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Original Question
NSG361Pediatric Nursing Summer 2022 Otitis Media and Tonsillitis Case Study Student Name:__________________________________________ Scenario: The nurse is caring for a 3-year-old child admitted to the ED. The parent tells the nurse that the child has had a low-grade fever for two(2) days and is complaining of ear pain and a sore throat. The child’s appetite has been “off” but he has been drinking and using the bathroom as usual. The child weighs 14 kg. The child is also allergic to penicillin. 1. The nurse is completing the admission process, what routine information regarding risk factors for otitis media would the nurse want to obtain from the parent? (List at least 2) (2pts) • ________________________________________________________________________________ • ________________________________________________________________________________ 2. The parent asks, “Why does my child keep getting infections? Is there something I should do?” Discuss 2factors that predispose infants and young children to otitis media. (2pts) • ________________________________________________________________________________ • ________________________________________________________________________________ Case Study Progression The health care provider (HCP) diagnoses the child with bilateral otitis media and strep pharyngitis. The HCP prescribes the following for discharge: • Amoxicillin/clavulanic acid 500mg po BID x 7 days• Follow up with the ENT (ear, nose, and throat) specialist• Acetaminophen 140 mg (10 to 15 mg/kg/dose orally every 4 to 6 hours) po every 4-6 hours prn fever 4. The nurse reviews the above orders before completing the discharge teaching. Which order should be questioned and why? (2pts) _________________________________________________________________________________________________ _________________________________________________________________________________________________ Case Study Progression The parent is given a new prescription for azithromycin 160 mg po everyday x 5 days. 5. Calculate the dosage the nurse would instruct the parent to give. (Show work) (2pts) _______________ 6. The nurse is providing the parent with information on medication administration. Which of these statements by the parent indicates a need for further teaching? (Select all that apply) (2pts) 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 my child refuses to take the medication, I will tell him 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 he feels better after a few days.” 7. The parent asks when the child can return to daycare. Which of these statements is the best response by the nurse? (1pt) a. “He should be able to return in about a week.” b. “He can return 24 hours after his last documented normal temperature.” c. “He can return 24 hours after he starts the antibiotics.” d. “He can return 48 hours after his last documented normal temperature.” Case Study Progression The parent takes the child to the ENT specialist. It is determined that his enlarged tonsils might be contributing to the frequent throat and ear infections. A tonsil and adenoidectomy (T&A) are scheduled. He will be admitted post-op for a 24-hour observation on the medical-surgicalunit. Case Study Progression After surgery, the child is admitted to the medical-surgicalunit. The child is awake and alert, bilateral breath sounds are clear, and his oxygen saturation is 98% on room air. Both parents are at the bedside. The HCP has prescribed the following orders: • Admit for 24-hour observation• Vital signs every 4 hours• NPO• Methylprednisone 2.3 mg IV every 8 hours x 3 doses• Acetaminophen (120mg) with codeine (12.5mg) po every 6 hours prn pain• Amoxicillin 120 mg po every 8 hours• Aggressively gargle and swish with mouthwash after eating or drinking 8. Which of the above orders should the nurse question and provide a rationale for why? (4pts) _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 9. The nurse is outlining a plan of care that addresses common risk factors for post-op care of a T&A. Include at least 2 nursing interventions that would be appropriate for managing each risk. (8pts) Risk Interventions a. Airway • • b. Pain • • c. Fluid and electrolyte balance • • d. Bleeding Risk • • 10. Discuss how the nurse would assess and monitor the child for pain. (2pts) _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 11. The nurse is reviewing discharge instructions with the parent. What is the best client teaching for discharge home? Discuss at least 4 (4pts) • _________________________________________________________________________________________ • _________________________________________________________________________________________ • _________________________________________________________________________________________ • _________________________________________________________________________________________ Case Study Outcome The parent indicates an understanding of discharge instructions and follow-up care. The child meets discharge criteria and is discharged home to follow up with ENT in 2 weeks.
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