Week 2 Assignment 1: iHuman Simulation
Introduction
The iHuman platform is an opportunity for you to interact with a simulated patient and gather data. When working in iHuman, practice as if this were a real patient. For example, the platform allows you to ask several questions when taking a patient history. In real life, you likely will be limited in time. Practice setting yourself a patient history time limit and work on being efficient in your clinical interview.
If you require technical support with the iHuman platform, use the iHuman Help Center to contact iHuman Technical Support directly. Technical support only includes a malfunction of the platform; they cannot help with issues involving content!
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Instructions
In this assignment, you will review a patient scenario in iHuman. Please see the course announcement for the case assigned this week. Your deliverable for this assignment is a paper based on the iHuman Soap Note Template (Word).
- Follow the requirements listed in the iHuman Soap Note Template.
- When your iHuman Soap Note Template is complete, upload it to this assignment.
All papers must conform to the most recent APA standards.
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Please refer to the Grading Rubric for details on how this assessment and plan is graded.
To Submit Your Assignment:
- Select the Add Submissions button.
- Drag or upload your files to the File Picker.
- Select Save Changes.
Assessment
- Otitis media is an ear infection that produces inflammation in the middle ear. The majority of middle ear infections result from a buildup of mucus in the middle ear caused by an infection such as a cold. Signs and symptoms include fever, being sick, and earache. In younger kids, signs that the baby has an ear infection include rubbing or pulling the ear, fussiness, lack of appetite, and sings of difficulty hearing. This is the primary diagnosis that the patient has otitis media since it represents most of the symptoms of otitis media and the severe bilateral bulging tympanic membranes seen on the exam (Mayo clinic, 2021).
- Pharyngitis is the most frequent cause of acute pharyngitis in children is a virus, but there can be bacterial cause, as well. Viral pharyngitis can go away on its own (Dunphy et al., 2019). The signs and symptoms include pain, swelling, and redness of the throat.
- Influenza is a viral infection that has an impact on the lungs’ airways. Signs and symptoms include sore throat, fever, running nose, and body ache. I ruled this out since the patient has negative test results.
- Croup iscommon in children between the age of 6 months and 3 years, and is caused by a virus. The main signs of croup are seals bark cough and laryngitis, which are not related to our patient.
Final Diagnosis: Otitis media
Plan
Pharmacology
Amoxicillin 80-90mg/kg/day in 2 divided dose for 10days
Acetaminophen 160 mg/5ml- 5ml every 4-6 hours as needed
Non-Pharmacology
Increase fluid intake
Clean humidifier
Cool mist vaporizer
Saline nasal spray
Diagnostics
Otoscopy during physical examination
Consults/Referrals
No referral needed
Patient education
Mother must be advised to keep the child’s vaccination up to date
Hand hygiene
Avoid smoking and tobacco use in front of the child
Importance of taking antibiotics on time for 10 days
Side effect of amoxicillin can cause diarrhea
Call the doctor if the child has allergic reaction which can cause skin rash, problems with swallowing, shortness of breath, or swelling of the face, hands, or mouth.
Follow Up
Whether or not antibiotics were recommended, your son’s symptoms should get better in 24 to 48 hours. Call your doctor or nurse for help if your child’s condition does not improve within 48 hours, or worsens at any time.
Even if your son may still have a fever and fussiness after taking antibiotics, his conditions should get better every day.
Contact the healthcare provider as soon as you can if your child seems sicker than before when he saw the pediatrician.
References
Johns Hopkins Medicine. (2022). Influenza. Retrieved January 11, 2023, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/influenza
Mayo Foundation for Medical Education and Research. (2021). Ear infection (middle ear). Mayo Clinic. Retrieved January 10, 2023, from https://www.mayoclinic.org/diseases-conditions/ear-infections/symptoms-causes/syc-20351616
Pelton, S., & Tähtinen, MD, PhD, P. (22AD). Otitis Media. UpToDate. Retrieved January 11, 2023, from https://www.uptodate.com/contents/ear-infections-otitis-media-in-children-beyond-the-basics
U.S. National Library of Medicine. (2022). Amoxicillin: Medlineplus Drug Information. MedlinePlus. Retrieved January 11, 2023, from https://medlineplus.gov/druginfo/meds/a685001.html
Wolford RW, Goyal A, Belgam Syed SY, et al. Pharyngitis. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519550/
Value: 100 points
Due: 7
Gradebook Category: Assignments—iHuman Assignments
Introduction
The iHuman platform is an opportunity for you to interact with a simulated patient and gather data. When working in iHuman, practice as if this were a real patient. For example, the platform allows you to ask several questions when taking a patient history. In real life, you likely will be limited in time. Practice setting yourself a patient history time limit and work on being efficient in your clinical interview.
If you require technical support with the iHuman platform, use the iHuman Help Center to contact iHuman Technical Support directly. Technical support only includes a malfunction of the platform; they cannot help with issues involving content!
Instructions
In this assignment, you will review a patient scenario in iHuman. Please see the course announcement for the case assigned this week. Your deliverable for this assignment is a paper based on the iHuman Soap Note Template (Word).
- Follow the requirements listed in the iHuman Soap Note Template.
- When your iHuman Soap Note Template is complete, upload it to this assignment.
All papers must conform to the most recent APA standards.
Please refer to the Grading Rubric for details on how this assessment and plan is graded.
To Submit Your Assignment:
- Select the Add Submissions button.
- Drag or upload your files to the File Picker.
- Select Save Changes.
Submission status
| Submission status | Submitted for grading |
|---|---|
| Grading status | Graded |
| Time remaining | Assignment was submitted 10 hours 15 mins early |
| Last modified | Sunday, 15 January 2023, 1:40 PM |
| File submissions | |
| Submission comments | Comments (0) |
Reflective Post
Differential Diagnoses
1. Acute viral sinusitis: A potential diagnosis for the patient is acute viral sinusitis. Acute viral sinusitis is caused by inflammation in the mucous membranes of the paranasal sinuses (Dunphy et al., 2019). The patient reports symptoms consistent with acute viral sinusitis, including the patient’s description of pain, which includes pain and a feeling of pressure in the facial region when bending forward (Dunphy et al., 2019). In addition to the description of pain, the patient reports a recent sinus infection 3 months ago, which is often seen with patients who have recurring sinusitis (Kwon & O’Rouke, 2022). The patient reports a history of sinus infections, the most recent being 3 months ago, though more information would need to be obtained to determine if this is a chronic sinusitis. The patient’s current reports of intermittent single or bilateral obstruction of the nares also supports the diagnosis of viral sinusitis (Dunphy et al., 2019). The patient also reports relief with hot showers, which can help drain the thick mucous and relieve both sinus and nasal pain (Dunphy et al., 2019). The patient also reports no improvement in symptoms with oral decongestants, which is suggestive of sinusitis (Dunphy et al., 2019).
2. Viral rhinitis: Viral rhinitis is an additional potential diagnosis for the patient, as viral rhinitis may present as nasal congestion and pain (Dunphy et al., 2019). The patient has reported symptoms of slight periorbital edema upon wakening, as well as some eye discharge. Eye drainage that is primarily stringy or watery is often associated with viral rhinitis, as well as forced mouth breathing, which the patient is exhibiting (Dunphy et al., 2019). It is important to note that the patient does not report a sore throat, sneezing, or itchy eyes, which can be seen in either viral rhinitis or allergic rhinitis (Dunphy et al., 2019). Because these symptoms are primary symptoms, it is less likely the patient is experiencing viral rhinitis; however, due to other presenting symptoms and history, it cannot be fully excluded.
3. Chronic rhinosinusitis with nasal polyps: While the patient is reporting an acute episode of sinus congestion and runny nose, the patient’s health history also supports potentially reoccurring episodes of likely sinusitis. Chronic sinusitis would indicate prolonged inflammation, inadequately treated infection, and 3 months of consecutive symptoms (Dunphy et al., 2019). A likely cause could include nasal polyps, as the patient is reporting signs of nasal inflammation, specifically nasal congestion and rhinorrhea (Bachert et al., 2021). Both symptoms are commonly seen in rhinosinusitis caused by nasal polyps (Bachert et al., 2021). The patient also reports symptoms of nasal occlusion, such as mouth breathing and partial or bilateral nasal obstruction (Dunphy et al., 2019). Nasal polyps would be ruled out if unidentified with nasal endoscopy (Bachert et al., 2021).
4. Hormone-related rhinitis: The patient is a transgender woman who reports a 10-year history of hormone suppressant therapy. Rhinitis can be a side effect of hormone therapy (Mullol et al., 2019). The patient reports subjective findings of nasal congestion and rhinorrhea, though again, the patient is not exhibiting other key findings in rhinitis, such as sneezing or an itchy nose, making exclusion of the diagnosis more likely (Yildiz, 2020).
Acute viral sinusitis
Pharmacological management: Pharmacological management of acute viral sinusitis includes use of normal saline spray to clear the sinuses (Dunphy et al., 2019). It would be beneficial to recommend as needed Tylenol (650 mg every 4-6 hours as needed), or ibuprofen (400 to 600 mg every 6 hours as needed) to optimize pain relief due to the pressure in the frontal and maxillary sinuses (Dunphy et al., 2019). Because the patient reports nasal blockage while sleeping, offering an expectorant like guaifenesin (200 to 400 mg every 4 hours as needed), may be useful to loosen sinus secretions and help to alleviate pressure and blockages caused by the secretions (Dunphy et al., 2019). Flonase should be prescribed, two sprays in each nostril daily for 2 weeks to help alleviate the inflammation (Dunphy et al., 2019).
Non-pharmacological management: Recommending a homemade preparation of a teaspoon of salt with 8 oz. of warm water to infuse through the nares can help loose the secretions, as well as suggesting use of a humidifier and a warm/steamed bath or shower (Dunphy et al., 2019). The patient reports benefits from hot showers, so encouraging twice daily exposure to warm (not hot) steam would be useful.
Labs/diagnostics: Diagnostic testing and labs are unnecessary with the presentation of viral sinusitis (Dunphy et al., 2019). If symptoms persist after 4-5 days of medications, then I would order an AP/lateral and occipitomental x-ray to further assess, as well as assess for any signs of a bacterial infection (Dunphy et al., 2019). If bacterial infection symptoms are present, I would order labs such as a CBC (Dunphy et al., 2019).
Referrals/Interprofessional communications: The patient would not require a referral to a specialist for viral sinusitis, however, if the patient is not improving from treatment after 2 weeks and sinusitis reoccurs, a possibly referral to an allergist or otolaryngologist may be useful to determine if there is an allergic factor or structural factor present (Dunphy et al., 2019).
Patient education: (1) The patient should be educated pharmacotherapy, such as avoiding use of over-the-counter oral decongestants due to the likelihood of rebound congestion (Hatton & Hendeles, 2022). (2) Education regarding the ineffectiveness of an antibiotic should be provided, as the likely cause of the sinusitis is viral, not bacterial, in nature (Dunphy et al., 2019). (3) The patient should be educated on monitoring of symptoms, such as looking for an improvement within the next 4-5 days (Dunphy et al., 2019). (4) Education should be provided about cleaning the humidifier daily with 1:10 bleach and water (Dunphy et al., 2019). (5) I would discuss with the patient signs and symptoms of a bacterial infection, such as purulent nasal secretions, and advise to contact the office should these symptoms develop. (6) I would review with the patient the cause of viral sinusitis, specifically inflammation of the sinuses that is viral in nature (Mullol et al., 2020). (7) I would educate the patient that viral sinusitis is one of various types of sinusitis (Mullol et al., 2020), and review what differentiates viral from bacterial sinusitis, such as the presence of purulent nasal drainage and prolonged period of symptoms (>10 days) in bacterial sinusitis (Patel & Hwang, 2022). (8) I would inform the patient that bacterial sinusitis is often a complication of viral sinusitis, and to reiterate the importance of adhering to the medication and treatment regimen and being aware of signs of infection (Patel & Hwang, 2022). (9) I would discuss with the patient the reason for potential complications of viral sinusitis, including the development of a bacterial infection and thus, risk for development of periorbital or orbital cellulitis, for example (Patel & Hwang, 2022). (10) I would educate the patient regarding environmental factors that exacerbate the symptoms, such as smoke and smoking (Dunphy et al., 2019).
Follow-up: The patient should follow-up within 12-14 days to ensure treatment was successful and there are no worsening symptoms (Dunphy et al., 2019).
Health maintenance: The patient should be educated on the importance of staying healthy to help avoid future complications, the inability to alleviate symptoms, and the potential of the development of chronic sinusitis. Examples would include avoiding areas high in pollutants, avoiding smoking or secondhand smoke (Dunphy et al., 2019). I would also encourage the patient to avoid contact with sick individuals and wash hands thoroughly.
Social determinant of health obstacle: One obstacle the patient may face is regarding certain systemic barriers, both through the state and federally (Safer & Chan, 2019). In relation to healthcare, these barriers could affect insurance coverage access (Safer & Chan, 2019), which could ultimately impact the patient’s ability to afford prescriptions sent and office visit follow-ups. I would help to address this barrier by ensuring the patient has access to insurance coverage and help provide resources for affordable prescriptions, such as with GoodRx.
References
Bachert, C., Bhattacharyya, N., Desrosiers, M., & Khan, A. (2021). Burden of disease in chronic rhinosinusitis with nasal polyps. Journal of Asthma and Allergy, 11(14), 127-134. https://doi.org/10.2147/JAA.S290424.
Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2019). Primary care: Art and science of advanced practice nursing – An interprofessional approach. (5th ed.). F.A. Davis.
Hatton, R., & Hendeles, L. (2022). Why is oral phenylephrine on the market after compelling evidence of its ineffectiveness as a decongestant? Annals of Pharmacotherapy, 56(11), 1275-1278. https://10.1177/10600280221081526
Kwon E, & O’Rourke MC. (2022). Chronic sinusitis. In: StatPearls. StatPearls Publishing.
Mullol, J., Del Cuvillo, A., & Lockey, R. F. (2020). Rhinitis phenotypes. The Journal of Allergy and Clinical Immunology, 8(5), 1492–1503. https://doi.org/10.1016/j.jaip.2020.02.004
Patel, Z., & Hwang, P. (2022). Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis. UpToDate. https://www.medilib.ir/uptodate/show/6871
Safer, J., & Chan, K. (2019). Review of medical, socioeconomic, and systemic barriers to transgender care. Contemporary Endocrinology. https://doi.org/10.1007/978-3-030-05683-4_2
Yildiz, E. (2020). Nonallergic rhinitis. Inflammation in the 21st Century. https://doi.org/10.5772/intechopen.94544