E-BOOK: Advanced Health Assessment & Clinical Diagnosis in Primary Care, 5th Edition
Physical Examination and Health Assessment
BASED ON ORDER #ESS80636 prompt week 4
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PROMPT 1 EDWIN
According to Lieberthal et al. (2014) of the American Academy of Pediatrics, otitis media (OM) remains the most common condition for which antibacterial agents are prescribed for children in the United States. Clinician visits for OM decreased from 950 per 1000 children in 1995â€“1996 to 634 per 1000 children in 2005â€“2006. There has been a proportional decrease in antibiotic prescriptions for OM from 760 per 1000 in 1995â€“1996 to 484 per 1000 in 2005â€“2006. Having this perspective and increase cases of among children, it is appropriate for advance practice nurse to learn the pathophysiology and treatment of this condition. Acute otitis media is an acute, suppurative infectious process marked by the presence of infected middle ear fluid and inflammation of the mucosa lining the middle ear space. The infection is most frequently precipitated by impaired function of the Eustachian tube, resulting in the retention and suppuration of retained secretions (Limb et al., 2020). Eustachian tube dysfunction, entities causing Eustachian tube compression or outlet obstruction, or an abnormality of host immunologic response can be a predisposing factor in the development of acute otitis media. The key feature of otitis media is the bulging of the tympanic membrane, and reduced mobility of the tympanic membrane when pressure is applied (Limb et al., 2020).
Otitis media is among the most common issues faced by physicians caring for children in the outpatient setting. Approximately 80% of children will have at least one episode of acute otitis media (AOM), and between 80% and 90% will have at least one episode of otitis media with effusion (OME) before school age (Harmes, 2013). There is no gold standard for the diagnosis of AOM. In fact, AOM has a spectrum of signs as the disease develops. According to Lieberthal et al. (2014), in 2009, the American Academy of Pediatrics convened a committee composed of primary care physicians and experts in the fields of pediatrics, family practice, otolaryngology, epidemiology, infectious disease, emergency medicine, and guideline methodology. The subcommittee partnered with the Agency for Healthcare Research and Quality and the Southern California Evidence-Based Practice Center to develop a comprehensive review of the new literature related to AOM since the initial evidence report of 2000. The resulting evidence report, and other sources of data were used to formulate the practice guideline recommendations (Lieberthal, 2014). Antibiotics are the mainstay of treatment of uncomplicated acute otitis media in adults, and initial antibiotic choice is determined by knowledge of the most common causative pathogens (Limb et al., 2020). Patient could benefit with amoxicillin 875 mg with clavulanate 125 mg orally twice daily for 5-7 days to treat otitis media (Limb et al., 2020).
Conjunctivitis is an infection in the outer part of the eyes, and it is commonly known as pink eye. In technical terms, it is an inflammation of the conjunctiva, which lines the white part of the eyes (Mayo Clinic, 2020). Clinical manifestations of conjunctivitis include a pink color in the white part of the eyes, increased production of tears, itching, irritation, burning, crusting, and discharge (Centers for Disease Control and Prevention, 2019). Although the white parts of the eyes are inflamed and pink, vision, pupil size, and reactivity to light are not affected and are still normal (Jarvis & et al., 2020). Conjunctivitis is caused by many different irritants like viruses, bacteria, allergies, and chemicals. Bacterial conjunctivitis is most commonly caused by Haemophilus influenzae, Streptococcus pneumoniae, Staphylococcus aureus, and Chlamydia (Roat, 2021). Viral conjunctivitis is caused by adenovirus, herpes simplex virus, and varicella-zoster virus (Auwaerter & Marinopoulous, 2019). It is typically diagnosed by a provider simply assessing the eyes and asking simple questions. There doesnâ€™t need to be a diagnostic test done to specifically diagnose conjunctivitis.
Treatment for conjunctivitis differs between bacterial and viral conjunctivitis because antibiotics work best on bacteria, but not on viruses. For viral conjunctivitis, there is pharmacological treatment available to combat the virus, but it is recommended to not use medications unless there is a systemic issue occurring (Roth, 2019). However, those with viral conjunctivitis should be instructed to use a warm compress or cloth to soothe the clinical manifestations. For bacterial conjunctivitis, there are many different antibiotics that can be used to treat the infection. According to the American Academy of Optometry, if neither a gonococcal or chlamydial infection is certain, the recommended treatment is to use moxifloxacin 0.5% drops three times a day for 7 to 10 days or trimethoprim/polymyxin B four times a day (Yeung & Weismann, 2019). Clinical manifestations should resolve with these medicationsl; however, if they do not dissipate, a different medication may have to be used. Alternatives include an erythromycin ophthalmic ointment four times a day for 5 to 7 days and bacitracin/polymyxin B ophthalmic four times a day for 7 to 10 days (Auwaerter & Marinopoulous, 2019). If there is resistance that is detected, a single dose of ceftriaxone 1 gram intramuscularly with azithromycin 1 gram orally one time may be required to properly treat the conjunctivitis (Yeung & Weismann, 2019).
Conjunctivitis is important for advanced practice nurses to learn about and understand because it is a very common eye infection. As advanced practice nurses, we are very likely to encounter patients who have conjunctivitis whether it is bacterial or viral in the inpatient and outpatient settings. According to the Cleveland Clinic, there are around three to six million cases of conjunctivitis that occur in the United States every single year (Cleveland Clinic, 2020). It is very common, and we as advanced practice nurses need to be able to recognize this condition and know how to treat it. Also, another important part of knowing the condition is also educating patients on how to prevent conjunctivitis. The instructions are to wash the hands often, wash the hands before and after applying any type of medication into the eyes, and not sharing different eye products or towels with other people (Cleveland Clinic, 2020). This is not a severe or critical type of condition; however, because it is so commonly seen, it is important for advanced practice nurses to know about conjunctivitis, know how to treat it, and know exactly what to educate patients on.