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Patient Care Process for Acute Bacterial Rhinosinusitis
Collect
Patient characteristics (e.g., age, weight)
Patient history (e.g., past infections, current and past antibiotic/antiviral use noting previous failures, medication allergies, history of allergic rhinitis)
Determine whether patient is in daycare, is a daycare worker, or has a child in daycare
Objective data:
Temperature
Signs and symptoms (see Clinical Presentation)
Presence of congestion, fullness, or pain in the nose, face, or ear
Presence of purulent or discolored nasal discharge
Other diagnostic tests, when indicated (e.g., CT, sinus puncture)
Assess
Infection status, including presence of signs and symptoms
Determine which symptoms may need additional therapy (e.g., ongoing nose pain)
Decide if referral is needed (e.g., mental status changes, visual disturbances, immunosuppressive illness, nosocomial infections, anatomic defects, unilateral findings)
Use information collected, patient factors (e.g., patient age, symptom severity), and joint decision-making with parents/caregivers to determine whether antibiotics are needed
If antibiotics are appropriate, determine proper choice of antibiotic, dose, duration, and dosage form
Plan
Select drug therapy regimen including specific antibiotic, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Tables 108-2 and 108-3)
Monitor efficacy (e.g., temperature, pain), safety (e.g., medication-specific adverse effects), and timeframe
Educate patient and/or caregiver (e.g., purpose of treatment, drug therapy) emphasizing adherence to treatment regimen
Recommend self-monitoring of body temperature
Implement
Provide patient education regarding the infection and all elements of treatment plan
Use motivational interviewing and coaching strategies to maximize adherence
Schedule follow-up, when indicated
Recommend measures to reduce nose pain and inflammation, if present
Follow-up: Monitor and Evaluate
Improvement/resolution of signs and symptoms; reassess the plan if the patient’s symptoms worsen or decline within 48 to 72 hours of symptom onset
Use of nasal decongestant sprays and antihistamines; these are not recommended for treatment
Presence of adverse effects, particularly allergic reactions and diarrhea
Patient adherence to treatment plan using multiple sources of information
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Patient Care Process for Acute Pharyngitis
Collect
Patient characteristics (e.g., age, weight)
Patient history (e.g., past infections including rheumatic fever and rheumatic heart disease, current and past antibiotic/antiviral use noting previous failures, medication allergies)
Determine whether patient is a school-age child, parent/caregiver of a school-age child, or works with school-age children
Objective data:
Temperature
Signs and symptoms (see Clinical Presentation)
Other diagnostic tests, when indicated (e.g., rapid antigen-detection test [RADT], throat culture, microbiologic testing)
Assess
Infection status, including presence of signs and symptoms
Determine which symptoms may need additional therapy (e.g., ongoing throat pain)
Use information collected, patient factors (e.g., patient age, symptom severity), and joint decision making with parents/caregivers to determine whether antibiotics are needed
If antibiotics are appropriate, determine proper choice of antibiotic, dose, duration, and dosage form
Plan
Select drug therapy regimen including specific antibiotic, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Tables 108-4 and 108-5)
Monitor efficacy (e.g., ...