This child's subjective information includes sneezing, mild cough, and low-grade fever of
100 degrees for three days. The child has a history of having
... [Show More] only two incidents of URTI and no
other illnesses. Immunizations are all up to date. During the consultation, it would be
appropriate to ask about allergies, and any current medications the child might be taking. The
child is in preschool, not exposed to any smoking and has no other siblings at home. Asking
about any recent travel out of the country, and current and past health problems is essential. Ask
the parents if they have tried over the counter medications to treat the symptoms or notice any
alleviating or aggravating factors in the condition.
A complete assessment should be conducted with a review of symptoms. It would be
appropriate to check the ears, eyes, nose, and throat. Palpate the sinuses and feel for any swollen
lymph nodes. Listen to the heart and lungs, bowel sounds, assess the abdomen, skin, and spine.
Objective information includes redness to the throat is noted with no phlegm, pus, or drainage.
Tonsils appear normal. There are bilateral pink color tympanic membranes. Lung and heart
sound is typical. The rest of the exam was remarkable—vital signs T 99, R 20, P 100. The child
appears well-hydrated, is alert, cooperative, in good spirits.
According to the symptoms, the child may have an Upper Respiratory Tract infection.
The most common illness in childhood is upper respiratory tract infections (URTI), most acute,
and self-limited. Several infectious pathogens can cause URTI but mostly caused by respiratory
viruses. Every year a child has eight to ten URTIs that resolve on their own without any
treatment. Clinical symptoms in infants and children include sore throat, fever, cough, vomiting,
and rhinorrhea lasting seven to fourteen days and most common during the fall and wintertime
(Khan et al., 2020). According to Norris (2019), “Children are the major reservoir of cold
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viruses, often acquiring a new virus from another child in school or daycare" (p. 890). During a
URTI, the respiratory tract can be swollen and reddened. Some people may have headaches,
malaise, fever, and chills, which can be severe (Norris, 2019). Another differential diagnosis may
be that the child is experiencing allergies. Allergens can be medical, pharmaceutical, and
environmental. Some common allergens are dust mites, animal dander, pollen, and some
household chemicals causing irritation, inflammation, and redness to the respiratory tract (Norris,
2019). At this time, sinusitis, tonsillitis, asthma, and pneumonia can be ruled out because the
symptoms do not correlate with those diagnoses.
With an uncomplicated URTI, lab tests are usually not ordered if a child is healthy, and a
diagnosis is made clinically. Pediatricians can provide a nonpharmacological plan that includes
supportive treatment for symptom management of URTI, which provides for nasal saline
irrigation, increase fluid intake, humidification, and rest. Saline nasal irrigation can be used at
home with low positive pressure and does not harm the child. You would insert the saline in
through one nostril and should come out the other to help drain them out, also known as washing
or rinsing out the nasal cavity (Head et al., 2018). Eating a nutritious and healthy balanced diet
will keep the child well-nourished. The child should be taken out of daycare for a few days to
help prevent the spread of URTI. Parents should be counseled about URTI’s being self-limiting
course with no indications for antibiotic use unless there is deterioration (Khan et al., 2020).
Parents should monitor any sudden changes to their health, breathing, skin color, and appearance.
The CDC (2020), mentions that there are “recent estimates, more than a quarter and up to onehalf of all antibiotics prescribed in U.S. ambulatory care are inappropriate” (Turan et al., 2020, p.
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