K.J. is a 17-month-old Winnebago Indian female who is brought to her pediatricia
ID: 243795 • Letter: K
Question
K.J. is a 17-month-old Winnebago Indian female who is brought to her pediatrician by both parents. The patient has had a 24-hour history of fever, irritability, crying, tugging at both ears, and significantly decreased appetite. Her mother reports that K."s temperature last evening was 101 degrees F and that she had difficulty sleeping despite taking ibuprofen. Mom also reports taking the child to the nurse practitioner nine days ago with cough, runny nose, and apparent earache and receiving a prescription for Pediazole. "There have been colds going around the daycare center," she informs the doctor. She has been very conscientious about giving K. her Pediazole three times a day for the past nine days. Past Medical History: Former 40-week 8 lb-1 oz infant delivered vaginally; uncomplicated prenatal course; Apgar scores WNL; was breast-fed and supplemented with formula; no surgeries or hospitalizations; immunizations are current; one episode of pneumonia at age 14 weeks; recurrent AOM x 5 during the past 14 months; most recent episode 9 days ago and currently receiving treatment with Pediazole; patient has previously received both cephalosporins and macrolides for AOM; only adverse effect has been significant diarrhea with Augmentin. Developmental Milestones: Within normal limits for 1 to 2 year old toddler; Child can pull self up to stand and walk a few steps without support, use exlamations, say "dada" and "mama", try to imitate words, respond to "no", wave bye-bye, and use objects correctly. Family History: Parents are both in good health; one sister, age 3.5 years, has had a recent upper respiratory infection. Social History: K. lives at home with her parents, who are both employed outside the home; she attends a daycare facility every week day, father is a smoker; mother is a former smoker who quit 6 years ago, there is a pet gerbil in the home. Medications: Pediazole 100 mg po Q6h, Ibuprofen 15 mg po Q6h Allergies: No known drug allergies. Question: Identify 7 risk factors that are consistent with a diagnosis of acute otitis media in this patient.
Explanation / Answer
Risk factors of Otitis media in K. J are:
1. Age ; between 6 - 36month of age is at risk for AOM
2. Being exposed to cigarette smoke - as the father of K. J is a smoker
3. Being attending day care increase the risk of spread of infecting bacteria
4. Previous infection
5. Exposed to Sibling with URTI
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