Case Study: Child Patient with Frontal Headache, Nausea

NURS 6541: Primary Care of Adolescents and Children | Week 4

Patients with disorders of the eye, ear, nose, and throat (EENT) often present with a variety of symptoms that can be associated with multiple disorders. This makes diagnosis difficult because what may appear to be a gastrointestinal or respiratory disorder, for example, might actually be an EENT disorder such as otitis media. Consider 8-month-old Melissa, who presents with a complaint of tugging on her left ear, fussiness, and decreased appetite over the last 3 days. She does not have a fever, and her physical examination is normal. As the advanced practice nurse caring for patients like Melissa, you must always consider the differential diagnoses and perform the appropriate assessments and diagnostics prior to providing treatment and management recommendations for patients and their families.

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This week you explore eye, ear, nose, and throat disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives – Case Study: Child Patient with Frontal Headache, Nausea

By the end of this week, students will:

• Assess pediatric patients for eye, ear, nose, and throat disorders
• Evaluate differential diagnoses for pediatric eye, ear, nose, and throat disorders
• Analyze treatment and management plans for pediatric patients with eye, ear, nose, and throat disorders
• Analyze strategies for educating parents on their children’s disorders
• Evaluate the impact of culture on the treatment and management of eye, ear, nose, and throat disorders
• Understand and apply key terms, principles, and concepts related to eye, ear, nose, and throat disorders in pediatric patients
• Assess pediatric patients with signs of eye, ear, nose, and throat disorders

Learning Resources

Required Readings

• Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L.  (Eds.). (2017). Pediatric primary care (6th ed.). St. Louis, Missouri: Elsevier.
• • Chapter 29, “Eye Disorders” (pp. 703-735)This chapter reviews the development, physiology, and pathophysiology of the eye. It provides guidelines for eye care including assessment and management strategies for common eye disorders, injured eyes, and deformities of the eyelids.

• Chapter 30, “Ear Disorders” (pp. 736-755)This chapter reviews the structure and function of the ear and presents guidelines for the assessment and management of ear problems.

American Academy of Pediatrics. (2004). Clinical practice guideline: Diagnosis and management of acute otitis media. Pediatrics, 113(5), 1451–1465.

This article examines the diagnosis and management of uncomplicated acute otitis media in patients from 2 months to 12 years of age. It focuses on defining acute otitis media, pain management, assessment, and selection of appropriate antibacterial treatments.

Chow , A.W., Benninger, M.S., Brook, I., Brozek, J.L., Goldstein, E.J.C., Hicks, L.A., Pankey, G.A., Seleznick, M., Volturo, G., Wald, E.R., & File Jr, T.M. (2012). IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clinical Infectious Diseases , 54(8), 72-112.

Note: Retrieved from the Walden Library databases.

Shulman, S.T, Bisno, A.L., Clegg, H.W., Gerber, M.A., Kaplan, E.L., Lee ,G., Martin, J.M., & Van Beneden, C. (2012). Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 58(10), 86-102. Case Study: Child Patient with Frontal Headache, Nausea

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 mother presents with her 2-year-old African American male child with complaints of ear pain and decreased sleep. Earlier this week, he had a runny nose and congestion with a mild cough that occurred mostly when lying down. His temperature is 100.7.

PE: Pt is walking around room, exploring in no acute distress.
HEENT: Mild nasal congestion, clear postnasal drainage, and lungs clear to auscultation. Ear exam reveals right tympanic membrane erythematous, translucent, in a neutral position, with no pus or fluid noted. Left tympanic membrane is full, reddish/orange in appearance, and opaque with pus.
Neck: Shotty anterior cervical adenopathy
Lungs: Clear to auscultation

Case Study 2

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

PE: A smiling male patient 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 distress.
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.

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?

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to a colleague who chose one of the first three case studies and a second colleague who chose one of the last three case studies. Choose colleagues who selected a different case study than you did.

• Explain how culture might impact the diagnosis, management, and follow-up care of patients with the respiratory, cardiovascular, and/or genetic disorders your colleagues discussed.
• Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Evaluation and Management of HEENT Disorders, NURS6541 Case Study: Child Patient with Frontal Headache, Nausea