Primary care week 3 Questions

Annabelle is a 9 year old who comes with her mother today. Her mother states that Annabelle started out with a “runny nose” 3 days ago and then last night woke up during the night complaining of pain in her right ear. Mom took her temperature and it was 99.4 degrees oral. She gave her Tylenol and it came down to 98.0 degrees. Mom is concerned because Annabelle’s temperature typically runs 97.0 degrees and she tells you “For Annabelle, 99.4 degrees is a high fever”. Mom tells you that Annabelle is drinking well but does not want to eat. She has had a couple of loose stools this morning but no blood in her stools.
Currently, her vital signs are 99.1 oral, AHR 110, RR 18. She looks like she doesn’t feel good and is sitting quietly with a frown.

  1. What additional questions would you ask Annabelle and her mother today? –
  2. Do you agree with mom that 99.4 is a significant fever? Why or why not?
  3. What will your focused physical exam include?
  4. What will your focused physical exam include?
  5. When you look inside Annabelle’s right ear, you visualize what appears to be a piece of popcorn sitting in outer two-thirds of the external auditory canal. The canal is red and has swelled slightly but you can see around the kernel. TM appears gray. In deciding how to proceed, you think about your options. Should you irrigate the ear with water? Why or why not?
  6. Prior to any type of procedure, you have the mother sign an informed consent for a procedure. What are the three major areas you must discuss when doing any type of procedure?
  7. When removing a popcorn kernel from her ear, you seat Annabelle with the affected ear facing you. She is quite calm and cooperative. You decide to use a curette to try to get behind the kernel to pull it out. Why is it important to keep a hand resting on her head while using the curette?
  8. You remove the kernel from her ear! Since the EAC is quite swollen and red, and somewhat abraded from the curette, what might you prescribe for her? Please list the directions as you would put them in a prescription.
    The student should pick an appropriate otic topical antibiotic and list the directions appropriately.
  9. What would be your postprocedure education?
    Use all of the medication as prescribed; FU in one to two days; report headache, fever, drainage, and/or severe pain from ear.
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