NURS 6541 PRIMARY CARE OF ADOLESCENTS AND CHILDREN IHUMAN WEEK 2 WALDEN UNIVERSITY
Differential Diagnosis:
Acute Otitis media H66.93: A painful ear infection that occurs when the middle ear becomes
inflamed and infected. Between 50% and 85% of children experience this at least once by the
age of 3 and is one of the most common causes of hearing impairment in children. Most frequent
bacteria that cause this are streptococcus pneumonia, haemophiles influenzae, Moraxella
catarrhalis, and staphylococcus aureus (Quraishi et al. 2014).
Acute Otitis media with effusion H65.199: A condition in which there is fluid in the middle ear
but no signs of acute infection. This causes a decrease in hearing due to poor transmission of
sound into the inner ear (Vanneste and Page. 2019).
Allergic Rhinitis J30.9: A common inflammatory disease affecting the upper and lower
respiratory airways. Symptoms can manifest as nasal symptoms, ocular symptoms, cough, or
headache. Most common allergens that can cause these symptoms include house dust mites,
pollens, cats and dogs, and molds (Katotomichelakis. 2017).
Mastoiditis H70.10: A common complication of acute otitis media in which the infection of
themiddle ear extends to the mastoid air cells and can lead to bony septation erosion and
coalescence of small air cells into larger full of puss referred to as mastoiditis. It is most
commonly caused by streptococcal pneumonia (Kynion. 2018).
Rhinovirus infection 079.3: An RNA virus that causes more than 50% of upper respiratory tract
infections and is one of the leading causes of viral bronchiolitis in infants (Vandini,, Biagi,
Fischer, & Lanari. 2019).
Additional laboratory and diagnostic tests: With tests negative for strep, influenza, throat
culture, and pertussis, no other tests are recommended at this time.
Consults: No consults are recommended at this time. If ear infections become chronic, a consult
to ENT could be made for possible ear tube placement.
Therapeutic modalities: Pharmacological treatment warrants antibiotic therapy due to moderate
symptoms and fever. The first choice of antibiotic is Amoxicillin 80-90 mg/kg for 10 days for
children who do not have a penicillin allergy, at which point Azithromycin is preferred drug
(Qureishi et al. 2014). To help manage the fever, Tylenol 160mg every 4-6 hours but not
exceeding 5 doses in 24 hours. Ibuprofen 100mg can be given every 6-8 hours based on the
child’s weight may be used but not more than 4 times in a day. It is recommended when needed
to alternate by taking Tylenol and an hour later if fever has not subsided and symptoms persists
then take Ibuprofen, dosages based on weight. Non-pharmacological treatment for the cough and
fever includes drinking as much fluids as possible in small but frequent amounts, lukewarm
sponge baths, cool washcloths on forehead and back of neck, and minimal clothing. For the
cough, many over-the-counter cough medications such as dextromethorphan and
diphenhydramine do not provide much relief and are not recommended for children under 4
years of age. Giving a single 2.5 ml dose of honey has shown to decrease cough and should be