Children Health Module 5 Clinical Discussion
This week has not been challenging. The challenge I have is accommodate the availability of clinical days with my work and other plansâ€™ schedule. Due to the number of students attending the clinical site I am taking my rotation in. It is always challenging to pick a clinical day or change it and I must accommodate my work schedule with the clinical days.
The patient I had this week is a 34-month-old female presents to the clinic with her father and mother with a fever of 101 F and loss of taste. Symptoms started yesterday. The mother endorsed that the child started daycare in October, and she has been on and off with congestion or runny nose. She reported giving patient her favorite strawberry drink and patient was unable to taste the strawberry flavor. The mother denied aggravating or alleviating factors. Parents requests a rapid COVID antigen test. No other concerns. ROS: General: Fever, no weight change, generally healthy, no change in activity level. Head: No injury, no bruising. Eyes: Normal vision, no tearing, no pain. Ears: No change in hearing, no bleeding. Nose: nasal congestion, no epistaxis, no discharge, no foreign body. Mouth: Loss of taste, no dental difficulties, no gingival bleeding. Neck: No stiffness, no pain, no tenderness, no noted masses. Chest: No dyspnea, no wheezing, no hemoptysis, no cough. Heart: No syncope, no orthopnea. Abdomen: No change in appetite, no abdominal pains, no bowel habit changes, no emesis, no melena. GU: no change in nature of urine. Musculoskeletal: No pain in muscles or joints, no limitation of range of motion. Neurologic: No weakness, no tremor, no changes in mentation. Psychiatric: no changes in sleep habits. Denies vomiting, foreign travel. She might have been exposed to sick contacts in the daycare. Vitals: Temperature is 97.5, pulse is 99 bpm, breathing is 25 breath per minute. The rest of vitals could not be performed because the child was crying and refusing blood pressure and pulse oximeter. Exam was performed while patient was in dad’s arms. The child was more cooperative after providing a strawberry lollipop, she is in no acute distress. Head: Normocephalic, no lesions. Eyes: PERRLA, EOM’s full, conjunctivae clear. Ears: Left TM erythematous, right TM normal, EAC’s clear. Nose: Mucosa normal, no obstruction. Throat: Clear, no exudates, no lesions. Neck: Supple, no masses, no thyromegaly, no bruits. Chest: Lungs clear, no rales, no rhonchi, no wheezes. Heart: RR, no murmurs, no rubs, no gallops. Abdomen: Soft, no tenderness, no masses, BS normal. Back: Normal curvature, no tenderness. Extremities: FROM, no deformities, no edema, no erythema. Neuro: Physiological, no localizing findings. Skin: Normal, no rashes, no lesions noted. Aa part of the assessment, the parents signed consent for COVID testing and the COVID test done in the clinic was negative. The plan as always if patient does not get better or is symptoms are worse, parents should bring her to the ER. The parents were advised for the patient to rest, increase fluids, and get Motrin as needed (McCance Burns et al., 2017, p.504). The patient was prescribed antibiotics and advised of yogurt or probiotics with the antibiotic use (Dlugasch, & Story, 2021, p.724). Education was given to the parents regarding good handwashing, changing toothbrush in 3 days, saltwater gargles, not sharing cups or utensils, and keeping ear canals dry with ear plugs while swimming. The differential diagnosis includes acute left otitis media, acute upper respiratory tract infection, or COVID infection.
I learned a lot from this case this week. Looking at the case as a whole is more important that getting all details of the exam. A holistic approach was better to get the definitive diagnosis of this patient.
Dlugasch, L., & Story, L. (2021). Applied pathophysiology for the advanced practice nurse. Jones & Bartlett Learning.
McCance Burns, C. E., Dunn, M. A., Brady, A. M., Starr, B. N., Blosser, G. C., & Garzon, L. D. (2017). Pediatric Primary Care. (6th ed.). St. Louis, MO: Elsevier.