Parents Shaw, & Duncan, 2008). Also, parents and

Parents generally require medical help of
their children for Eye, Ear, Nose, and Throat (EENT) or contagious disorders. It
is fundamental for an advanced practice nurse to use their expertise to properly
diagnose and implement a treatment plan based on the conditions reported.  A challenge that an advanced practice nurse face
regularly, are that most signs and symptoms of EENT tend to imitate other
respiratory system and gastrointestinal disorders which may cause the patient
to be misdiagnosed (Hagan, Shaw, & Duncan, 2008). Also, parents and
caregivers are sometimes forced to miss work because of their caring for their
sick children thus, cause of some financial burdens to the family (Barber,
Ille, Vergison, & Coates, 2014).

 

Reflection
on a Patient with Streptococcus Pharyngitis (Strep throat)

J. T. is an 11-year-old Hispanic little girl
who was accompanied by her mother into the clinic. She complained of a sore
throat, headache, nausea, bad breath, pain when swallowing resulting in a decreased
appetite and fever of 102.1 degrees. J. T’s mother also explained that her
daughter’s symptoms were brought to her attention four days ago; fever, painful
swallowing and throat pain, using a pain scale of 0 -10 she stated it was a
6/10. She decided to seek medical attention when T. J’s difficulty swallowing
worsened to where she could no longer swallow a sip of water well. If a patient
present with symptoms such as fever, sore throat, headaches, enlarge anterior
cervical lymph nodes, tender and enlarged tonsillar, nausea, malaise, prominent
sore throat, dysphagia, strawberry tongue and bad breath, the utmost possible
diagnosis will be strep throat (Burns et al., 2013). The bacteria that most
often cause pharyngitis and tonsillitis in children between the ages of 5
through 15-year-old is GABHS, and it accounts for approximately 15% to 30% of
infections in this age group with a fever and acute sore throat (Burns et al.,
2013). It is imperative that the advanced practice nurse should gather
information on the history of present illness (HPI) during the process of
formulating a differential diagnosis of diseases (Hagan, Shaw, & Duncan,
2008).

 

Experience
in Assessment and Management of Streptococcus Pharyngitis (Strep Throat)

I conducted a thorough assessment on J. T.

and concluded Streptococcus pharyngitis (strep throat) to be her diagnosis over
a viral pharyngitis and allergic rhinitis. I came to this conclusion because an
infectious mononucleosis is usually the source of viral pharyngitis and because
my patient had conveyed she was suffering from headaches and painful swallowing.

To further strengthen my diagnosis, while performing my assessment I also auscultated
a clear lungs sound, the white patches noted to the tonsil, the tonsils were
red and swollen, a visible strawberry tongue, I smelt a foul odor from the
mouth, and tender lymph nodes palpated to the neck area, the tympanic membrane was
not visible due to the presence of cerumen. My thorough assessment enabled me
to determine Streptococcus Pharyngitis (Strep throat) as the primary diagnosis
for J. T. However, Streptococcus Pharyngitis (Strep throat) can be caused by
either bacterial or viral infections and a common problem or symptom is a sore
throat in children (Burns et al., 2013). This is why it is important to
collect the swab from the throat to determine what organism that is liable for
the infection.

An Allergic rhinitis was considered as a
differential diagnosis due to the presenting symptoms of wheezing, itching,
stuffy nose, sneezing, and bad breath. The physical assessment reveals nasal
mucosa was pale, nasal congestion, and rhinitis causes the child to breathe
through the mouth breather thus resulting in halitosis (Hagan et al., 2008). The
Epstein-Barr virus was revealed to be the etiologic cause of heterothallic-positive
infectious mononucleosis in about 99% of most cases (Cohen, 2000). Burns et al.

revealed that viral pharyngitis would be considered as a differential diagnosis
with the presentation of the symptoms such as fever, fatigue, lymphadenopathy,
sore throat, splenomegaly, and lymphadenopathy (2013).

 

However, in regard to Streptococcus
Pharyngitis (Strep Throat), is with the clinical presentation of throat pain
that manifest rapidly, fever, painful swallowing, sudden frontal headache,
generalized body aches, red and swollen tonsils, sometimes with streaks of pus
or with white patches, tender lymph nodes palpated to the neck (Mayo Clinic,
2015).

 

The management and treatment of Streptococcus
pharyngitis include the use of oral penicillin V. 500 mg two to three times a
day over a period of 10 days. This it is proven to be safe, efficient, low
cost, and it is a narrow spectrum. But if the patient cannot tolerate oral
intake, Penicillin G benzathine (Bicillin L-A) 1.2millon units intramuscular
(IM) times one dose for patient that weight over 27 kg (Pichichero, Sexton,
Edwards, & Baron, 2016). J. Ts’ recorded weight is 41.8 kg (92 lbs.) and
height 150 cm (4’9″) BMI 19.9. For the children that weight less than 27 kg
will be given Penicillin G benzathine (Bicillin L-A) 600,000 units
alternatively Bicillin C-R 900/300 (Penicillin G benzathine penicillin G
procaine) IM times one dose (Pichichero et al., 2016). It is imperative to
verify that the patient is not allergic to penicillin before ordering the
medication otherwise Azithromycin 12mg/kg/dose on the first day, then
6mg/kg/dose orally on the second day through the fifth day (Pichichero et al.,
2016). 

 It is important to explain to the
patient and parents that she will feel a sting at the injection site, and the
medication may have some side effects such as vomiting, nausea and diarrhea.

However, if the symptoms continue or worsen, they should come back to the
clinic or go to the nearest emergency facility immediately.

It becomes clear while educating the patient
and her mother on how important for her to comply and strictly follow the
antibiotics regiment specified, she will feel better within two to three days. But,
she is still contagious until after 24 to 48 hours of an antibiotic therapy
treatment. The fever can be managed by administering Acetaminophen 10-15mg/kg
by mouth every four to six hours as needed for a fever greater than 100.4
degrees Fahrenheit or Ibuprofen 10mg/kg by mouth every six to eight hours for a
temperature greater than 100.4 degrees Fahrenheit (Pichichero et al., 2016).

It is important to explain to patients and
parents to practice proper hand washing and to increase their fluid intake in
order to recover from dehydration and while doing so; not to share drinks and avoid
drinks such as lemonade and orange juice because they are acidic. I used these valuable
websites and resources such as the American Academy of Pediatrics (AAP) and the
Centers for Disease Control and Prevention (CDC) web page addresses to patients
and parents. Burns et al., advises that it is an obligation of a healthcare
provider to educate the patient, family, and caregiver (2013). 

 

How
the Experience correlated my Class Studies to the Real-world Clinical Setting

    The correlation between
the experience and my class work is the knowledge attained to efficiently
identify the signs and symptoms of strep throat amongst children when they
visit the clinic. The formulation of the appropriate diagnoses is brought about
by collecting a thorough medical history and performing a complete physical
examination on the patient is paramount. This experience which correlates with
my class work also relates to my real-life experiences in the clinic. I gained first-hand
knowledge when children are seeking medical assistance display signs and
symptoms of an upper respiratory infection, they must be meticulously evaluated
to determine if it is a viral or bacterial infection of the contributing
organism. 

 

Conclusion

The utilization of up-to-date evidenced based
care is an important attribute an advance practice nurse should have to ensure
an accurate diagnosis and treatment to combat the patient’s symptoms. Children
are prone to being exposed to others who may be sick with strep throat, at
places such as daycare facilities where parents are forced leave their children
at, while they are at work. Educating parents and caregivers to ensure not
smoke around children and educating patients on methods to prevent the spread of
the organism resulting in the infection is vital. The encouragement of proper
hand washing and the avoidance of other children that exhibit the symptoms of
strep throat will diminish the probability of the infection.