The nurse is assessing a 13-year-old female client at a family health clinic.
1030: Client arrived to the clinic today accompanied by mother who is complaining of sore throat and pain while swallowing. Client's mother states that symptoms began two days ago; denies cough, rash, abdominal cramping, diarrhea, or nausea/vomiting. On inspection, tonsils appear erythematous and slightly swollen. Vitals stable except slightly febrile (38.2° C or 100.8° F). Immunizations are up to date. Her medical history is unremarkable, she does not take any medications. Client to see primary health care provider.
1050: Throat swab obtained. Client discharged with presumed viral pharyngitis. Educated client and mother on symptomatic care; frequently gargle with salt water, take over-the-counter acetaminophen for pain and fever, and prevent dehydration. Client instructed to return to clinic or emergency department if worsening symptoms appear a 13-year-old female client at a family health clinic.
0915: Client arrived at the clinic 2 weeks later complaining of progressive worsening of symptoms. The client's mother states that daughter has significantly decreased oral intake due to inability to swallow food and drinks. She reports of continued throat pain and difficulty breathing, especially at nighttime in bed. Persistent coughing noted, non-productive. On inspection, erythematous and edematous palatine tonsils with some exudate and white spots. Results from throat swab was negative for GABHS (group A beta-nemolytic streptococcus). Client is slightly tachycardic and tachypneic, remains febrile. Client to see primary health care provider.
Select 3 other symptoms that indicate the client will likely require a tonsillectomy procedure.
vesicular breath sounds at bases
abdominal cramping
weight gain
recurrent throat infections
excessive drooling
muffled voice
