RT Book, Section A1 Frei, Christopher A1 Frei, Bradi A2 DiPiro, Joseph T. A2 Talbert, Robert L. A2 Yee, Gary C. A2 Matzke, Gary R. A2 Wells, Barbara G. A2 Posey, L. Michael SR Print(0) ID 1154961779 T1 Upper Respiratory Tract Infections T2 Pharmacotherapy: A Pathophysiologic Approach, 10e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9781259587481 LK accesspharmacy.mhmedical.com/content.aspx?aid=1154961779 RD 2024/03/28 AB Patient Care Process for Acute Bacterial RhinosinusitisCollectPatient 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 daycareObjective data:TemperatureSigns and symptoms (see Clinical Presentation)Presence of congestion, fullness, or pain in the nose, face, or earPresence of purulent or discolored nasal dischargeOther diagnostic tests, when indicated (e.g., CT, sinus puncture)AssessInfection status, including presence of signs and symptomsDetermine 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 neededIf antibiotics are appropriate, determine proper choice of antibiotic, dose, duration, and dosage formDetermine if the patient meets criteria for high-dose amoxicillin-clavulanatePlanSelect 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 timeframeEducate patient and/or caregiver (e.g., purpose of treatment, drug therapy) emphasizing adherence to treatment regimenRecommend self-monitoring of body temperatureImplementProvide patient education regarding the infection and all elements of treatment planUse motivational interviewing and coaching strategies to maximize adherenceSchedule follow-up, when indicatedRecommend measures to reduce nose pain and inflammation, if presentFollow-up: Monitor and EvaluateImprovement/resolution of signs and symptoms; reassess the plan if the patient’s symptoms worsen or decline within 48 to 72 hours of symptom onsetUse of nasal decongestant sprays and antihistamines; these are not recommended for treatmentPresence of adverse effects, particularly allergic reactions and diarrheaPatient adherence to treatment plan using multiple sources of information