movies.”
d. “This medicine can be given with or without food.”
e. “I don't have to finish the medication if she feels better after a few days.”
7. Mrs. E. asks when C.E. can return to daycare. Which of these statements is your best
response?
a. “She should be able to return in about a week.”
b. “She can return twenty-four hours after her last documented normal temperature.”
c. “She can return twenty-four hours after she starts her antibiotics.”
d. “She can return forty-eight hours after her last documented normal temperature.”

CASE STUDY PROGRESS


Mrs. E. takes C.E. to an ENT specialist. It is determined that her enlarged tonsils might be
contributing to the frequent throat and ear infections, and a tonsil and adenoidectomy (T&A) is
scheduled. She will be admitted postoperatively for 24-hour observation. After the surgery, the
postoperative nurse receives C.E. to the short-stay unit from the post-anesthesia care unit
(PACU). C.E. is awake and alert, bilateral breath sounds are clear, and her oxygen saturation is
98% on room air. She has tolerated sips of clear fluids, and her parents are with her.
8. Which of these orders would you expect to see in her postoperative orders? (Select all
that apply, and discuss the rationales for your choices.)
a. Vital signs q4h
(Time Lapsed Assessment/Progress)
b. Clear liquids. Advance to regular toddler diet.
(Recovering from sore throat)
c. Methylprednisolone (Solu-Medrol) 2.3 mg IV q8h × 3 doses
d. Acetaminophen (Tylenol) (120 mg) with codeine (12.5 mg) 5 mL PO q6h prn for pain
(Pain relief)
e. Home prescription for amoxicillin (Amoxil) 120 mg PO q8h
f. Maintain peripheral IV with D5NSS at 50 mL/hr until taking PO well and then saline lock
g. Aggressively gargle and swish with water after eating or drinking.

9. State at least two nursing interventions for each of these commonly encountered nursing
problems during the postoperative phase of care.
a. Airway
 Elevate patient
 Inspect for swelling/obstructive airway
b. Pain
 Offer clear fluids or ice pops for pain
 Give acetaminophen
c. Fluid and electrolyte balance
 Provide fluids for hydration
 Ensure adequate fluid intake
d. Bleeding risk
 Refrain from talking/coughing which could irritate throat
 Observe for swallowing-could mean bleeding

10. How would the nurse monitor C.E. for pain?


The Oucher is a poster created for children to help them express how much pain or hurt they
are experiencing. On the Oucher, there are two scales: a number scale for older kids and a
picture scale for smaller kids.

11. You are reviewing discharge instructions with Mrs. E. She asks, “How would I know if we
need to come back?” Discuss common findings and when Mrs. E. would need to seek
immediate medical attention for C.E.
Pain is to be expected in the days following surgery. An ice collar can help with pain relief. Keep
an eye out for bloody coughing or vomiting. If you suspect bleeding, seek medical help right
once. Confirm that C.E. is getting enough fluids. Fever can indicate a lack of fluids or an
infection.

CASE STUDY OUTCOME


Mrs. E. indicates an understanding of discharge instructions and follow-up care. C.E. continues
to take oral fluids well and meets discharge criteria and is discharged to home to follow up with
the ENT physician in 2 weeks.

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