Homework answers / question archive /  DATAChief Complaint: HPI: Medications:AllergiesPMH:   FH: SH:  ROS: O: PE: HEENTEars: Nose:   "Ear ache"   8 year old presents with right ear otalgia for past 24 hours

 DATAChief Complaint: HPI: Medications:AllergiesPMH:   FH: SH:  ROS: O: PE: HEENTEars: Nose:   "Ear ache"   8 year old presents with right ear otalgia for past 24 hours

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 DATAChief Complaint: HPI: Medications:AllergiesPMH:   FH: SH:  ROS: O: PE: HEENTEars: Nose: 

 "Ear ache" 

 8 year old presents with right ear otalgia for past 24 hours. Previous URI symptoms prior to this last week. Mother affirms fever, even though she has no thermometer at home. Pain is 8/10 and has interfered with sleep. Tylenol has provided some relief. Dry cough present. Nasal stuffiness present with positive green nasal discharge. Denies sinus pain or headache. Denies stiff neck, body aches, SOB, rash, sore throat, or diarrhea. Appetite and fluid intake adequate. No history of previous ear infections. No sick contacts.  Tylenol PRN (last dose yesterday). : NKDA

No history of asthma, previous ear infections or treatment with antibiotics. Immunizations UTD

Non contributory.  Doing well is school, lives with parents and 1 sibling in a non smoking household.

noncontributory other than what is noted in the HPI.

 BP 98/50 HR 90  RR 20 Temp 99.4 F , Weight 57 lbs. 

  Healthy appearing, well nourished, 8 year old in NAD noted playing in toy room. :  Eyes without erythema or discharge. External canals pink without swelling or debris. Right TM is intact, red, and bulging with no discharge. Bony landmarks are obscured. Light reflex is absent. Positive right mastoid tenderness. Left TM is intact with positive light reflex. Hearing is intact. Weber lateralizes to the right ear. Rinne AC > BC. Turbinates +2 with green discharge, no polyps, septum intact. No sinus tenderness. Throat: Tonsils are pink, + 3, without exudates.  Pharynx with mild erythema. Neck: No cervical adenopathy. Heart and Lungs: S1, S2, RRR without murmur or extra heart sounds. Lungs CTA. Abdomen: Soft, no abdominal pain, masses, HSM, or CVAT. No edema. Skin: no rash. Neuro: Alert and oriented.

 Assessment and Diagnosis:  ACUTE OTITIS MEDIA

Question:

1.     In this assignment, please choose an antibiotic for the situation and the diagnosis. In practice, make sure you have an indication for an antibiotic and don't prescribe them for viral infections. Provide comfort measures to treat the symptoms such as analgesics, decongestants, antitussive agents, saline rinses and so on.

 

2.     Write ONLY the Prescription with refill or not. Use only the Sanford Guide for your antibiotic selection and dosage for this assignment. Use the "first line agent" in the Sanford Guide unless there are compelling reasons to do otherwise. The Infectious Disease Society of America (IDSA) and the American Association of Pediatrics (AAP) have guidelines that don't always agree. Epocrates will also have differing doses. Please keep your eye out for new guidelines and use them as a "guide" to help make a decision based on each situation. 

3.     Show all of your math and state the result in  mg/kg/day.