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CASE SIMULATION #112

Three-year-old C.E. is admitted to the emergency department fast track clinic. Her mother tells the nurse
that C.E. has had a low-grade fever for 2 days and is complaining of ear pain and a sore throat. Mrs. E.
states that C.E.’s appetite has been ‘off’, but she has been drinking and using bathroom as usual.

1. As you get C.E. settled in the exam room, what routine information regarding risk factors
for otitis media (OM) would you want to obtain from Mrs. E.?

2. Mrs. E. asks, “Why does C. keep getting ear infections? Is there something I should do?”
Explain the etiology of ear infections.

3. What will you include in your physical examination, and why?

CASE STUDY PROGRESS:

As you continue to get a history from Mrs.E, you learn that C.E. has had “ear problems” and
throat infection since she was a baby. She is in daycare each weekday, Dad smokes outside of
the house, and there is a family history of seasonal allergies. C.E. is allergic to penicillin. Her
weight is 14kg. the PCP diagnoses C.E with bilateral otitis media and strep pharyngitis. C.E. is
given a prescription of Augmentin 600mg bid p.o for seven days. She is to be discharged to
home with instructions to follow-up with the ENT specialist

4. You review the order before completing discharge teaching. What is your first action?
Name:
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CASE STUDY PROGRESS:

Mrs. E. is given a new prescription for azithromycin (Zithromax) PO 160 mg every day for 5 days

5. Azithromycin is dispensed 200 mg/5 mL. Calculate the dosage for Mrs. E. to administer to C.E.

6. You are providing Mrs. E. with information on medication administration. Which of these
statements by Mrs. E. indicates need for further teaching? (Select all that apply.)
a. “I will place the correct amount of antibiotic in the ear canal once a day.”
b. “ I will monitor for vomiting, diarrhea, or stomachaches because this might be a side
effect of the medication.”
c. “If C. refuses to take her medication, I will tell her it tastes like the candy we get at the
movies.”
d. “This medicine can be given with or without food.”
e. “I don't have to finish the medication if she feels better after a few days.”

7. Mrs. E. asks when C.E. can return to daycare. Which of these statements is your best
response?
a. “She should be able to return in about a week.”
b. “She can return twenty-four hours after her last documented normal temperature.”
c. “She can return twenty-four hours after she starts her antibiotics.”
d. “She can return forty-eight hours after her last documented normal temperature.”

CASE STUDY PROGRESS:

Mrs. E. takes C.E. to an ENT specialist. It is determined that her enlarged tonsils might be contributing to
the frequent throat and ear infections, and a tonsil and adenoidectomy (T&A) is scheduled. She will be
admitted postoperatively for 24-hour observation.

After the surgery, the postoperative nurse receives C.E. to the short-stay unit from the post-
anesthesia care unit (PACU). C.E. is awake and alert, bilateral breath sounds are clear, and her oxygen
saturation is 98% on room air. She has tolerated sips of clear fluids, and her parents are with her.
Name:
Course/Year and Section
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8. Which of these orders would you expect to see in her postoperative orders? (Select all that
apply, and discuss the rationales for your choices.)
a. Vital signs q4h
b. Clear liquids. Advance to regular toddler diet.
c. Methylprednisolone (Solu-Medrol) 2.3 mg IV q8h 3 doses
d. Acetaminophen (Tylenol) (120 mg) with codeine (12.5 mg) 5 mL PO q6h prn for pain
e. Home prescription for amoxicillin (Amoxil) 120 mg PO q8h
f. Maintain peripheral IV with D51⁄2 NS at 50 mL/hr until taking PO well and then saline lock
g. Aggressively gargle and swish with water after eating or drinking.

9. State at least two nursing interventions for each of these commonly encountered nursing
problems during the postoperative phase of care.
a. Airway
b. Pain
c. Fluid and electrolyte balance
d. Bleeding risk

10. How would the nurse monitor C.E. for pain?

11. You are reviewing discharge instructions with Mrs. E. She asks, “How would I know if
we need to come back?” Discuss common findings and when Mrs. E. would need to seek
immediate medical attention for C.E.

CASE STUDY OUTCOME:

Mrs. E. indicates an understanding of discharge instructions and follow-up care. C.E. continues
to take oral fluids well and meets discharge criteria and is discharged to home to follow up with
the ENT physician in 2 weeks

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