Discussion: Evaluation and Management of HEENT Disorders
Pediatrics is a medical science branch dealing with the care of children, adolescents, as well as adults. Some common forms of HEENT disorders are ear infections, allergies, eye infections, inflammation, and infections in the nasal cavity. In study case 3, the patient named Marcus, who is eight years old, complains frontal headache for 36 hours, nausea, sore-throat, and fever that goes up to 102. He also has a decreased appetite, and his breath smells close to that of a puppy. For this disorder, due to the reduced appetite and the smell from the breath indicates that there is an infection around the nasal cavity. Doing a physical inspection of the patient will include; a detailed history from the start of the symptoms to know if there is a possibility of a history of seasonal symptoms, an association of the patient with allergies, environment around the patient, and any medications used to treat existing symptoms if any.
Differential Diagnoses
Strep-throat
This is an infection caused by a bacterial with A β-hemolytic streptococcus, which is identified in 20–37% of children with pharyngitis (Thai, Dale & Ebell, 2018). Patients with streptococcal pharyngitis always exhibit symptoms of nausea or vomiting, mostly in younger children, body aches, sore-throat, fever, headache, rash, swollen, tenderness of neck lymph nodes, inflamed tonsils, painful swallowing, and tonsillar exudates. Diagnosis is typically made through rapid antigen detection tests or throat culture (Kalra, Higgins & Perez, 2016).
Infectious Mononucleosis
This is a viral infection of the Epstein-Barr virus. The affected patients always present with swollen armpits and neck lymph nodes, swollen spleen, fever, headache, fatigue, sore-throat, and skin rash (Karla, Higgins, & Perez, 2016). The disease is referred to as “kissing disease” since its spreading is via saliva, and is common among teenagers and young adults (Cocuz & Cocuz, 2016).
Tonsillitis
This is tonsils inflammation, which is as a result of virus infection and sometimes by bacteria. It is more often on kids but can occasionally be contracted by adults. Patients with this disorder always present with the symptoms of sore throat, fever, cough, difficulty swallowing, tender lymph nodes, and headache (El Hennawi, Geneid, Zaher & Ahmed, 2017).
Primary Diagnosis
In this case study three, this patient likely has Streptococcal pharyngitis. This infection mostly happens in school-age children, affecting almost 1 in 10 children yearly, which the patient in this case study, meets all these predictors. The patient must have a “Rapid Strep Test” done, which includes swabbing of the throat, and if it is positive, the patient ought to be treated for streptococcal infection with antibiotics. But if the test is negative and the provider still suspects strep throat, then a throat culture might be ordered, by sending the throat swab to a laboratory for the presence of bacteria, but results might take up to two days (Watanabe et al., 2017).
Treatment and Management
The first-line antimicrobial recommended for streptococcal pharyngitis treatment is penicillin. The recommendable dosage is 250 mg, which is orally taken twice or thrice a day for two weeks (Watanabe et al., 2017). Penicillin is also given due to cost-efficacy, safety, and a narrower spectrum of activity. However, a daily dose of 50 mg/kg amoxicillin for ten days is sufficient for a child who cannot swallow pills due to its penicillin class and has better tastiness in suspension form. For people allergic to penicillin, 20 milligrams per kilogram twice daily for ten days of an oral Cephalexin is recommendable (Gottlieb, Long & Koyfman, 2018). Azithromycin 12 milligrams per kilogram once a day might be given if the patient has moderate penicillin sensitivity. For fever or pain, acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are recommended. Warm salt water gargles might also be recommended for relief of sore throat. Encouraged for plenty of fluids and plenty rest and eat soothing foods.
Patient Education, Health Promotion and Anticipatory Guidance
The patent and family should be educated that streptococcus pharyngitis commonly spread through direct person-to-person transmission. The patient is considered infectious until taking the antibiotic for twenty-four hours; so, the patient must be encouraged to avoid public exposure at school or work and daycare centers to prevent transmission (Gottlieb, Long & Koyfman, 2018). Someone might become sick if the person touches mouth, nose, or eyes after touching something with these droplets on it, or if drinks from the same glass or eats from the same plate as the infected person. The patient and family should be educated to finish and use medication as prescribed to prevent treatment failure and antibiotic resistance. They should be instructed to discard toothbrush because it can harbor Group A strep (Gottlieb, Long & Koyfman, 2018).
Based on his age, it is recommendable that Marcus should have received the following immunizations: diphtheria, pertussis, and tetanus, inactivated poliovirus, and Haemophilus influenzae vaccines. The next set of vaccinations for Marcus should occur at a child’s age of 9 to 10 years. The immunization that Jose should receive for the next visit includes diphtheria, tetanus, and whooping cough, HPV, Measles, mumps, and Influenza (Flu).
Conclusion
Most of the head, ear, nose, and throat (HEENT) infections account for most of the pediatric visits. These disorders can be associated with multiple symptoms and make it difficult to diagnose. One should be familiar with these signs and symptoms to avoid the wrong prescription, which may be dangerous or lead to some fatal allergic reactions. At this point, it requires specialist care.
References
Cocuz, M. E., & Cocuz, I. G. (2016). Infectious Mononucleosis in Children-Current Clinical and
Epidemiological Aspects. Bulletin of the Transilvania, 55-60.
El Hennawi, D. E. D., Geneid, A., Zaher, S., & Ahmed, M. R. (2017). Management of recurrent
tonsillitis in children. American Journal of Otolaryngology, 38(4), 371-374.
Gottlieb, M., Long, B., & Koyfman, A. (2018). Clinical mimics: an emergency medicine-focused
review of streptococcal pharyngitis mimics. The Journal of emergency medicine, 54(5), 619-629.
Kalra, M. G., Higgins, K. E., & Perez, E. D. (2016). Common Questions About Streptococcal
Pharyngitis. American Family Physician, 94(1), 24-31. Retrieved from https://www.aafp.org/afp/2016/0701/p24.html.
Thai, T. N., Dale, A. P., & Ebell, M. H. (2018). Signs and symptoms of group A versus non
group A strep throat: a meta-analysis. Family practice, 35(3), 231-238.
Watanabe, H., Goto, S., Mori, H., Higashi, K., Hosomichi, K., Aizawa, N., … & Horii, A. (2017).
Comprehensive microbiome analysis of tonsillar crypts in IgA nephropathy. Nephrology Dialysis Transplantation, 32(12), 2072-2079.