The Pediatric Case Study Assignment Paper

The Pediatric Case Study Assignment Paper

Patient Information: Patient # 14721719 – March 16th, 2023

Initials: NM      Age: Six year old Gender: M  Race: Caucasian

Subjective:

Chief complaint (CC): “Persistent cough.”

History of Presenting Illness (HPI): NM is a six year old Caucasian male patient presented to the clinic accompanied by his mother with a chief complaint of a persistent cough that he has been having for seven days now.  The mother stated that the cough occurs throughout the day but worsens at night. She further stated that the cough is dry and that she has also noted incidences of rhinorrhea, fever, and some swelling around his eyes.  The patient has also been suffering from headaches, which his mother attempted to manage with acetaminophen 250mg PO Q4-6H PRN with minimal effect. The patient denies nausea, vomiting, and diarrhea.

Past Medical History (PMH):  The patient denies any history of chronic illnesses or previous hospital admission. The Pediatric Case Study Assignment Paper

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Current medication: Acetaminophen 250mg PO Q4-6H PRN for headache.

Allergies: NKDFA but reported being allergic to pollen , dust, and cigarette smoke.

Developmental Theory: Based on Piaget’s theory, the patient’s cognitive development is in the preoperational period. Although he is growing normally, he has not yet used cognitive functions as would typically be anticipated: he thinks before acting but cannot yet apply concrete logic.

Immunizations: Immunizations are up- to-date. He received his first dose of the Hepatitis B vaccine at birth, the second dose at four weeks, and the third dose at nine months. At two months old, he received his first dose of rotavirus, DTaP, PCV13, and IPV. At four months and six months old respectively, a second and third dose of DTaP and  PCV13 were administered.,. At nine months of age, he  received his first dose of MMRVvaccine. At one year of age, he received his first dose of Hepatitis A vaccine. At 15 months of age, he received an annual dose of influenza vaccine and his fourth  doses of DTaP and PCV13 vaccine. At 18 months of age, the patient received his second dose of MMRV  vaccine and second dose of the Hepatitis A vaccine.

Family History:

Allergy history of dust exposure  is present on both sides of the family. The 27-year-old mother has hypertension while the 31-year-old father is healthy with no known significant health history. Amongst the grandparents, only the paternal 56-year-old grandmother has a medical history, which includes asthma.

Social History: The patient is a middle school student who lives in an apartment with both of his parents and two other siblings, aged nine and three respectively . His father is a truck driver while his mother is a registered nurse who practices in a nearby hospital. They keep no pets but the father smokes cigarettes. The patient actively participates in sporting activities with his colleagues. The patient wears a seatbelt while in the car for safety. The patient eats a Mediterranean diet  rich in fruits and vegetables The Pediatric Case Study Assignment Paper.

Review of Systems (ROS):

GENERAL: The patient denies fatigue, dizziness, or a change in weight but does report  intermittentinstances of a headache and a fever.

HEENT: The patient rreports persistent headaches, rhinorrhea, and swelling in the eyes but denies issues with vision and hearing. He also denies tinnitus, sore throat, and difficulty with swallowing.

SKIN: The patient denies skin rashes and itchy skin .

CARDIOVASCULAR: The patient denies chest tightness or palpitation. He also denies any edema in his lower extremities.

RESPIRATORY: The patient denies breathing difficulties and accessory muscle use. Self-reported persistent cough present for seven days.

GASTROINTESTINAL: The patient denies nausea, vomiting, and diarrhea but reports a loss of appetite.

GENITOURINARY: The patient denies dysphoria, dysphagia, and urinary incontinence.

NEUROLOGICAL: The patient denies dizziness, fainting, loss of consciousness, or tingling in all extremities. He denies losing control of his bladder or bowels.

MUSCULOSKELETAL: He denies muscle or joint pain. He denies issues with his gait.

HEMATOLOGIC: He denies petechiae, abnormal bleeding, or bruising.

ENDOCRINOLOGIC: He denies fatigue, weakness, and any abnormal sensitivity to cold or hot substances.

Objective

Physical Examination

General: The boy is attentive, organized, well-groomed, talkative, and lively. He appears to be a healthy weight and appropriate height for his age.

Vital Signs: BP:100/63 mmHg; HR:84 bpm; RR: 20 bpm; T: 100.22 ⁰F; Wt. 21.6 kg (31.3 lbs.); Ht. 110.1 cm; BMI 17.8 kg/m2

HEENT: The head is atraumatic and normocephalic without tenderness or scarring. The fontanelles have already closed. Peri-orbital edema was noted bilaterally. No cerumen impaction or otorrhea were noted. The tympanic membrane is pearly-grey in color, translucent, and shiny in appearance with  the cone of light being located in the five o’clock position when viewing the right tympanic membrane and in the seven o’clock position when viewing the left tympanic membrane. Hearing is noted to be intact with good acuity to whispered voice equal bilaterally. The pupils are equal, round, and reactive to light and accommodation. The mouth revealed good dentition. No significant nasal discharge was evident upon inspection.

Cardiovascular: No distention of the carotid artery upon inspection. Heart rate and rhythm are normal with 2+ strength.   S1 and S2 are audible with no additional heart sounds heard such as murmurs, gallops, or rubs.

Respiratory: The chest wall was noted to be symmetrical with an  anteroposterior to transverse diameter ratio of about 1:2. Lung sounds were clear in all lobes bilaterally with no adventitious sounds heard such as  rales, rhonchi, or wheezes. No signs of respiratory distress were noted. The Pediatric Case Study Assignment Paper

Musculoskeletal: Good muscle tone, muscle strength, and normal reflexes were noted in all four limbs. No swelling or erythema were noted in any limbs.

Genitourinary (GU): No signs of infection, lumps, lesions, or discharge were noted in his external genitalia _. Both of his testes are well descended into the scrotum and palpable with no cryptorchidism. The urine sample is unremarkable.

Gastrointestinal (GI): On inspection, there is no discernible distension of the abdomen. Percussion reveals no abnormalities. Clear bowel sounds can be heard on auscultation in all four quadrants. No tenderness or organ enlargement were palpated.

Development exam findings

The patient appears to be physically strong and psychosocially developing  well for his age. His height and weight are within a normal BMI range. The patient’s vision and hearing are  unremarkable. He can ambulate, run, and hop with ease. His cognitive aptitude, including his ability to count and distinguish basic shapes and colors is unremarkable. He has an excellent memory and can recall recent and previous conversations. His vocabulary is suitable for his age. He is capable of speaking in complete phrases and  holding a full conversation. He has exhibited a knack for following instructions. The patient is friendly and outgoing. He can communicate his emotions and control his behavior. He appears to be content and well-adjusted for his age.

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Erickson’s theory of psychological development

Based on his age, the patient is in stage three of psychological development during, which children grow more assertive, curious, and inquisitive in their pursuit of knowledge (McLeod, 2023)The Pediatric Case Study Assignment Paper. He shows good initiative during the exam: the patient was eager to explore the examination room and engage with the examiner. He is intrigued by the many pieces of equipment used during the exam and wanted to know more about them. He also demonstrats assertiveness by making suggestions about how the exam could be conducted. He did, however, show signs of remorse throughout the exam when he knocked down one of the pieces of equipment used during the assessment.  He apologizes profusely and appears disturbed by the incident.

The patient is also in stage four  of psychological development, which occurs when children get a sense of competence and accomplishment from participation in school, sports, and other activities (McLeod, 2023). Throughout the examination, he had a strong sense of industry. The patient proudly presented his schoolwork and enthusiastically discussed his favorite subject. He constantly touts his achievements in sports and other extracurricular activities.

Diagnostic Tests and Results

Complete blood count with differentials (leukocytosis found).

C-reactive protein (found to be elevated).

Erythrocyte sedimentation rate (found to be elevated).

Anterior rhinoscopy (shows mucosal edema, obstructive polyps, and mucous crusting).

Plain sinus X-ray (indicates mucosal thickening and sinus opacity).

Throat swab for culture and sensitivity of the purulent post-nasal drip: result pending (Hammer & McPhee, 2018; Jameson et al., 2018)The Pediatric Case Study Assignment Paper.

Assessment

Differential Diagnoses

Rhinosinusitis

Rhinosinusitis (RS) is an inflammatory disorder of the paranasal and nasal sinus mucosae caused by bacteria or viruses. The clinical presentation of this disorder differs in children and adults. In children, this disorder is characterized by a cough, halitosis, irritability, poor energy, eye swelling, and thick, yellow-green postnasal (Hammer & McPhee, 2018; Jameson et al., 2018; Maaks et al., 2019)The Pediatric Case Study Assignment Paper. This disorder is subcategorized based on the duration of symptoms as acute, subacute, and persistent. . Acute RS may last up to one month, subacute, one to three months, and persistent RS will last longer than three months.

Streptococcus pneumonia, Haemophilus influenza, and Moraxella catarrhalis are common bacteria associated with acute bacteria rhinosinusitis (ABRS) (Jameson et al., 2018). In children, viral upper respiratory tract infections can advance to ABRS in some cases, while in other cases, progress to chronic RS. While radiological findings for viral and bacterial RS have some similarities, ABRS can be distinguished based on a number of factors including: persistent upper respiratory tract symptoms being present for more than 10 days,  cough or nasal discharge or both, fever, and purulent nasal discharge spanning more than three successive days correlated with facial pain or headache (Hammer & McPhee, 2018; Jameson et al., 2018; Maaks et al., 2019).

Based on the patient’s history, physical examination, and vital signs, acute RS is the most likely diagnosis. The patient has been experiencing a persistent cough, headache, fever, and swelling around the eyes for seven days. The cough worsens at night, indicating  possible post-nasal drip. The swelling around the eyes, rhinorrhea, and allergy history suggests an allergic component to the illness. The presence of peri-orbital edema is also consistent with RS.

Pertinent positives: Nasal discharge, peri-orbital swelling, cough, fever, and mucosal inflammation as seen on plain sinus x-ray.

Pertinent negatives: Absent anatomical aberrations on rhinoscopy.

 Meningitis

Meningitis is an infection of the delicate membranes that surround the brain and spinal cord. Most frequently, a viral or bacterial illness that enters the cerebral spinal fluid is to blame. Meningitis can also be brought on by a parasite or fungi (Hammer & McPhee, 2018; Jameson et al., 2018). Fever, headache, stiff neck, sensitivity to light, drowsiness, and disorientation are symptoms of viral meningitis (Curtis et al.,2020). On the other hand, symptoms of bacterial meningitis include elevated temperature, excruciating headache, stiff neck, sensitivity to light, drowsiness, and confusion (Masuoka et al.,2022). According to Jameson et al. (2018), there may also be a rash, nausea, vomiting, and sore tongue. Meningitis is also a possible diagnosis owing to a complaint of headache and fever but other symptoms that are typical for meningitis such as a stiff neck, disorientation, and drowsiness were not evident in the case presentation.

Foreign body

Foreign bodies in the ear, sinuses, and throat are a prevalent concern in practice. Children in this exploratory developmental period frequently put items in their mouths, noses, and ears. According to Jameson et al. (2018)The Pediatric Case Study Assignment Paper, these children may have no symptoms or exhibit aberrant symptoms such as crying, generalized pain, refusing to eat, and having blood-stained saliva. Children who have a foreign body in their airway may have stridor, dyspnea, cough, hoarse voice, and throat pain. The presence of foreign objects in the body may also be manifested by recurrent aspiration pneumonia, headache, respiratory distress, inability to eat, dysphagia, vomiting, and wheezing. Based on the case presentation, this is a possible diagnosis owing to the patient’s report of cough, rhinorrhea, headache, and fever but it is ruled out because no blood-stained saliva, generalized pain, and instances of dyspnea were evident.

Primary diagnosis: Acute RS

Plan of care

Pharmacologic: Amoxicillin-clavulanate 20 mg per kg of body weight PO BID X 7/7 (Rosenthal & Burchum, 2018). Tylenol (acetaminophen) 100 mg/ 5 ml, 10 ml PO PRN X 3/7 (Rosenthal & Burchum, 2018). Sudafed nasal decongestant (pseudoephedrine HCl) 15 mg/ 5 ml, 10 ml INH QID X 10/7 (Rosenthal & Burchum, 2018).

Non-pharmacologic treatment: Encourage plenty of rest; drink plenty of fluids; apply a warm compress to the nose and forehead; and use warm, moist air inhalations (Mayo Clinic, 2021).

Patient Education and Anticipatory Guidance: Medication should be kept where the children cannot reach them. The mother should look out for medication side effects as well as signs and symptoms such as breathing difficulty for safety. The child should be given sufficient fluids and a diet rich in fruits and vegetables (AAP, 2017; Richardson, 2020)The Pediatric Case Study Assignment Paper. The patient and his mother need to be reminded about the importance of completing the entire course of antibiotics. The patient’s family should be advised against exposing the patient to known allergens that may trigger the patient’s symptoms. His father should be cautioned against the first and second-hand harmful effects of cigarette smoking on the entire family.

Follow-Up: Schedule a follow-up in one week to assess the patient’s response to prescribed medication and monitor for adverse effects. The patient’s mother is to return to the patient to the clinic at anytime for further help if the patient’s symptoms persist beyond one week despite drug use or worsen .

References

American Academy of Pediatrics [AAP]. (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents. (4th ed.). APA.

Battisti, A.S., Modi, P., & Pangia, J. (2022). Sinusitis. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK470383/#:~:text=Differential%20Diagnosis&text=Tension%20headaches%2C%20vascular%20headaches%2C%20foreign,mistaken%20for%20sinusitis%5B9%5D

Centers for Disease Control and Prevention [CDC]. (2023). Child and adolescent immunization schedule. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

Curtis, S., Stobart, K., Vandermeer, B., Simel, D. L., & Klassen, T. (2010). Clinical features are suggestive of meningitis in children: A systematic review of prospective data. Pediatrics, 126(5), 952-960. https://doi.org/10.1542/peds.2010-0277

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine. (8th ed.). McGraw-Hill Education.

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds). (2018). . (20th ed.). McGraw-Hill Education.

Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylord, N.M., Driessnack, M., & Duderstadt, K.G. (2019). Burns’ pediatric primary care. (7th ed.). Elsevier.

Mayo Clinic. (2021). Acute sinusitis: Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/diagnosis-treatment/drc-20351677  The Pediatric Case Study Assignment Paper

Masuoka, S., Miyazaki, O., Takahashi, H., Tsutsumi, Y., Hiyama, T., Kitamura, M., … & Nosaka, S. (2022). Predisposing conditions for bacterial meningitis in children: What radiologists need to know. Japanese Journal of Radiology, 40(1), 1-18. https://link.springer.com/journal/11604

McLeod, S. (2023). Erik Erikson’s stages of psychosocial development. Simply Psychology. https://www.simplypsychology.org/Erik-Erikson.html

McLeod, S, (2023). Jean Piaget’s theory and stages of cognitive development. Simply

Psychology. https://www.simplypsychology.org/piaget.html

Richardson, B. (2020). Pediatric primary care: Practice guidelines for nurses. (4th ed.). Jones & Bartlett Learning.

Rosenthal, L.D., & Burchum, J.R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. Elsevier.

 Pediatric Case Study: SOAP Note Evaluation

Patient Information:

Initials: NM    Age: 6 y/o Gender: M Race: Caucasian

Subjective:

Chief complaint (CC): “Persistent cough.”

History of Presenting Illness (HPI): NM, 6-y/o Caucasian male patient presented to the clinic accompanied by his mother with a chief complaint of persistent cough that he has been having for seven days now.  The mother stated that the cough occurs throughout the day but worsens at night. She further stated that the cough is dry in nature and that she has also noted incidences of running nose, fever, and some swelling around his eye.  The patient has also been suffering from headache which his mother attempted to manage with acetaminophen 250mg PRN with minimal effect. Denies nausea, vomiting and diarrhea. The Pediatric Case Study Assignment Paper

Past Medical History (PMH):  denies any history of chronic illnesses or previous hospital admission.

Current medication: Acetaminophen 250mg PRN for headache.

Allergies:  NKDFA but reported allergic to pollen grain, dust and cigarette smoke.

Developmental Theory: Piaget:  Based on Piaget theory,  the patient cognitive development is in the preoperational period. Although he is growing normally, he has not yet used cognitive functions as would typically be anticipated: he thinks before acting but cannot yet apply concrete logic.

Immunizations: up-to-date. He received his first dose of Hepatitis B vaccine at birth, second dose at four weeks, and third dose at nine month. At 2nd month, he received his first dose of rotavirus, DTaP, PCV13, and IPV. At 4th month,  second dose of Dtap  PCV13 and at 6th month, 3rd doses of DTaP and PCV13. At 9th month, received 1st dose of Measles, mumps , rubella ( MMR) and Varicella vaccine. At 1 year, received 1st dose of Hepatitis A vaccine, . At 15th month, received annual dose of influenza vaccine, and 4th doses of Dtap, and PCV13 vaccine. At 18th month, received, 2nd  dose of Measles, mumps , rubella ( MMR) and Varicella vaccine and 2nd dose of Hepatitis A vaccine. The Pediatric Case Study Assignment Paper

Family History:  Allergy history present on both sides of the family. The mother ( 27 y/o) : hypertension. The  paternal grandmother ( 56 y/o): asthma.  Father ( 31 y/o): healthy with no known significant health history.

Social History:  The patient is a middle school student who lives with both of his parent and two other siblings aged 9, and 3 respectively in their apartment. His father is a truck driver while his mother is a registered nurse, who practice in a nearby hospital. They keep no pets but the father smokes cigarette. He actively participate in sport activities with his colleagues. Wear seat-belt while in the car for safety. Eats healthy food rich in fruits and vegetable.

Review of Systems (ROS):

GENERAL:  patient denies changes in weight,  fatigue, and dizziness but reported instances of headache and fever.

HEENT: patient repeated persistent headache, running nose, swelling in the eye but denied issue with vision and hearing.  He also denied tinnitus, sore throat and trouble swallowing. The Pediatric Case Study Assignment Paper

SKIN: denied rashes, and itchiness on his skin.

CARDIOVASCULAR: the patient denies chest tightness or palpitation. He also denies any edema on his lower extremities.

RESPIRATORY: The patient denies difficulties with breathing, including wheezing but reported having cough that has persisted for seven days.

GASTROINTESTINAL: denies nausea, vomiting and diarrhea but reported loss of appetite.

GENITOURINARY: the patient denies dysphoria, dysphagia and urinary incontinence.

NEUROLOGICAL: the patient denies dizziness, fainting, losing consciousness, or tingling in extremities. Denies losing control of his bladder or bowels.

MUSCULOSKELETAL: denies muscle or joint pain. Denies issues with gait.

HEMATOLOGIC: denies petechiae, abnormal bleeding or bruising.

ENDOCRINOLOGIC: denies fatigue, weakness, and any abnormal sensitivity to cols or hot substances. The Pediatric Case Study Assignment Paper

Objective

Physical Examination

General : The boy is attentive, organized, well-groomed, talkative, and lively. He appears to be a healthy weight and height for his age.

Vital Signs : BP :100/63 mmHg HR :84 bpm; RR : 20 bpm; T: 100.22 ⁰F ; Wt. 21.6 kg (31.3 lbs); Ht. 110.1 cm; BMI 17.8 kg/m2

HEENT: The head is atraumatic and normocephalic without tenderness or scarring. Fontanelles have already closed. Peri-orbital edema noted bilaterally. No cerumen impaction or otorrhea noted. tympanic membrane is normal in appearance with normal landmarks and cone of light. Hearing is noted to be intact with good acuity to whispered voice. Pupils equal, round, and reactive to light and accommodation. Mouth revealed good dentition. No  significant nasal discharges was evident.

Cardiovascular: No distention of the carotid artery inspected.Heart rate and rhythm are normal. No audible murmurs, gallops, or rubs are auscultated. The patient S1 and S2 were audible and of normal intensity

Respiratory: The chest wall was noted to be symmetric and without deformity.Lung sounds were clear in all lobes bilaterally without rales, ronchi, or wheezes.No signs of respiratory distress noted.

Musculoskeletal: Good muscle tone  strength, and normal reflexes were noted in all four limbs.No swelling or erythema noted.

Genitourinary (GU):  No signs of infection, lumps, lesions, or discharge were noted. Both of his testes are well descended into the scrotum and palpable with no cryptorchidism. Urine sample is unremarkable.

Gastrointestinal (GI):  On inspection, there is no discernible distension of the abdomen. Percussion reveals no abnormalities. Clear bowel sounds can be heard on auscultation in all four quadrants. No tenderness or organ enlargement palpated The Pediatric Case Study Assignment Paper.

Development exam findings

The patient appears to be strong and developing normally. His height and weight are within the typical range. The patient’s vision and hearing are similarly normal. He can walk, run, and hop with ease. His cognitive aptitude, including his ability to count and distinguish basic shapes and colors, is good. He has an excellent memory and can recall recent and previous conversations. His vocabulary is suitable for his age. Capable of speaking in complete phrases and even holding a conversation. He also exhibited his knack for following instructions. The patient is friendly and outgoing. He is able to communicate his emotions and control his behavior. Looks content and well-adjusted.

Erickson theory  of psychological development

Based on his age, the patient is in stage 3 of psychological development, during which children grow more assertive, curious, and inquisitive in their pursuit of knowledge (McLeod, 2023)The Pediatric Case Study Assignment Paper. He showed a good initiative during the exam. The patient was eager to explore the examination room and engage with the examiner. He was intrigued by the many pieces of gadget used during the exam and wanted to know more about them. He also demonstrated assertiveness by making suggestions about how the exam could be conducted. He did, however, show signals of remorse throughout the exam when he knocked down one of the gadgets used during the assessment.  He apologize profusely and appear disturbed by the incident.

The patient is also in stage 4 of psychological development, which occurs when children get a sense of competence and accomplishment from participation in school, sports, and other activities (McLeod, 2023)The Pediatric Case Study Assignment Paper. Throughout the examination, he had a strong sense of industry. The patient proudly presented his schoolwork and enthusiastically discussed his favorite subject. He constantly touts about his achievements in sports and other extracurricular activities.

Diagnostic Tests and result

Complete blood count with differentials (leucocytosis found).

C-reactive protein (found to be elevated).

Erythrocyte sedimentation rate (found to be elevated).

Anterior rhinoscopy (shows mucosal edema, obstructive polyps, and mucous crusting).

Plain sinus X-ray (indicates mucosal thickening and sinus opacity).

Throat swab for culture and sensitivity of the purulent post-nasal drip: result pending (Hammer & McPhee, 2018; Jameson et al., 2018)The Pediatric Case Study Assignment Paper.

Assessment

Differential Diagnoses

Rhinosinusitis

Rhinosinusitis (RS) is an inflammatory disorder of the paranasal and nasal sinus mucosae. The clinical presentation of this disorder differs in children and adult. In children, this disorder is characterized by a cough, halitosis, irritability, poor energy, eye swelling, and thick, yellow-green postnasal (Hammer & McPhee, 2018; Jameson et al., 2018; Maaks et al., 2019). This disorder is subcategorised in acute, subacute, and persistent based on duration of symptoms. Rhinosinusitis can be cause by bacteria or viruses. Acute RS may last upto one month, subacute, 1to 3 months and persistent RS longer than three months.

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Streptococcus pneumonia, Haemophilus influenza, and Moraxella catarrhalis are common bacteria associated with Acute bacteria rhinosinusitis (ABRS) (Jameson et al., 2018). In children, viral upper respiratory tract infections can advance to ABRS in some cases, while other cases progress to chronic rhinosinusitis. While radiological findings for viral and bacterial Rhinosinusitis have some similarities, ABRS can be distinguished based on a number of factors including: persistent upper respiratory tract symptoms being present for more than 10 days, including cough or nasal discharge or both; fever, purulent nasal discharge spanning more than three successive days correlated with facial pain or headache (Hammer & McPhee, 2018; Jameson et al., 2018; Maaks et al., 2019)The Pediatric Case Study Assignment Paper.

Based on the patient’s history, physical examination, and vital signs, Acute rhinosinusitis is the most likely diagnosis. The patient has been experiencing a persistent cough, headache, fever, and swelling around the eye for seven days. The cough worsens at night, indicating a possible postnasal drip. The swelling around the eye, running nose, and history of allergies suggest an allergic component to the illness. The presence of peri-orbital edema is also consistent with sinusitis.

Positives: Nasal discharge, peri-orbital swelling, cough, fever, and mucosal inflammation as seen on Plain Sinus X-ray

Pertinent negatives: Absent anatomical aberrations on rhinoscopy.

 Meningitis

Meningitis is an infection of the delicate membranes that surround the brain and spinal cord. Most frequently, a viral or bacterial illness that enters the cerebral spinal fluid is to blame. Meningitis can also be brought on by a parasite or fungi (Hammer & McPhee, 2018; Jameson et al., 2018). Fever, headache, stiff neck, sensitivity to light, drowsiness, and disorientation are symptoms of viral meningitis (Curtis et al.,2020)The Pediatric Case Study Assignment Paper. On the other hand, symptoms of bacterial meningitis include high temperature, excruciating headache, stiff neck, sensitivity to light, drowsiness, and confusion (Masuoka et al.,2022). According to Jameson et al. (2018), there may also be a rash, nausea, vomiting, and sore tongue. Menigitis is also a likely diagnosis in this case owing to complaint of headache, fever but other symptoms that are typical for meningitis such as stiff neck, disorientation, and drowsiness were not evident in case presentation.

Foreign body

Foreign bodies in the ear, sinuses, and throat are a prevalent concern in practice. Children at this exploratory developmental period frequently put items in their mouths, noses, and ears. According to Jameson et al. (2018)The Pediatric Case Study Assignment Paper, these children may have no symptoms or exhibit aberrant symptoms such as crying, generalized pain, refusing to eat, and having blood-stained saliva. Children who have a foreign body in their airway may have stridor, dyspnea, cough, horse-voice, and throat pain. Presence of foreign object in the body may also be manifested by Recurrent aspiration pneumonia, headache, respiratory distress, inability to eat, dysphagia, vomiting and wheezing. Based on the case presentation, this is a likely diagnosis owing to client report of cough, running nose, headache and fever but rule out because no blood stained saliva, generalized pain, and instances of dyspnea was evident.

Primary diagnosis: Rhinosinusitis

Plan of care

Pharmacologic: Amoxicillin-clavulanate 20 mg per kg of body weight BD X 1/52 (Rosenthal & Burchum, 2018). Tylenol (acetaminophen) 100 mg/ 5 ml, 10 ml PRN X 3/7 (Rosenthal & Burchum, 2018). PO Sudafed nasal decongestant (pseudoephedrine HCl) 15 mg/ 5 ml, 10 ml by inhalation QID X 10/7 (Rosenthal & Burchum, 2018).

Non-pharmacologic Treatment. Encourage plenty of rest. Drinking plenty of fluids. Applying a warm compress to the nose and forehead and using Warm, moist air inhalations (Mayo Clinic, 2021)The Pediatric Case Study Assignment Paper.

Patient Education and Anticipatory Guidance: Medicines should be kept where the children cannot reach them. The mother should look out for medication side effects and signs and symptoms that may include a worsening of the condition. The child should be given sufficient fluids, and diet rich in fruits and vegetables (AAP, 2017; Richardson, 2020). The patient and his mother need to be enlightened on about the importance of completing the entire course of antibiotics. The patient family should be advised against exposing the client on known allergens that trigger the patient’s symptoms. His father should be cautioned against harmful effect of cigarette on the entire family.

Follow Up: Schedule for a follow-up in one week to assess the patient response to prescribed medication and to monitor adverse effect. Client mother to return to patient to the clinic anytime if client symptoms persist or worsen for further help.

References

American Academy of Pediatrics [AAP]. (2017). Bright futures: guidelines for health supervision of infants, children, and adolescents, 4th ed. APA.

Battisti, A.S., Modi, P., & Pangia, J. (2022). Sinusitis. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK470383/#:~:text=Differential%20Diagnosis&text=Tension%20headaches%2C%20vascular%20headaches%2C%20foreign,mistaken%20for%20sinusitis%5B9%5D

Centers for Disease Control and Prevention [CDC]. (2023). Child and adolescent immunization schedule. https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

Curtis, S., Stobart, K., Vandermeer, B., Simel, D. L., & Klassen, T. (2010). Clinical features suggestive of meningitis in children: a systematic review of prospective data. Pediatrics, 126(5), 952-960

Hammer, D.G., & McPhee, S.J. (Eds). (2018). Pathophysiology of disease: An introduction to clinical medicine, 8th ed. McGraw-Hill Education.

Jameson, J.L., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., & Loscalzo, J. (Eds) (2018). Harrison’s principles of internal medicine, 20th ed. McGraw-Hill Education.

Maaks, D.L.G., Starr, N.B., Brady, M.A., Gaylord, N.M., Driessnack, M., & Duderstadt, K.G. (2019). Burns’ pediatric primary care, 7th ed. Elsevier.

Mayo Clinic (2021). Acute sinusitis: Diagnosis and treatment. https://www.mayoclinic.org/diseases-conditions/acute-sinusitis/diagnosis-treatment/drc-20351677  The Pediatric Case Study Assignment Paper

Masuoka, S., Miyazaki, O., Takahashi, H., Tsutsumi, Y., Hiyama, T., Kitamura, M., … & Nosaka, S. (2022). Predisposing conditions for bacterial meningitis in children: what radiologists need to know. Japanese Journal of Radiology, 40(1), 1-18.

McLeod, S. (2023). Erik Erikson’s stages of psychosocial development. Simply Psychology. https://www.simplypsychology.org/Erik-Erikson.html

McLeod, S, (2023). Jean Piaget’s theory and stages of cognitive development. Simply

Psychology. https://www.simplypsychology.org/piaget.html

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