week 3 response 1

Case Scenario 4: Tony

3-year-old who is brought to the clinic by his parents for right ear pain and a fever of 101 for the past 2 days. His mother says he was coughing and had a runny nose 5 days earlier. On exam, he has a bulging TM. He attends daycare. His past history is significant for Type I Penicillin allergy, and he is up to date on his immunizations. He weighs 33 pounds.

What physical exam components should the APRN perform?

Ear exam with an otoscope in addition to supporting signs and symptoms, is sufficient for the diagnosis of Acute Otitis Media (Danishyar & Ashurst, 2023). According to the AAP guidelines, Tony has evidence of bulging of the tympanic membrane with new onset of ear pain, fever, and respiratory tract symptoms, which correlate with the diagnosis of AOM (AAP, 2013).

How should the APRN manage Tony?

The goal of treatment is to control pain and treat the infectious process with antibiotics.

Pain: Ibuprofen 10mg/kg every 6-8 hours, maximum of 40mg/kg/day.

For Tony, give 5ml (100mg/5ml formulation) every 6-8 hours

Abx: Penicillin is first line for AOM but due to his IgE-mediated reaction, an alternative is Azithromycin 10mg/kg on the first day, then 5mg/kg on days 2-5, maximum 500mg/day 1 and maximum 250mg for days 2-5 (UpToDate, 2025).

For Tony, give 5ml (100mg/5ml formulation) on day one and 2.5ml on days 2-5.

What education should the APRN provide to Tony's parents?

Parents should be informed about the pathophysiology of AOM, which commonly occurs after URI and in children due to their anatomy. Children have horizontal ear canals that inhibit proper drainage of fluid, unlike adults.

Parents should be educated on the importance of hand hygiene, PCV13 and influenza vaccines for the prevention of upper respiratory tract infections and the avoidance of tobacco smoke exposure. Important to take medication as prescribed for the entire

course, choosing a licensed day care facility, and follow up if symptoms do not resolve or worsen (Maaks et al., 2019).