Discussion:Urgent Care of Cough & Congestion

Discussion:Urgent Care of Cough & Congestion

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Discussion #1

Mr. JD is a 24-year-old who presents to Urgent Care with a 2-week history of cough and congestion. He says it started out as a “normal cold” and it will not go away. He has a productive cough for green mucous and has green nasal discharge. He says he has had a low-grade temperature for the past 2 days. John reports an intermittent frontal headache with this cold. He is otherwise healthy, with no known allergies. In his assessment it is found that his vital signs are stable, temperature is 99.9 degrees F, tympanic membranes (TMs) are clear bilaterally, pharynx is erythematous with no exudate; there is greenish postnasal drainage; turbinates are swollen and red; frontal sinus tenderness; no cervical adenopathy, and lungs are clear bilaterally.

Is there any additional subjective or objective information you need for this client? Explain. Additional subjective information I would collect includes whether there is facial pain while bending over, headache, halitosis, or toothache which are characteristics of acute bacterial sinus infection in combination with the previously reported symptoms (Caspersen, Walter, Walsh, Rosenfeld, & Piccirillo, 2015). I would also inquire information regarding occupational/environmental exposures and whether he has ever had these symptoms before.

Would you treat Mr. JDs cold? Why or why not? I would opt for “watchful waiting” for 7 days, and not prescribe antibiotics immediately. Acute bacterial sinus infections typically can resolve on their own (Rosenfeld, 2016), and reduces the likelihood of antibiotic resistance and/or side effects of the medication.

What would you prescribe and for how many days? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings. Would this treatment vary if Mr. JD was a 10 year-old 78 lb child? Amoxicillin clavulanate 500/125 mg orally every 8 hours or 875/125 mg orally every 12 hours should be initiated as a first-line therapy for 5 to 7 days (Chow, Benninger, Brook, Brozek, Goldstein, Hicks, Pankey…File, 2012). Amoxicillin is penicillin-like class of antibiotic, that works by stopping the growth of bacteria. Clavulanic acid is a beta-lactamase inhibitor that prevents bacteria from destroying amoxicillin (MedlinePlus, 2019). Amoxicillin clavulanate (Augmentin) is administered orally by tablet, chewable tablets, or by suspension (MedlinePlus, 2019). More than half of the amoxicillin and approximately 25% to 40% of the clavulanic acid are excreted unchanged in urine (U.S. National Library of Medicine, 2019). Half-lives of amoxicillin and clavulanic acid are roughly 1.3 hours and 1 hour, respectively in otherwise healthy adults that have normal renal function (U.S. National Library of Medicine, 2019). Contraindications for Augmentin include history of hypersensitivity to amoxicillin, clavulanate or to beta-lactam drugs such as penicillin, and/or in patients with a history of cholestatic jaundice/hepatic dysfunction that is associated with Augmentin (U.S. National Library of Medicine, 2019). The dosage for Augmentin would change for a pediatric patient. The dosage for a child weighing 40 kg or more is up to 1750mg/day of amoxicillin and up to 4000 mg/day of the XR tablets (U.S. National Library of Medicine, 2019).

What health maintenance or preventive education is important for this client based on your choice medication/treatment? There are several health maintenance topics and preventative education points to address with the patient. The patient should be educated on symptoms that patient should promptly report such as allergic reaction, headache with stiff neck or difficulty turning head (Mayo Clinic, 2019). Additionally, the patient should be instructed on side effects of medication which include nausea, diarrhea, tooth discoloration, and indigestion (Mayo Clinic, 2019). Finally, the patient should be educated on prevention which include good hand hygiene, avoiding ill contacts, using a humidifier, and avoiding air pollution.

Discussion #2

Discussion:Urgent Care of Cough & Congestion

Discussion:Urgent Care of Cough & Congestion

Mr. JD is a 24-year-old who presents to Urgent Care with a 2-week history of cough and congestion. He says it started out as a “normal cold” and it will not go away. He has a productive cough for green mucous and has green nasal discharge. He says he has had a low-grade temperature for the past 2 days. John reports an intermittent frontal headache with this cold. He is otherwise healthy, with no known allergies.

In his assessment it is found that his vital signs are stable, temperature is 99.9 degrees F, tympanic membranes (TMs) are clear bilaterally, pharynx is erythematous with no exudate; there is greenish postnasal drainage; turbinates are swollen and red; frontal sinus tenderness; no cervical adenopathy, and lungs are clear bilaterally.

1. Is there any additional subjective or objective information you need for this client? Explain. The additional subjective information should include, his past and present medical history. This should be comprehensive. Such as, any history of asthma, emphysema, chronic or acute bronchitis and cardiac issues to name a few. His history of current medications should be discussed. Also has JD had any wheezing, SOB or chest pain associated with his “normal cold”? It’s important to determine if he has taking any medications to help with symptoms. A current set of vital signs should be obtained.

Discussion:Urgent Care of Cough & Congestion

2. Would you treat Mr. JD’s cold? Why or why not? Yes I would treat Mr. JD. Cold symptoms typically peak after three to five days and then improve over the next week. A sinus infection can stick around longer. A runny nose, stuffy nose or sinus pressure that lasts for more than 10 days, suspect an infection. Yellow or green mucous is indicative of a sinus infection (Woodard, 2016, p. 1).

3. What would you prescribe and for how many days? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings. According to research, Amoxicillin 500 mg q8h for 10–14 days or until 7 days after symptom-free (may need 21 day of treatment) is the first choice for non-penicillin allergic patients (Woo & Robinson, 2016, p. 1257). Amoxicillin has similar bactericidal action as penicillin. It acts on susceptible bacteria during multiplication stage by inhibiting cell wall mucopeptide biosynthesis. The superior bioavailability and stability to gastric acid and has broader spectrum of activity than penicillin. This medication is metabolize in the liver and excreted through urine. The half-life of Amoxicillin in adults is 0.7-1.4 hr (“Medscape,” 2019, p. 1). Black box warnings consist of, anaphylactic/hypersensitivity and super infection from prolonged use. Such as, fungal or bacterial infections and C. difficile-associated diarrhea to name a few (“UpToDate,” 2019, p. 15).

4. Would this treatment vary if Mr. JD was a 10 year-old 78 lb child? Include the class of the medication, mechanism of action, dosing, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings Children and infants older than 3 months of age weighing less than 40 kg, dosing is based on body weight. The usual dose is 20 to 40 milligrams per kilogram (kg) of body weight per day, divided and given every 8 hours, or 25 to 45 mg per kg of body weight per day, divided and given every 12 hours (“Medscape,” 2019, p. 5). The class of drug is penicillin (Amoxicillin) is the first choice for non-penicillin allergic patients including children. Amoxicillin similar bactericidal action as penicillin. It acts on susceptible bacteria during multiplication stage by inhibiting cell wall mucopeptide biosynthesis. The superior bioavailability and stability to gastric acid and has broader spectrum of activity than penicillin. This medication is metabolize in the liver and excreted through urine. The half-life of Amoxicillin in children is 61.3 mins. The black warnings consist of Amoxicillin rash occurs in 5% to 10% of children receiving amoxicillin. Infectious mononucleosis, acute lymphocytic leukemia, or cytomegalovirus infection increases risk for amoxicillin-induced maculopapular rash. Amoxicillin-class antibiotics are not recommended in these patients (“UpToDate,” 2019, p. 15).

5. What health maintenance or preventive education is important for this client based on your choice medication/treatment? Nonprescription management includes decongestants, either topical or systemic, to improve nasal obstruction. Mr. JD should be warned against long-term use of topical decongestants, but they can be very helpful in providing symptomatic relief during the few days it takes to respond to antibiotics. Saline nasal spray or wash prevents crusting of secretions in the nasal cavity, facilitating removal of secretions. Increase fluid intake to help liquefy secretions. The facial pain and headache associated with sinusitis can be severe, and the patient should be encouraged to take acetaminophen or ibuprofen for pain. A warm pack to the frontal and maxillary sinuses often provides pain relief, humidifier air at night, can alleviate the dry mouth caused by mouth breathing during sleep. Breathing in hot steam often helps clear nasal passages, but caution patients about burns (Woo & Robinson, 2016, p. 1258).

Discussion:Urgent Care of Cough & Congestion

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

ADDITIONAL INSTRUCTIONS FOR THE CLASS

Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source.
One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.
Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies.
Participation posts do not require a scholarly source/citation (unless you cite someone else’s work).
Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.
APA Format and Writing Quality

Familiarize yourself with APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required).
Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation.
I highly recommend using the APA Publication Manual, 6th edition.
Use of Direct Quotes

I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.
LopesWrite Policy

For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.
Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?
Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.
Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.
If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.
Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.