Week 6
Yosyp Martynyak
St. Thomas University
NUR-507 CLINICAL ADVANCED FNP PEDIATRIC
Dr. Fuentes
This week at the Pediatric clinical rotation was last week. It was a very informative and beneficial rotation for me. I never worked before with pediatric patients, and I learned a lot during the last 6 weeks. My preceptor guided and taught me all skills to become an expert in the pediatric field.
This week our patient was 11 years old male who came to the clinic with his parents complaining of a sore throat, difficulty swallowing and fever for the last 3 days. Symptoms started after the patient began going to the summer camp and got worse yesterday, which is why they decided to go to the clinic for evaluation. The vital signs for this patient are BP 102/62, HR- 85, RR-17, temp 101.4 F, weight 90 lb., height 4’4″, pulse ox 93% on room air. The patient is alert and oriented to the time and situation. The patient said that his pain is 6 out of 10, and pain is boosting during swallowing and coughing. The patient’s mother said she gave him Advil when his fever was higher than 101 F. During the visual assessment of the throat, and his tonsils were swollen and covered with yellowish discharges bilaterally. I ordered a throat swab, throat culture, CBC, and BMP for this patient to determine the cause of the inflammation of the pharynx and tonsils. Acute pharyngitis is one of the most typical illnesses for which children visit primary care providers. Viruses cause most cases of acute pharyngitis in children and are benign and self-limited. Group A beta-hemolytic Streptococcus is the most essential of the bacterial causes of acute pharyngitis. Viruses are the most expected cause of acute pharyngitis in kids. Respiratory viruses, such as influenza, parainfluenza, rhinovirus, coronavirus, adenovirus, and respiratory syncytial virus, are frequent causes of acute pharyngitis. Group A beta-hemolytic streptococcus GAS is the most common bacterial cause of acute pharyngitis, accounting for 15% to 30% of cases of acute pharyngitis in children (Arnold, 2018). We prescribed antibiotics for this patient because the rapid Streptococcus test returned positive. Multiple antimicrobial agents have been shown to be effective in treating group A beta-hemolytic streptococcal pharyngitis, including amoxicillin and numerous cephalosporins, macrolides, and clindamycin. When choosing an antimicrobial for the therapy of group A beta-hemolytic streptococcal pharyngitis, it is essential to consider efficacy, safety, antimicrobial spectrum (narrow versus broad), dosing schedules, compliance, and cost (Dooling, 2019). Since this was the first time this patient gets diagnosed with a Strep infection, we prescribed him Amoxicillin 50 mg/kg once daily for 10 days. The differential diagnosis for GAS pharyngitis is:
Influenza- almost identical symptoms, ruled out after rapid strep
RSV -can be ruled out after a throat culture or rapid test
Abscess in the throat – local infection of the oral cavity.
To prevent Streptococcal pharyngitis in future, this patient has to be educated about the importance of hand hygiene and how to cover the mouth with cough and sneezing. Also, the patient and his parent have to know how to take antibiotics and how important to finish all doses of the medication. Parents have to ensure their son has all vaccines up to date because it can prevent infection in future and decrease the chances of developing severe consequences.
This week at clinical rotation, I gained more experience in the Pediatric field, which will be very beneficial in my Nurse Practitioner carrier. It is the last week of clinical, but I learned a lot of skills and knowledge for my future professional practice.
References:
Arnold, J. C., & Nizet, V. (2018). Pharyngitis. Principles and Practice of Pediatric Infectious Diseases, 2, 202-208.e2. https://doi.org/10.1016/b978-0-323-40181-4.00027-x
Dooling, K. L., Shapiro, D. J., & Van Beneden, C. (2019). Overprescribing and Inappropriate Antibiotic Selection for Children With Pharyngitis in the United States, 1997-2010. JAMA Pediatrics, 168(11), 1073. https://doi.org/10.1001/jamapediatrics.2014.1582
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