Write a response to discussion-
Is there any additional subjective or objective information you need for this client? Explain.
Additional question I would include: Have you been taking any over the counter medication for your symptoms. It would also be important to know his daily medication list. His medical, social, surgical and familial history would provide more insight to his current illness. One of the questions I would be most curious about is if he is or was a smoker. Knowing this would inform me if he had any possible issues with lung compliance chronically.
Would you treat Mr. JDs cold? Why or why not?
Because of the duration of his symptoms, I would treat the patient. Cold symptoms usually resolve within a week. He reported having a headache, and green mucous when we’re both demonstrated on physical exam with the frontal tenderness and green post nasal drip. People with sinus infection can feel slime in the back of the throat, facial pain, pain when bending forward, and pain in the upper teeth or when chewing (Lemiengre et al., 2018). He likely had a common cold which was complicated by a sinus infection.
What would you prescribe and for how many days? Include the class of the medication, mechanism of action, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings.
I would ask the patient again about any therapies he has tried at home, whether it’s medication of non medicinal supportive therapy like warm compresses or nasal lavage. If the patient has tried these with no success, I would prescribe Amoxicillin 500 mg PO q8 hours for a length of 10 days and Fluticasone 2 sprays per nostril daily for 10 days. Although the use of antibiotics for sinusitis has been controversial, it would be indicated for this patient because he has had his symptoms for so long. Antibiotics may be indicated for bacterial rhinosinusitis to speed up recovery or to prevent suppurative complications (Lemiengre, Van Driel, Merenstein, Liira, Mäkelä, & De Sutter, 2018). Amoxicillin is an aminopenicillin, it is absorbed through the GI tract. It has an extra protein in it to help prevent antibiotic resistance. It is metabolized in the liver and excreted through the urine and stomach acid. Onset is 30 minutes; half-life is 1 to 1 & ½ hours. Peak is 1 to 2 hours. The most common side effects are nausea, vomiting and diarrhea. The benefits of the amoxicillin would outweigh the risks of having any adverse or allergic reactions. Improvement in the disease-specific quality of life after 3–4 days of treatment is assessed with the addition of amoxicillin (Garbutt, Banister, Spitznagel, & Piccirillo, 2012). Contraindications to amoxicillin are allergies to drug/class/compound. There are no black box warnings associated with Amoxicillin. Flonase is metabolized in the liver, contraindications are allergies to drug/class/compound, nasal ulcers, wound, hepatic impairment, glaucoma, cataracts. There are no black box warnings associated with Flonase.
Would this treatment vary if Mr. JD was a 10 year-old 78 lb child? Include the class of the medication, mechanism of action, dosing, route, the half-life; how it is metabolized in and eliminated from the body; and contraindications and black box warnings
Dosing for pediatrics is 45-90mg/kg/day PO divided q8 for 10 days. Children over 20 kg can be prescribed Amoxicillin 500 mg PO q8h for 10 days for sinusitis. Amoxicillin is available in liquid suspension and chewable tablet to made administration easier. The Flonase would not be a feasible choice for children.
What health maintenance or preventive education is important for this client based on your choice medication/treatment?
I would educate the importance of taking the full course of antibiotics even if he begins feeling better before the antibiotic tablets are gone. I would recommend to take medications with food due to the common occurrence of GI upset. Supportive therapies like tylenol and ibuprofen for fever and discomfort, warm compresses and saline nasal rinses should be encouraged to this patient. I would recommend rest, fluids, and a follow up appointment in 14 days.