Skenario English BLOK 12
Author : Amina
Noor A.
Case:
A 5-year-old girl was taken to the primary
health care physician because she was having sore throat, high
temperature, and runny nose.
Symptoms started 2 days ago and her mother given
paracetamol and reported the pain not relieve, she also complained of pain in the right ear at night. The
doctor examined her tonsils and found
them enlarged, and checked her ears with the otoscope and saw that both eardrums were congested and looked
reddish especially on the right. He recommended decongestant medication and analgesics and requested to see the
girl again a week later.
CLARIFYING
UNFAMILIAR TERMS:
1.
Sore Throat: a condition
marked by pain in the throat, typically caused by inflammation due to a cold or
other virus.
2.
Runny Nose: also known as
Rhinorrhea is an excess drainage, which may range from a clear fluid to thick
mucus, produced by the nasal and adjacent tissues and blood vessels in the
nose. The drainage of runny nose may run out of your nose or down the back of
your throat or both.
3.
Otoscope: an instrument
designed for visual examination of the eardrum and the passage of the outer
ear, typically having a light and a set of lenses.
4.
Decongestant: a medicine
used to relieve nasal congestion.
5.
Analgesic: a medicine
used to relieve pain.
ANALYZING:
Sore Throat
A
sore throat refers to pain, itchiness, or irritation of the throat. You may
have difficulty swallowing food and liquids, and the pain may get worse when
you try to swallow. Throat pain is the primary symptom of a sore throat. However,
other symptoms may include dry throat, swollen glands in the neck, white
patches on the tonsils, and hoarseness.
A
sore throat can affect people of all ages, but it has higher risk in children,
smokers, allergy sufferers, and people with a compromised immune system. There
are several causes of a sore throat, including viral infection, bacterial
infection, and also environmental factors such as allergic to mold, pet dander,
pollen, or other irritants.
Fever
Fever
also known as a high fever or a high temperature. It is not by itself an
illness. It’s usually a symptom of an underlying condition, most often an
infection. Many experts believe that fever is a natural bodily defense against
infection. There are also many non-infectious causes of fever.
Tonsillitis
Tonsillitis
is an inflammation (swelling) of the tonsils. At the back of your throat, two
masses of tissue called tonsils act as filters, trapping germs that could
otherwise enter your airways and cause infection. They also produce antibodies
to fight infection. But sometimes the tonsils themselves become infected.
Tonsillitis is common, especially in children. The condition can occur
occasionally or recur frequently.
Bacterial
and viral infections can cause tonsillitis. A common cause is Streptococcus
(strep) bacteria. Other common causes include Adenoviruses, Influenza virus,
Epstein-Barr virus, parainfluenza viruses, Enteroviruses, and Herpes Simplex
Virus. The main symptoms of tonsillitis are inflammation and swelling of the
tonsils, sometimes severe enough to block the airways. Other symptoms include
throat pain or tenderness, redness of the tonsils, a white or yellow coating on
the tonsils, painful blisters or ulcers on the throat, hoarseness or loss of
voice, headache, loss of appetite, ear pain, difficulty swallowing or breathing
through the mouth, swollen glands in the neck or jaw area, fever, chills, and
bad breath.
Tonsillitis
can cause a complication even it’s rare for complication to occur as a result
of tonsillitis. Some of the complications are:
1. Middle ear
infection (otitis media): where the fluid in the middle ear, between the
eardrum and inner ear, becomes infected by bacteria. In most cases, the
infection clears by itself.
2. Quinsy: is an
abscess that develops between one of the tonsils and the wall of the throat.
It’s a rare complication of tonsillitis that often affects teenagers and young
adults.
3. Sleep apnea:
persistent of recurring tonsillitis (chronic tonsillitis) may cause breathing
difficulties during sleep. This is known as obstructive sleep apnea (OSA).
4. Scarlet fever:
a condition that causes a distinctive pink-red skin rash
5. Rheumatic
fever: this causes widespread inflammation throughout the body, leading to
symptoms such as joint pain, rashes and jerky body movements
6. Glomerulonephritis:
an infection (swelling) of the filters in the kidneys that can cause vomiting
and a loss of appetite
Treatment for
tonsillitis will depend in part on the cause. To determine the cause, we must
perform a rapid strep test or throat swab culture. A lab test can detect a
bacterial infection. A viral infection will not show on the test, but may be
assumed if the test for bacteria is negative. In some cases, the physical
findings are convincing enough to diagnose a probable bacterial infection in
these cases, antibiotics may be prescribed without performing a rapid strep
test.
Tonsillar Hypertrophy Grading Scale
1. Tonsil 0:
tonsils fit within tonsillar fossa
2. Tonsil 1+:
tonsils <25% of space between pillars
3. Tonsil 2+:
tonsils <50% of space between pillars
4. Tonsil 3+:
tonsils <75% of space between pillars
5. Tonsil 4+:
tonsils >75% of space between pillars
Acute Otitis Media
Acute
otitis media (AOM) is an inflammation of part or all of the middle ear mucosa. AOM
defined by convention as the first 3 weeks of a process in which the middle ear
shows the signs and symptoms of acute inflammation, is the most common
affliction necessitating medical therapy for children younger than 5 years. Middle
ear usually is sterile; although there are microbes in the nasopharynx and
pharynx. There are physiological mechanisms of prevention of the entry of
microbes into the middle ear by the mucosal cilia of Eustachian tube, enzymes,
and antibodies.
AOM
occurs because of the body’s defense is disrupted. Eustachian tube blockage is
the main factor of otitis media. Because the Eustachian tube function is
impaired, the prevention of the invasion of bacteria into the middle ear also
disrupted, so that germs enter into the middle ear ad causing inflammation.
AOM
implies rapid onset of disease associated with one or more of the following
symptoms: otalgia, otorrhea, headache, fever and irritability, loss of
appetite, vomiting, and diarrhea. Pneumatic otoscopy is the standard of care in
the diagnosis of acute and chronic otitis media. The following findings may be
found on examination in patients with AOM:
·
Sign of inflammation in the tympanic membrane
·
Bulging in the posterior quadrants of the tympanic membrane may
bulge; scalded appearance of the superficial epithelial layer
·
Perforated tympanic membrane (most frequently in posterior or
inferior quadrants)
·
Presence of an opaque serum like exudate oozing through the entire
tympanic membrane
·
Pain with/without pulsation of the otorrhea
·
Fever
Management
Antibiotics
are the only medications with demonstrated efficacy in the management of AOM;
therefore, these agents are the initial therapy of choice. The antibiotic
chosen should cover most of the common bacterial pathogens and be
individualized for the child with regard to allergy, tolerance, previous
exposure to antibiotics, cost, and community resistance levels. Duration of
treatment may also be a consideration in the choice of antibiotic. Antibiotics
used in the management of AOM including Amoxicillin, Erythromycin, Trimethoprim-sulfamethoxazole,
Cefixime, Clindamyin, Ceftriaxone.
Prognosis
Death
from AOM is rare in the era of modern medicine. With effective antibiotic
therapy, the systemic signs of fever and lethargy should begin to dissipate,
along with the localized pain, within 48 hours.
Decongestant
Decongestants
are a type of medicine that can provide short-term relief for a blocked nose
(nasal congestion). They can be taken to ease the symptoms of congestion when
you have a common cold, hay fever, or other allergic reactions, such as to dust
mites, the flu, or sinusitis. Many decongestants can be bought over the counter
in pharmacies without a prescription. They are available as tablets or a nasal
spray.
The
skin lining in your nose contains many tiny blood vessels. If something
irritates this lining, such as an infection or allergy, more blood flows to
these vessels as part of your body’s immune response, making them swell. This
can block your nasal airway, making it difficult for you to breaths through your
nose. Decongestants reduce swelling of the blood vessels inside your nose. This
helps to open up your nasal airway, making breathing easier. However, although
decongestants can help you t breathe more easily, they cannot cure the
underlying cause of your blocked nose, such as a cold or allergy.
Paracetamol
Paracetamol is
a painkilling (analgesic) medicine available over-the-counter without a
prescription. Paracetamol can be used to ease mild to moderate pain for example
headaches, sprains, or toothache. It also can be used to control a fever.
Paracetamol is available as tablets, caplets, capsules, oral suspension, etc.
paracetamol is sold by a range of manufacturers, under many different brand
names. In some countries, paracetamol is known as acetaminophen. In some
products, paracetamol is combined with other ingredients. For example, it may
be combined with a decongestant and sold as a cold and flu remedy.
Paracetamol
works as a painkiller by affecting chemicals in the body called prostaglandins.
Prostaglandins are substances released in response to illness or injury.
Paracetamol blocks the production of prostaglandins, making the body less aware
of the pain or injury. Paracetamol reduces temperature by acting on the area of
the brain responsible for controlling temperature.
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