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PATIENT CARE PROCESS

Patient Care Process for Acute Bacterial Rhinosinusitis

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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

    • Determine if the patient meets criteria for high-dose amoxicillin-clavulanate

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

 

Patient Care Process for Acute Pharyngitis

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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., temperature, ...

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