The patient is a 4-year-old male delivered to the primary care office by his father, Mr. Smith. The major complaints are sneezing, mild cough, and low-grade fever. At the moment of his physical examination, almost all vital signs and systems are within normal limits, including his good spirit, clear lungs, and tonsils. The patient is well-hydrated, cooperative, and alert, but his temperature is 99 (it was 100 three days ago), and he has a mildly erythemic throat. The father is the only sibling in the non-smoking household, and his employment covers the insurance for the boy. He expects the prescription of antibiotics so the son can visit his preschool the next day. The patient’s diagnosis needs to be thoroughly discussed to create an effective treatment plan with pharmacologic and non-pharmacologic interventions and provide Mr. Smith with information about his son’s condition.
Considering that the boy has all immunizations and lives in a safe environment (free from smoking and other harmful exposures) but visits a preschool, a virus can be a reason for his health problem. Infections with viruses are common in the respiratory tract of a child (van Doorn & Yu, 2019). The child has mild throat redness (sore throat or pharyngitis) and sneezing, which are the signs of a common cold, and a history of two upper respiratory tract infections (URIs). Excluding such risk factors as passive smoking and medical disorders, attention should be paid to possible close contact with infectious children in a preschool (Tazinya et al., 2018). There could also be anatomical anomalies because the child has already been diagnosed with the same disease several times. Regarding the presenting symptoms, differential diagnoses like rhinitis, pneumonia, and sinusitis emerge, but they can be ruled out because of the absence of other critical signs. The child does not have a runny nose, which is inherent to rhinitis or sinusitis, and his lungs are clear, which is impossible for pneumonia. A URI is a diagnosis to be treated pharmacologically and non-pharmacologically.
When a child is diagnosed with a common cold or URI, the main goal of treatment is to manage the symptoms, predict complications, and relieve disturbing pain. According to Amin et al. (2022), increased antibiotic consumption is commonly observed in adults and children with URIs, which might lead to antimicrobial resistance. However, it is wrong to neglect the impact of pharmacologic treatment if patients need urgent recovery. Besides, several non-pharmacologic recommendations can be given to stabilize the patient, prevent acute infections, and maintain physiological and emotional comfort.
The patient’s diagnosis is not related to a bacterial infection, which proves the necessity to avoid using antibiotics. Today, it is possible to take a rapid test for biomarkers and identify if a bacterial or viral infection is a cause of the disease to predict inappropriate antibiotic usage (van Doorn & Yu, 2019). Thus, a pharmacological treatment plan aims to relieve pain and cough signs, manage fever, and not expose the patient to unnecessary medications. Ibuprofen or acetaminophen can be prescribed to reduce fever in a short period. Antihistamines are necessary for their antispasmodic and antitussive characteristics to treat cough in children (Lam et al., 2021). In treating URIs, nasal sprays, vapor rubs, and cough syrups are not dangerous for young children. However, most of them are over-the-counter, and it does not take much time or effort to purchase them (Lam et al., 2021). However, the father of the patient has already shown his desire to use antibiotics to speed up the healing process, which is not recommended for pediatric patients. Thus, clear prescriptions and medicines should be identified and explained to the patient and his parent.
In addition to effective medications, several non-pharmacological interventions and recommendations should be offered to support the patient’s body. Lifestyle changes should be promoted to help the child stabilize his physical health. Thus, rest, plenty of fluids, adjusted room temperatures, and humidity are examples of immediate changes. If the boy is not allergic, it is possible to offer him honey with milk at least three times a day. This non-pharmacological product contains the necessary amount of sugar, amino acids, and vitamins and completes certain antibacterial, antiviral, and anti-inflammatory functions (Lam et al., 2021). A virus can be easily spread to others or become aggressive, and it is better to isolate the patient for several days, follow simple hand hygiene rules, and check all vital signs regularly. If the patient wants to sleep more often compared to his ordinary habits and routines, the father should allow this possibility. Alternative medicines like taking vitamins, eating healthy food, and drinking herbal teas are other options in the current treatment plan.
Communication between a nurse, a child, and a parent plays an important role in promoting fast recovery and healing. As a primary care provider, the father should be informed about lifestyle changes and the importance of rest in his son’s life for the next week. Communication should not contain threats or assaults concerning the father’s intention to send the boy to a preschool. Kind and thoughtful explanations should be given to the father, including the possibility of taking sick leave or hiring a care provider at home. There is no need for hospitalization, and all care is home-based. Thus, a safe and supportive environment must be established to prevent the progress of infections and bacteria. Finally, the father has to understand that as soon as the deterioration of the boy’s health is observed, an immediate hospital visit is obligatory.
Resources for Additional Information
To provide the father with credible resources about the boy’s condition, a nurse can use several ideas. First, there are many scholarly articles that explain antibiotic over prescription and the necessity to avoid these medications in pediatric care. There are also many guidelines for parents and patients to follow when they face URIs. Finally, all treatment decisions are based on recent verified studies, and the parent can find more alternatives in free databases. Mr. Smith should understand that his role in supporting and treating his child is vital. Doctors and nurses are responsible for examining, diagnosing, and developing effective treatment plans. The father should follow these recommendations instead of prioritizing personal decisions.
In general, the condition of the child is not critical at the moment of his primary visit to a healthcare facility. The diagnosis has been given with respect to the father’s information, the patient’s symptoms, and the overall evaluation. Pharmacologic and non-pharmacologic interventions have been offered as a part of a treatment plan. Communication with the parent should not be neglected because this form of cooperation allows them to pose questions and give clear answers. Sometimes, healthcare providers cannot understand parental needs and obligations, but when the child’s health has to be improved, only the best decisions are made and explained.
Amin, M. T., Abd El Aty, M. A., Ahmed, S. M., Elsedfy, G. O., Hassanin, E. S., & El-Gazzar, A. F. (2022). Over prescription of antibiotics in children with acute upper respiratory tract infections: A study on the knowledge, attitude and practices of non-specialized physicians in Egypt. PloS One, 17(11).
van Doorn, H. R., & Yu, H. (2019). Viral respiratory infections. In E. Ryan, D. Hill, T. Solomon, N. Aronson, & T. Endy (Eds.), Hunter’s tropical medicine and emerging infectious diseases (10th ed., pp. 284-288). Elsevier.
Lam, S. H., Homme, J., Avarello, J., Heins, A., Pauze, D., Mace, S., Dietrich, A., Stoner, M., Chumpitazi, C. E., & Saidinejad, M. (2021). Use of antitussive medications in acute cough in young children. Journal of the American College of Emergency Physicians Open, 2(3).
Tazinya, A. A., Halle-Ekane, G. E., Mbuagbaw, L. T., Abanda, M., Atashili, J., & Obama, M. T. (2018). Risk factors for acute respiratory infections in children under five years attending the Bamenda regional hospital in Cameroon. BMC Pulmonary Medicine, 18(1).