Fever Case Study

Fever
Fever

Case study 1: fever

  The case study is about a 5-year old child who is diagnosed with right ear infection. The patient’s mother reports that the child is very irritable, fatigued and have a fever for 102 F for the past 2 days. The mother also states that the child has been eating but has been drinking fluids only. The healthcare provider described the tympanic membrane (TM) as erythmatic, bulging with fluid levels and was dull. 

Based on these clinical presentations, the differential diagnosis for this patient is Acute Otitis Media, Acute Otitis Media with effusion, Mastoiditis and foreign body in the ear (McCance, & Parkinson, 2010).  From the clinical manifestation of fever, erythmatic TM, swollen TM and otalgia is an indicator that the patient is having bacterial infection in his right ear. The patient is not because the patient could be having swollen lymph nodes caused by immune response to the infection (CDC, 2016).

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Fever
Fever

Case study 1: fever

  The case study is about a 5-year old child who is diagnosed with right ear infection. The patient’s mother reports that the child is very irritable, fatigued and have a fever for 102 F for the past 2 days. The mother also states that the child has been eating but has been drinking fluids only. The healthcare provider described the tympanic membrane (TM) as erythmatic, bulging with fluid levels and was dull. 

Based on these clinical presentations, the differential diagnosis for this patient is Acute Otitis Media, Acute Otitis Media with effusion, Mastoiditis and foreign body in the ear (McCance, & Parkinson, 2010).  From the clinical manifestation of fever, erythmatic TM, swollen TM and otalgia is an indicator that the patient is having bacterial infection in his right ear. The patient is not because the patient could be having swollen lymph nodes caused by immune response to the infection (CDC, 2016).

Question 1: Fever is commonly considered to be triggered by viral or bacterial infection. The body has the ability to regulate its body temperature to maintain it at 37ºC. The hypothalamus –part of brain-helps control body temperature by triggering changes to the effectors such as muscles and sweat glands (McCance, & Parkinson, 2010). The temperature receptors in the human skin detect the external temperature that is transmitted to the hypothalamus.

This is the processing centre automatically trigger changes to effectors (muscles and glands). For instance, when it is too cold, the processing centre sends nerve impulses to skin where erector pilli muscles contract, causing skin hairs to erect and trap more warmth, reducing the heat loss, when heat is high, and skin muscles to relax causing hairs to lay down flat facilitating heat loss.

In addition, when it is too hot, the sweat glands in the skin secrete sweat on the surface that increases heat loss through evaporation, thereby cooling the body.  Other responses include reducing blood flow to peripheral organs or increasing blood flow to the peripheral organs when it is cold, and inducing shivering (McCance & Parkinson, 2010).

Fever occurs if thermostat resets to higher temperature mainly due to an infection.  When the bacteria invade the tissue, one of the immune system reactions is production of pyrogens. These chemicals are carried to the brain where they inhibit the heat sensing neurons while exciting the cold sensing neurons, these alterations of the temperature sensors makes the hypothalamus to trigger mechanism of raising temperature, which causes fever (Lieberthal et al. 2013).

Question 2: The clinical manifestation that indicates localized inflammatory response in this case study is erythema, fever, otalgia and swelling of the eardrum. The physiological factor associated with erythema is increased vasodilatation that increased blood flow to the infected area. This is mediated by release of inflammatory chemicals such as prostaglandins, histamine, and leukotrienes.

The physiological factor that caused swelling of the eardrum is increased permeability in order to increase fluid loss at the inflammation area (McCance, & Parkinson, 2010). This causes an increase mobility of the immune cells and also works as coagulation system that prevents spread of infection. The swelling is also associated with exudates behind the eardrum. Pain (otalgia) is associated with increased release of prostaglandins- chemical mediators that increases stimulation of pain receptors at the site of infection.

The physiological factor for fever is due to increased blood flow, which increases warmth in the infection site. The high levels of temperature increase production of the white blood cells. The increased blood flow is also secondary to release of chemical mediators such as histamine (Shaikh et al. 2011).

Question 3: A complete blood count (CBC) is important during clinical decision-making. This is because it provides information of relative different types of cells in the circulation system. In patients with bacterial infection, the white blood count is generally the most powerful piece of information from CBC. The CBC  indicates  elevated  levels of WBC (leukocytosis).Bacterial  infections are also associated with increased in neutrophil levels (polymorphonuclear cell) (McCance, & Parkinson, 2010).

 These CBC findings are due to systemic responses where the epithelial cells in the middle ear release beta defensins whose main role is to stimulate production of pro-inflammatory cytokines that acts as chemo-attractants for mast cells, T cells, neutrophils and dendritic cells that will inhibit bacterial toxins directly. Therefore, the elevated levels of neutrophil and WBC is systemic response to bacterial infection in the middle ear (McCance & Parkinson, 2010).

 Conclusion

 Ear infections are most common infections in pediatric primary care settings.  The infections are mainly caused by bacterial infection. The main goals of treatment are to manage clinical symptoms and to manage hearing loss. For bacterial infections, the child should be treated using Amoxicillin in the right dosages. Sometimes ear infections can heal without use of antibiotics. However, the ‘watch and wait’ approach should be only be applied for 48-72 hrs, if no improvements are reached, then the patient must be treated with appropriate antibiotics.

References

CDC. (2016). Get smart: Know when antibiotics work. Otitis media: Physician information sheet (pediatrics) retrieved from http://www.cdc.gov/getsmart/campaign-materials/info-sheets/child-otitismedia.html.

Lieberthal, A.S., Carroll,A.E., Chonmaitree ,T., et al.(2013).The diagnosis and management of acute otitis media. Pediatrics, 131:e964..

McCance, K. & Parkinson, C. (2010). Study guide for Pathophysiology, the biologic basis for disease in adults and children, sixth edition. St. Louis, Mo.: Mosby.

Shaikh, N., Hoberman, A., Kaleida ,P.H., et al. (2011).Otoscopic signs of otitis media. Pediatr Infect Dis J 30:822.

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Question 1: Fever is commonly considered to be triggered by viral or bacterial infection. The body has the ability to regulate its body temperature to maintain it at 37ºC. The hypothalamus –part of brain-helps control body temperature by triggering changes to the effectors such as muscles and sweat glands (McCance, & Parkinson, 2010). The temperature receptors in the human skin detect the external temperature that is transmitted to the hypothalamus.

This is the processing centre automatically trigger changes to effectors (muscles and glands). For instance, when it is too cold, the processing centre sends nerve impulses to skin where erector pilli muscles contract, causing skin hairs to erect and trap more warmth, reducing the heat loss, when heat is high, and skin muscles to relax causing hairs to lay down flat facilitating heat loss.

In addition, when it is too hot, the sweat glands in the skin secrete sweat on the surface that increases heat loss through evaporation, thereby cooling the body.  Other responses include reducing blood flow to peripheral organs or increasing blood flow to the peripheral organs when it is cold, and inducing shivering (McCance & Parkinson, 2010).

Fever occurs if thermostat resets to higher temperature mainly due to an infection.  When the bacteria invade the tissue, one of the immune system reactions is production of pyrogens. These chemicals are carried to the brain where they inhibit the heat sensing neurons while exciting the cold sensing neurons, these alterations of the temperature sensors makes the hypothalamus to trigger mechanism of raising temperature, which causes fever (Lieberthal et al. 2013).

Question 2: The clinical manifestation that indicates localized inflammatory response in this case study is erythema, fever, otalgia and swelling of the eardrum. The physiological factor associated with erythema is increased vasodilatation that increased blood flow to the infected area. This is mediated by release of inflammatory chemicals such as prostaglandins, histamine, and leukotrienes.

The physiological factor that caused swelling of the eardrum is increased permeability in order to increase fluid loss at the inflammation area (McCance, & Parkinson, 2010). This causes an increase mobility of the immune cells and also works as coagulation system that prevents spread of infection. The swelling is also associated with exudates behind the eardrum. Pain (otalgia) is associated with increased release of prostaglandins- chemical mediators that increases stimulation of pain receptors at the site of infection.

The physiological factor for fever is due to increased blood flow, which increases warmth in the infection site. The high levels of temperature increase production of the white blood cells. The increased blood flow is also secondary to release of chemical mediators such as histamine (Shaikh et al. 2011).

Question 3: A complete blood count (CBC) is important during clinical decision-making. This is because it provides information of relative different types of cells in the circulation system. In patients with bacterial infection, the white blood count is generally the most powerful piece of information from CBC. The CBC  indicates  elevated  levels of WBC (leukocytosis).Bacterial  infections are also associated with increased in neutrophil levels (polymorphonuclear cell) (McCance, & Parkinson, 2010).

 These CBC findings are due to systemic responses where the epithelial cells in the middle ear release beta defensins whose main role is to stimulate production of pro-inflammatory cytokines that acts as chemo-attractants for mast cells, T cells, neutrophils and dendritic cells that will inhibit bacterial toxins directly. Therefore, the elevated levels of neutrophil and WBC is systemic response to bacterial infection in the middle ear (McCance & Parkinson, 2010).

 Conclusion

 Ear infections are most common infections in pediatric primary care settings.  The infections are mainly caused by bacterial infection. The main goals of treatment are to manage clinical symptoms and to manage hearing loss. For bacterial infections, the child should be treated using Amoxicillin in the right dosages. Sometimes ear infections can heal without use of antibiotics. However, the ‘watch and wait’ approach should be only be applied for 48-72 hrs, if no improvements are reached, then the patient must be treated with appropriate antibiotics.

References

CDC. (2016). Get smart: Know when antibiotics work. Otitis media: Physician information sheet (pediatrics) retrieved from http://www.cdc.gov/getsmart/campaign-materials/info-sheets/child-otitismedia.html.

Lieberthal, A.S., Carroll,A.E., Chonmaitree ,T., et al.(2013).The diagnosis and management of acute otitis media. Pediatrics, 131:e964..

McCance, K. & Parkinson, C. (2010). Study guide for Pathophysiology, the biologic basis for disease in adults and children, sixth edition. St. Louis, Mo.: Mosby.

Shaikh, N., Hoberman, A., Kaleida ,P.H., et al. (2011).Otoscopic signs of otitis media. Pediatr Infect Dis J 30:822.

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