Assignment Guidelines

You are an APN in a Quick Care Clinic. Mom brings Joey, her 8-year-old son, in for possible GAS pharyngitis. You notice that Joey has been seen and treated multiple times this year for the same condition. Your clinic does not have the ability to culture, and mom refuses the rapid test “because it is always negative, but I know he has it.” According to the article by the Infectious Disease Society of America, how would you treat Joey? Be sure to support your answer. Could he be a chronic pharyngeal carrier?

Word length: minimum of 250 words

 Please use Article attached to this assignment. Use 2 References from Article. And APA style.

Instructor Feedback from this assignment

Good thoughts asking about med compliance, medication options are good, what are the doses?  Less likely that he is a carrier since he has not been tested positive and he typically would not have symptoms

Example of Assignment

I would ask the mother if he completed the last antibiotic treatment. If she reports medication adherence, I would assess if the child has been in contact with ill persons, which could increase his risk of reinfection. If there was no contact with an ill person, I would educate the mother on the rapid antigen detection test (RADT) and throat culture diagnostic tests that are recommended to diagnose GAS pharyngitis in children.

According to Shulman et al. (2012), an accurate diagnosis of GAS pharyngitis could not be made by clinical signs/symptoms alone because they are similar to the signs/symptoms of nonstreptococcal pharyngitis. Shulman et al. (2012), stated that testing for GAS pharyngitis is not recommended for children or adults with clinical features that suggest a viral infection such as cough, rhinorrhea, hoarseness, and oral ulcers. When testing adolescents and children for GAS pharyngitis a negative RADT should be accompanied by a throat culture. A throat culture is not indicated for a positive RADT because they are highly specific (Shulman, et al., 2012). The first-line treatment for GAS pharyngitis is Penicillin or Amoxicillin (Shulman, et al., 2012). Patients with a penicillin allergy could be treated with Cephalosporin, Clindamycin, Clarithromycin, or Azithromycin (Shulman, et al., 2012).

The persistence of the child’s symptoms indicates that he may be a chronic pharyngeal GAS carrier. Shulman et al. (2012), stated that a patient with more than one episode of streptococcal pharyngitis close together may be a chronic pharyngeal GAS carrier. According to Shulman et al. (2012), when antibiotic treatment is prescribed for streptococcal pharyngitis, a response is usually seen within 24 to 48 hours of treatment. Shulman et al. (2012), stated that the disease is self-limiting and would resolve without treatment within a few days. A chronic pharyngeal GAS carrier may be experiencing recurrent viral infections and would not need antimicrobial therapy (Shulman, et al., 2012). GAS carriers have a low risk of spreading GAS pharyngitis to close contacts and developing suppurative/nonsuppurative complications (i.e. acute rheumatic fever) (Shulman, et al., 2012). I would educate the mother on the differences and treatment of bacterial and viral infections. I would treat the child with supportive therapy for his symptoms. I would prescribe an NSAID such as Children’s Ibuprofen 10 mg by mouth every 6 to 8 hours as needed for fever or throat pain. I would educate the mother on ensuring the child gets adequate rest and adequate hydration. I would educate the mother and child on proper handwashing techniques. I would schedule a follow-up appointment in seven days.

References

Shulman, S. T., Bisno, A. L., Clegg, H. W., Gerber, M. A., Kaplan, E. L., Lee, G., . . . Beneden, C. V. (2012). Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the infectious diseases society of america. Clinical Infectious Diseases, 55(10), e86–e102. doi:10.1093/cid/cis629