Patient Encounter Part

BB is now 23 months old, brought by his father to the pediatrician. He has a 4-day history of left ear pain, excessive crying, decreased appetite, and difficulty sleeping over the past 2 days. The child's temperature last night was 39°C (102.2°F) by electronic axial thermometer. The father gave the child several doses of acetaminophen drops (80 mg/0.8 mL), but the pain or temperature did not improve and none was given this morning. His immunizations are up to date. He was last treated for acute otitis media 4 months ago using oral amoxicillin 40 mg/kg/day divided every 12 hours. He has no known drug allergies.

Medications prior to admission: Acetaminophen drops as needed for pain and fever. PE:

General: Crying, tugging on his left ear

VS: T 39°C (102.2°F), BP 104/58 mm Hg (90th percentile), HR 133 bpm, RR 36 bpm, wt 14 kg (30.8 lb) (75th percentile), ht 89 cm (75th percentile)

HEENT: Tympanic membranes erythematosus (L>R); left ear is bulging and nonmobile. Throat erythematous; nares patent.

Diagnosis: Acute otitis media, left ear

You and the pediatrician decide to start BB on high-dose oral amoxicillin (90 mg/kg/ day divided every 12 hours, using a 400 mg/5 mL suspension) for a total of 10 days and continue acetaminophen drops (10 mg/kg/dose every 6 hours as needed for fever or pain).

Based on the information available, create a care plan for BB. The plan should include:

(a) Statement of the drug-related needs and/or problems,

(b) Patient-specific detailed therapeutic plan with specific dosing, and

(c) Parent/caregiver education points.

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