CASE SCENARIO

Three-year-old C.E. is admitted to the Emergency Department (ED) 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 the bath-
room 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.

CASE STUDY PROGRESS

As you continue to get a history from Mrs. E., you learn that C.E. has had “ear problems” and throat
infections 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 14 kg. The
Pediatrician diagnoses C.E. with bilateral otitis media and strep pharyngitis. C.E. is given a prescription
for Augmentin 600 mg bid PO × 7 days. She is to be discharged to home with instructions to follow-up
with the ENT (ear, nose, and throat) specialist.

3. You review the order before completing discharge teaching. What is your first action?

CASE STUDY PROGRESS

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

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

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.

5. What postoperative orders do you expect to be ordered?

6. 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

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

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.