An 18-month-old child is seen in the clinic with a temperature of 40° C. The child's parents tell the nurse that the child developed the fever the previous evening and was inconsolable during the night
The provider examines the child and notes a bulging, erythematous tympanic membrane. The nurse will expect to:
a. ask the parent to return to the clinic in 2 days to see whether antibiotics need to be started.
b. discuss a referral to an ear, nose, and throat specialist for follow-up treatment.
c. teach the parent to give analgesics for 3 days while observing for worsening symptoms.
d. tell the parent to administer amoxicillin at 45 mg/kg/dose twice daily.
ANS: D
Patients with severe symptoms of AOM should begin treatment with antibiotics upon diagnosis. For children 6 months to 2 years of age, treatment should begin when the diagnosis is certain, as evidenced by erythema of the tympanic membrane (TM) and distinct discomfort. Amoxicillin 45 mg/kg/dose twice daily is indicated. Observation for 2 days is not recommended for this child, because the diagnosis is certain; therefore, asking the parent to return in 2 days or to give only symptomatic treatment is incorrect. Referral to an ear, nose, and throat (ENT) specialist is not recommended unless the child has recurrent AOM or if treatments repeatedly fail.
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