Sample Answer for NUR-635 Topic 11 DQ 1 Included After Question
Jack is a 3-year-old male who presents with ear pain and fever for 36 hours. Jack weighs 32 pounds. On visual inspection, you notice middle ear effusion and a budging tympanic membrane. Based on the patient’s presentation, Jack is diagnosed with acute otitis media (AOM). Use the guidelines and relevant literature in your topic Resources to discuss the following:
Describe the diagnostic factors associated acute otitis media (AOM).
Briefly describe the bacteria associated with bacterial ear infections. Include which bacteria are associated with the highest prevalence and how these bacteria are classified (e.g., gram-negative, gram-positive, etc.)
Explain the factors associated when deciding to use antibiotic therapy versus observation.
Determine a treatment strategy for Jack; if choosing a pharmacologic approach include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication, including spectrum of coverage and mechanism of action.
Determine monitoring, side effects, and drug-drug interactions associated with each medication.
How would you address Jack’s pain associated with AOM?
In the event Jack presented with a bacterial eye infection in addition the ear infection, how would change your treatment plan? Explain your rationale.
American Association of Colleges of Nursing Core Competencies for Professional Nursing Education
This assignment aligns to AACN Core Competencies 1.2, 2.2, 2.5. 4.2, 6.4, 9.2
A Sample Answer For the Assignment: NUR-635 Topic 11 DQ 1
Title: NUR-635 Topic 11 DQ 1
Describe the diagnostic factors associated with acute otitis media (AOM).
Acute otitis media (AOM) is infection (bacterial or viral), inflammation, and fluid in the middle ear (Rosenthal & Burchum, 2021). Diagnostic criteria for AOM include sudden onset of signs and symptoms, middle ear effusion, and middle ear inflammation (Rosenthal & Burchum, 2021). Signs of a middle ear effusion are a bulging tympanic membrane with little mobility or a ruptured tympanic membrane with purulent drainage (Rosenthal & Burchum, 2021). Inflammation is indicated by pain and erythema of the tympanic membrane (Rosenthal & Burchum, 2021). AOM is often preceded by a viral respiratory infection, causing inflammation, swelling, and subsequent eustachian tube blockage (Rosenthal & Burchum, 2021).
Briefly describe the bacteria associated with bacterial ear infections. Include which bacteria are associated with the highest prevalence and how these bacteria are classified (e.g., gram-negative, gram-positive, etc.)
The most common bacterial causes of AOM are Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae (Rosenthal & Burchum, 2021). Haemophilus influenzae is the most common cause of bacterial AOM, accounting for 52% of cases (Rosenthal & Burchum, 2021). Haemophilus influenzae is a gram-negative coccobacillus (Centers for Disease Control and Prevention [CDC], 2022a). Moraxella catarrhalis is a gram-negative diplococcus commonly found in the respiratory tract (Murphy, 2023). Moraxella catarrhalis is the second most common cause of AOM (Rosenthal & Burchum, 2021). Finally, Streptococcus pneumoniae is a gram-positive, lancet-shaped anaerobic bacteria and is the third most common cause of AOM (CDC, 2022b; Rosenthal & Burchum, 2021).
Explain the factors associated with deciding to use antibiotic therapy versus observation.
Children should not automatically be prescribed antibiotics for AOM. The patients who should get antibiotics when AOM is suspected or diagnosed with AOM are infants less than six months of age, patients who are immune compromised, and patients with craniofacial abnormalities such as a cleft palate. AOM symptoms usually resolve in three days with or without antibiotics (Pelton & Tahtinen, 2023). Similarly, about 80% of AOM cases resolve without treatment within a week (Rosenthal & Burchum, 2021). When children are diagnosed with AOM, they should be treated for pain if it is present and monitored for 48 to 72 hours with a definitive follow-up appointment (Pelton & Tahtinen, 2023).
Determine a treatment strategy for Jack; if choosing a pharmacologic approach, include the drug, dose, frequency, and treatment length, and explain your rationale for choosing this medication, including spectrum of coverage and mechanism of action.
Jack’s treatment plan includes initial observation for the first 48-72 hours. A follow-up appointment will be made two to three days after the initial visit. Jack’s parents will be instructed to treat his pain with over-the-counter acetaminophen and ibuprofen (see dosages and recommendations below in the following question). If Jack’s symptoms do not improve by the follow-up appointment, Jack will be prescribed the following antibiotic:
Amoxicillin 45 mg/kg oral suspension by mouth BID for 10 days
Amoxicillin is the first line of therapy due to the common bacterial causes of AOM susceptibility to the drug (Lieberthal et al., 2013). Amoxicillin is a broad-spectrum penicillin that covers a variety of gram-positive bacteria and some gram-negative coverage (Bobak et al., 2022; Rosenthal & Burchum, 2021). Amoxicillin covers most streptococcus species (Bobak et al., 2022). According to the American Academy of Pediatrics (2013), Amoxicillin is the preferred treatment if the patient “has not received amoxicillin in the past 30 days or the child does not have concurrent purulent conjunctivitis or the child is not allergic to penicillin” (p. e980).
Determine monitoring, side effects, and drug-drug interactions associated with each medication.
Amoxicillin
Monitoring: Monitor for a hypersensitivity reaction, including a rash. If a rash develops, patients can have a skin test to check for a type-I hypersensitivity reaction (Bobak et al., 2022). The antibiotic class of penicillin is the most common cause of allergic drug reactions (Rosenthal & Burchum, 2021). Otherwise, laboratory monitoring is not indicated for short-term therapy with amoxicillin (Bobak et al., 2022).
Side effects: Amoxicillin is usually well tolerated. However, amoxicillin’s most common side effects are nausea, vomiting, and diarrhea (Bobak et al., 2022; Rosenthal & Burchum, 2021).
Drug-drug interactions: Amoxicillin use with probenecid may cause increased levels of amoxicillin (Evans et al., 2023). Oral anticoagulants with amoxicillin may increase bleeding time (Evans et al., 2023). Finally, the use of amoxicillin with oral contraceptives may decrease the efficacy of the contraceptives (Evans et al., 2023).
How would you address Jack’s pain associated with AOM?
Jack can be prescribed acetaminophen and ibuprofen on an alternating schedule for pain control. The recommendation for each medication is as follows:
Acetaminophen 160 mg PO Q6 hours as needed for pain
Ibuprofen 100 mg PO Q 6 hours as needed for pain
Giving clear instructions on over-the-counter dosing for weight-based pediatric medications is especially important. Patient education visual charts show a table of age, weight, and doses for acetaminophen and ibuprofen. Examples of acetaminophen and ibuprofen dosing from the American Academy of Pediatrics are shown below:
In the event Jack presented with a bacterial eye infection in addition to the ear infection, how would you change your treatment plan? Explain your rationale.
Amoxicillin is the first-line treatment in AOM. However, the presence of conjunctivitis indicates a more aggressive dual therapy treatment. According to the American Academy of Pediatrics (2013), “clinicians should prescribe an antibiotic with additional β-lactamase coverage for AOM and… has concurrent purulent conjunctivitis” (p. e980). The combination therapy includes high-dose amoxicillin-clavulanate at 90 mg/kg/day of amoxicillin and 6.4 mg/kg/day of clavulanate in two divided doses (Lieberthal et al., 2013).
Jack weighs 32 pounds or 14.5 Kg. The treatment plan is as follows:
Amoxicillin 45 mg/kg oral suspension PO BID for 10 days
Clavulanate 3.2 mg/kg oral suspension PO BID for 10 days
References
Bobak, A. J., Khanna, N. R., & Vijhani, P. (2022, August 8). Amoxicillin. StatPearls.https://www.ncbi.nlm.nih.gov/books/NBK482250/
Centers for Disease Control and Prevention. (2022a, March 4). Haemophilus influenzae. Centers
for Disease Control and Prevention. https://www.cdc.gov/hi-
disease/clinicians.html#:~:text=Haemophilus%20influenzae%20is%20a%20pleomorphic,that%2
0have%20distinct%20capsular%20polysaccharides.
Centers for Disease Control and Prevention. (2022b, January 27). Streptococcus pneumoniae:
Information for clinicians. Centers for Disease Control and Prevention.
Evans, J., Hanoodi, M., & Wittler, M. (2023, August 16). Amoxicillin clavulanate. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK538164/
Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D., Schwartz, R. H., Thomas, P. A., & Tunkel, D. E. (2013). The Diagnosis and Management of Acute Otitis Media. Pediatrics (Evanston), 131(3), e964-e999. https://doi.org/10.1542/peds.2012-3488
Murphy, T. (2023, August 9). Moraxella catarrhalis infections. UpToDate. https://www.uptodate.com/contents/moraxella-catarrhalis-infections
Pelton, S. I., & Tahtinen, P. (2023, September 8). Acute otitis media in children: Treatment. UpToDate. https://www.uptodate.com/contents/acute-otitis-media-in-children-treatment
Rosenthal, L. D., & Burchum, J.R. (2021). Lehne’s pharmacotherapeutics for advanced
practice nurses and physician assistants (2nd ed.). Elsevier. ISBN: 9780323554954
