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– 2 years ago
**files (3)**
– ## SOAPNote1ComprehensiveSOAPonPediatricsHEENT.docx
– ## PediatricSOAPNoteExample.pdf
– PediatricSOAPTemplateandRubric-1.docx
**## SOAPNote1ComprehensiveSOAPonPediatricsHEENT.docx**
**Please follow APA format, add citations and references. Document will be verified for plagiarism and AI use. Thank you!**
**Directions:** Read over the SOAP note and formulate a primary diagnosis. Based on the diagnosis complete the SOAP note with the details that would be expected for the diagnosis. Use UptoDate and/or Dyna MedPlus to find out what is expected from the history and physical, diagnostic workup and management for the diagnosis. Include other peer review resources and and journal articles to support the development of your SOAP note. Complete and attach the evaluation & management score sheet to show how you coded the note for billing in each section.
· Upload a copy of your completed SOAP note.
· Upload a copy of the evaluation & management score sheet.
**Case Study:** A 3-year-old girl is brought to your office by her mother because she has a fever and complains that her right ear hurts. She has no significant medical history. The child is not pleased to be in the PCP's office and has been crying. Her mother explains that she developed a “cold” about 3 days ago with sniffles. Her temperature is 37.8°C (100°F). Physical exam was completed with some difficulty because of the child's irritability. The only abnormalities are slight redness of the throat, a nose full of thick green mucus, and injected tympanic membranes. She denies nausea, vomiting, diarrhea, headache, or change in urine output.
**## PediatricSOAPNoteExample.pdf**
Running head: STREPTOCOCCAL PHARYNGITIS 1
First Name, Last Name
Florida International University
Professor
Date
STREPTOCOCCAL PHARYNGITIS 2
Subjective
Initials of Patient: C.T
Patient Age: 8 years old
Patient Gender: Female
Patient Ethnicity: American-Haitian
Source of information: Patient’s mother and patient, reliable
Chief Complaint: Sudden onset of sore throat started this morning, cough, fever started 2 days,
and feeling malaise
History of Present Illness:
C.T. is a 8-year old female who presents today accompanied by her mother due to sudden
onset of sore throat, a recent fever, a cough, and feeling malaise. The mother reports that the
child has been sick for about two days, the child started with a fever of 101.0 and a non-
productive cough. For the fever, she has been giving the child Tylenol which helps in reducing the
fever and the child’s max temperature was 101.5. The mother verbalize that the child woke up
this morning with complaining of severe sore throat and the child complains of pain with
swallowing. The mother states that she can see the child’s throat is red and irritated. She had the
child gargle with some warm salt water which did not help. In addition, she verbalized a decrease
in the child’s appetite for about 2 days.
Past Medical History:
Unremarkable
Past Surgical History:
None
Family History:
STREPTOCOCCAL PHARYNGITIS 3
Mother, 34 years old, alive, unremarkable
Father, 36 years old, alive, HTN
Brother 3 years old, alive, unremarkable
Maternal Grandmother 62 years old, alive, no health issues
Maternal Grandfather 65 years old, alive, Type 2 Diabetes mellitus, Hyperlipidemia
Paternal Grandmother 66 years old), alive, Type 2 Diabetes mellitus, HTN
Paternal Grandfather 70 years old, alive, HTN
Social History:
C.T. is well develop and well-nourish 8 year old girl. She is fully immunized. C.T. lives
with both parents. Her mother is a teacher at a local elementary school. Her father is a real
estate agent. The maternal set of grandparents live nearby and visit the children on often. C.T.
enjoys playing with her little brother after school and she in gymnastic after school. She often
visits her grandparents during the weekends. She loves to play outdoors and riding her bicycle
Medications Taken at home:
Medication Name Indication
Acetaminophen 1 tsp po every 4-6 hours PRN for fever
Allergies:
No known drug or food allergies.
Immunizations:
Immunizations: (vaccine & date given) – Patient is up-to-date on all immunizations as per CDC
Birth- HepB
2 months – HepB, DTaP, Hib, IPV, PCV, RV given (11/02/2010)
STREPTOCOCCAL PHARYNGITIS 4
4 months – DtaP, Hib, IPV, PCV, RV given (01/06/2011)
6 months – HepB, DtaP, Hib, IPV, PCV, RV given (03/04/2011)
12 months – Hib, PCV, Varicella, MMR, HepA given (09/05/2011)
16 months – DtaP, Influenza given (01/05/2012)
18 months – HepA given (04/06/2012)
28 months – Influenza given (02/07/2013)
40 months – Influenza given (02/06/2014)
48 months – DtaP IPV, MMR, Varicella given (12/05/2014)
Review of Systems:
General:
Integumentary:
Recent fever, fatigue, and malaise. Denies weight loss or poor weight
gain.
Denies any rash. Denies itchiness, no bruises or lesions.
Neurological: Denies dizziness, loss of consciousness, or seizure activity, numbness
or tingling.
Head:
Eyes:
Ears:
Nose/Mouth/Throat:
Normocephalic. Denies any hair loss, no lesions.
Denies any blurred vision, no difficulty focusing, vision 20/20.
Denies any ear pain, hearing loss, ringing in ears, discharge.
Positive for sore throat, swollen glands, and redness to pharynx.
Denies nose bleed, dysphagia, hoarseness, or nasal congestion.
Cardio: Denies chest pain, no palpitations or peripheral edema.
Respiratory: Non-productive cough. Denies shortness of breath, wheezing or night
sweats.
STREPTOCOCCAL PHARYNGITIS 5
GI: Decrease appetite for the past 2 days. Patient denies abdominal pain,
nausea, vomiting, or change in stool pattern or color.
GU: Denies dysuria, urgency, frequency, hematuria or suprapubic pain.
Musculoskeletal:
Developmental:
Milestone
Behavior/Psychiatric:
Patient denies muscle or joint pain, paralysis, or ataxia.
C.T. is in third grade gifted program. She can bathe and dress herself,
and brush her teeth independently. She enjoys gymnastic, singing, and
reading story books.
Denies any mood swings, tantrums, behavioral disorders, sleeping
problems, psychotic disorders, or mental health problems.
Objective
Vital Signs and Other Measurements:
Age Gender Ethnicity Height Weight BMI
8 years old Female American-
Haitian
54
inches
65 lbs 9.8%
Temp HR BP RR O2Sat
102 F 98 100/54 24 98%
Physical Exam:
STREPTOCOCCAL PHARYNGITIS 6
General: Patient is alert and calm, is properly dressed and appears well-
nourished. No signs of acute distress. Her BMI is in the 47th
percentile. There are no concerns for abuse.
Neurological: Patient is alert & oriented x 4. Cranial nerves II-XII grossly intact,
has normal speech, no difficulty in concentration. Muscle tone and
reflexes appear normal. All deep tendon reflexes 2+, no focal
deficits.
Head:
Eyes:
Ears:
Nose:
Throat/Mouth:
Head and characteristic facies symmetry noted. Hair distribution
even.
PERRLA. Corneal light reflex and red reflex present. No strabismus.
Canals patent, TM’s are normal. No purulent drainage noted.
Nares symmetrical. Nasal mucosa with no inflammation, normal
appearing turbinate.
Pharynx is severely erythematous with +2 tonsils outside of the
pillars with white exudates. Submandibular glands are tender to
touch, palatal petechia noted.
Neck: Anterior cervical lymphadenopathy present. Trachea midline. Neck
supple with full ROM.
Lungs: RR: 24. O2 sat: 98% on room air. Breaths are regular and unlabored.
Chest movement is symmetrical. Clear breath sounds bilaterally in all
lobes.
STREPTOCOCCAL PHARYNGITIS 7
Cardio: HR: 98. S1 and S2 present, with normal rhythm and rate. No heart
murmurs, S3, or S4 noted. BP: 100/54. Capillary refill within normal
limits. No peripheral edema. Radial and pedal pulses +2.
GI: Abdomen is soft without organomegaly. Bowel sounds present x 4
quadrants. No masses, no rebound tenderness. No distention noted.
GU: Bladder is non-distended. No costovertebral angle tenderness noted.
Musculoskeletal: Spine is straight with no scoliosis or kyphosis noted. Full ROM
against gravity with full resistance in all extremities noted. No
edema, ecchymosis or erythema noted.
Integumentary: Skin texture is warm, smooth, and soft. No lesions, no rash, no
bruising or scars noted. Capillary refill less than 2 seconds.
Behavior/Psychiatric: Alert and oriented. No distress. Behavior appropriate for age.
Exams:
Rapid strep swab administered in the office, the test is positive (sent for culture).
The gold standard for diagnosing group A beta-hemolytic streptococcal
(GABHS) pharyngitis is a throat swab culture. The sensitivity is 90% to 95%
but results are delayed. The Rapid Antigen Detection Test (RADT) yields
results in minutes (Borchardt, 2013).
Assessment
Current Diagnosis: Streptococcal Pharyngitis
Differential Diagnoses:
STREPTOCOCCAL PHARYNGITIS 8
1. Upper respiratory infection (URI)
2. Influenza
3. Viral Pharyngitis
Plan
1. Amoxicillin (400mg/5ml) 5ml PO every 12 hours x 10 days # 200ml no refills as per
Epocrates, weight dosing at 40mg/kg per day.
2. Use acetaminophen or ibuprofen to treat pain and fever as ordered.
3. No vaccines administered this visit. Parent counseled on yearly influenza vaccinations
and on the next set of recommended vaccinations due at ages 11-12 per CDC guidelines
(CDC, 2017). Strep swab sent for culture for pyrogenic types of strep and parent to be
notified if positive. It will not change treatment plan.
4. Complete antibiotics for full course even if symptoms disappear. Strep throat will be
contagious until 24 hours of antibiotic use. Avoid sharing personal items with other
siblings or household members, change toothbrush out in 36 hours. Adequate and
frequent hand washing to avoid transmission of virus to others. Drink plenty of fluids to
avoid dehydration. Return to school once fever free for at least 24 hours (Ferri, 2016).
5. Be sure that the patient gets plenty of rest and increase activity as tolerated. Warm salt
gargles for sore throat. Ensure that the patient drinks 6-8 glasses of water daily to stay
hydrated and increase intake of fluids with a fever. Be sure that the patient eats a
nutritious diet (Cash & Glass, 2014).
6. Preventive Care: Diet appropriate for child age, healthy eating habits, focus in school, no
arguing in the presence of the child. Safety: helmet, seat belt, no gun in the house, no
STREPTOCOCCAL PHARYNGITIS 9
smoking, stay active, adequate nutrition, fresh food and fruit, listen to parents and
teachers, be respectful.
Subjective Analysis
Streptococcal Pharyngitis, also known as strep throat is a bacterial infection caused by
Streptococcus pyogenes, also known as group A streptococcus. Group A streptococci (GAS) are
gram-positive bacteria which cause acute pharyngitis and is accountable for about 20-30% of
sore throat cases in children (Martin, 2015). GABHS pharyngitis is usually associated with
painful cervical adenopathy, chills, high fever, pharyngeal exudate, scarlatiniform rash, and
headache. While viral pharyngitis is accompanied by symptoms of cough, sneezing hoarseness,
and rhinorrhea (Martin, 2015).
Streptococcal bacteria are highly contagious. They can spread through airborne droplets
when someone with the infection sneezes or coughs, also through shared drinks or foods. In
addition, the bacteria can be transmitted through surfaces such as a doorknob or other surfaces
and one can transfer the bacteria through your mucous membranes. GAS pharyngitis is very
common amongst school-age children around the winter and spring time. Elementary school
children often develop one to three new streptococcal infections each school year (Martin,
2015). Furthermore, it is most commonly found in ages 5 years to 15 years old children. In
C.T.’s scenario, she is complaining of sudden onset of sore throat, fever, pain with swallowing,
and generalized malaise. These symptoms point to streptococcal pharyngitis.
Objective Analysis
Upon physical exam, C.T. has a fever of 102, her tonsils size are 2+ with an overlying
white exudate and her throat is erythematous. In addition, C.T. has tender anterior cervical
STREPTOCOCCAL PHARYNGITIS 10
lymphadenopathy and palatal petechia. About 50% of children with Streptococcal pharyngitis
have tender and enlarged cervical lymph nodes (Martin, 2015). Furthermore, 25% of cases of
streptococcal pharyngitis, the tonsils and pharynx may appear erythematous with
exudate (Martin, 2015). The history and physical examination solely cannot discern between
streptococcal pharyngitis versus an infection due to other causes. Laboratory confirmation is the
accurate method of making a diagnosis of GAS. In cases where GAS is suspected, it is essential
to obtain a rapid antigen test by swabbing the surface of the tonsils and posterior pharynx and
send the culture, which is the gold standard testing for GAS. Although the rapid antigen test has
a specificity of greater than 95%, the sensitivity of the test depends on the method used and that
is why a throat culture should be done to assess for GAS (Martin, 2015).
Assessment Analysis
The differential diagnoses for this patient are an upper respiratory infection (URI),
influenza, and viral pharyngitis. In upper respiratory infection, which is a viral infection, the
usual presenting symptoms include nasal congestion, headache, rhinorrhea, cough, and fever.
With GABHS, the patient can also have symptoms of fever and headache, however nasal
congestion, cough, and rhinorrhea are uncommon (Burns et al., 2017). In addition, with URI no
antibiotics are required and symptoms usually decrease or resolved in 7-10 days. With influenza,
the patient can present with similar symptoms that may resemble GABHS which are malaise,
fever, and sore throat. In C.T. case, the sudden onset of severe sore throat yields more towards
GABHS versus influenza. Another differential diagnosis would be viral pharyngitis. When a
patient is presented with a sore throat it can be difficult to differentiate between viral and
bacterial causes (Burns et al., 2017). However, symptoms with a cough, conjunctivitis,
STREPTOCOCCAL PHARYNGITIS 11
rhinorrhea, and hoarseness are usually presented with viral pharyngitis instead of streptococcal
pharyngitis.
Plan Analysis
Antibiotic treatment is the first line of treatment for patients with streptococcal
pharyngitis who are symptomatic and test positive for GABHS. The patient should be treated
with an antibiotic that is sensitive to GAS. Antibiotics have shown to be effective in reducing
symptoms, prevent the spread to others and reduce the risk of developing complications such
as rheumatic fever, acute glomerulonephritis, and post-streptococcal reactive arthritis (Burns et
al., 2017).
Streptococcus pyogenes (Group A streptococcus), the bacteria that causes strep throat
have remained sensitive to penicillin and overall when treating a bacterial infection, it is
desirable to use the most narrow-spectrum antibiotic that will treat the infection. Penicillin is a
narrow spectrum antibiotic which is a good option since it is well tolerated, has minimal side
effects, is not expensive, and has proven to be effective in treating streptococcal pharyngitis
(Burns et al., 2017). However, in treating children with GABHS, amoxicillin is frequently
substituted for penicillin for a more pleasant taste in liquid suspension and the efficacy is equal
to penicillin.
Supportive care such as antipyretic Acetaminophen, fluids, and rest are also
recommended. Noncompliance with the full course of antibiotic treatment can lead to treatment
failure and its vital that patient complete full course of antibiotic even though symptoms have
resolved. In addition, the patient's toothbrush should be discarded within 24 hours after the use of
antibiotics (Burns et al., 2017). Personal items should not be shared with siblings or household
members. The child can return to school after 24 hours after taking antibiotics and is afebrile.
STREPTOCOCCAL PHARYNGITIS 12
Culture Components
C.T. is Haitian-American and was born and raised in Boynton Beach, Florida. Her father
is White American and mother is Haitian. C.T. mostly speaks English with a few words of
Creole. C. T’s parent follows the Western cultural tradition since they reside in the United States
most of the lives. They have a strong family relationship and are Christians. In America, most
religions are practiced which is originated on the basis of religious freedom, however, most
Americans are Christians (Zimmermann, 2017). Although certain foods such as hamburgers,
potato chips, macaroni and cheese, and meatloaf are commonly considered American dishes, C.
T.’s family practice healthy eating habits which consist of heart-healthy foods. In addition, they
practice preventive care, good health habits such as staying physically active and managing
stress effectively. Western culture refers mainly to the United States and Europe (Zimmermann,
2017). With the United States becoming more diverse, the U.S. is referred to as the “melting pot”
at times in which various cultures have contributed to their own diversity of flavors to the
American culture (Zimmermann, 2017).
STREPTOCOCCAL PHARYNGITIS 13
References
Borchardt, R. A. (2013). Diagnosis and management of group A beta-hemolytic streptococcal
pharyngitis. Journal of the American Academy of Physician Assistants, 26(9), 53-54.
doi:10.1097/01.JAA.0000433876.39648.52
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017).
Pediatric primary care. (6th ed.). St. Louis, MI: Elsevier.
Cash, J. C., & Glass, C. A. (2014). Family practice guidelines. (3rd ed.). New York, NY:
Springer Publishing Company, LLC.
Center for Disease Control and Prevention. (2017). Recommended immunization schedule for
children and adolescents aged 18 and younger, United States, 2017. Retrieved from
https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-
schedule.pdf
Ferri, F. F. (2016). Ferris clinical advisor: 5 books in 1. Philadelphia, PA: Elsevier.
Martin, J. M. (2015). The mysteries of streptococcal pharyngitis. Current Treat Options
Pediatric, 1(2): 180–189. doi:10.1007/s40746-015-0013-9.
Zimmermann, K. A. (2017). American culture: Traditions and customs of the United States.
Retrieved from https://www.livescience.com/28945-american-culture.html.
[https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf](https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf)
[https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf](https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf)
[https://www.livescience.com/28945-american-culture.html](https://www.livescience.com/28945-american-culture.html)
STREPTOCOCCAL PHARYNGITIS 14
**PediatricSOAPTemplateandRubric-1.docx**
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**PediatricSOAPTemplateandRubric-1.docx**
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**## SOAPNote1ComprehensiveSOAPonPediatricsHEENT.docx**
**Please follow APA format, add citations and references. Document will be verified for plagiarism and AI use. Thank you!**
**Directions:** Read over the SOAP note and formulate a primary diagnosis. Based on the diagnosis complete the SOAP note with the details that would be expected for the diagnosis. Use UptoDate and/or Dyna MedPlus to find out what is expected from the history and physical, diagnostic workup and management for the diagnosis. Include other peer review resources and and journal articles to support the development of your SOAP note. Complete and attach the evaluation & management score sheet to show how you coded the note for billing in each section.
· Upload a copy of your completed SOAP note.
· Upload a copy of the evaluation & management score sheet.
**Case Study:** A 3-year-old girl is brought to your office by her mother because she has a fever and complains that her right ear hurts. She has no significant medical history. The child is not pleased to be in the PCP's office and has been crying. Her mother explains that she developed a “cold” about 3 days ago with sniffles. Her temperature is 37.8°C (100°F). Physical exam was completed with some difficulty because of the child's irritability. The only abnormalities are slight redness of the throat, a nose full of thick green mucus, and injected tympanic membranes. She denies nausea, vomiting, diarrhea, headache, or change in urine output.
**## PediatricSOAPNoteExample.pdf**
Running head: STREPTOCOCCAL PHARYNGITIS 1
First Name, Last Name
Florida International University
Professor
Date
STREPTOCOCCAL PHARYNGITIS 2
Subjective
Initials of Patient: C.T
Patient Age: 8 years old
Patient Gender: Female
Patient Ethnicity: American-Haitian
Source of information: Patient’s mother and patient, reliable
Chief Complaint: Sudden onset of sore throat started this morning, cough, fever started 2 days,
and feeling malaise
History of Present Illness:
C.T. is a 8-year old female who presents today accompanied by her mother due to sudden
onset of sore throat, a recent fever, a cough, and feeling malaise. The mother reports that the
child has been sick for about two days, the child started with a fever of 101.0 and a non-
productive cough. For the fever, she has been giving the child Tylenol which helps in reducing the
fever and the child’s max temperature was 101.5. The mother verbalize that the child woke up
this morning with complaining of severe sore throat and the child complains of pain with
swallowing. The mother states that she can see the child’s throat is red and irritated. She had the
child gargle with some warm salt water which did not help. In addition, she verbalized a decrease
in the child’s appetite for about 2 days.
Past Medical History:
Unremarkable
Past Surgical History:
None
Family History:
STREPTOCOCCAL PHARYNGITIS 3
Mother, 34 years old, alive, unremarkable
Father, 36 years old, alive, HTN
Brother 3 years old, alive, unremarkable
Maternal Grandmother 62 years old, alive, no health issues
Maternal Grandfather 65 years old, alive, Type 2 Diabetes mellitus, Hyperlipidemia
Paternal Grandmother 66 years old), alive, Type 2 Diabetes mellitus, HTN
Paternal Grandfather 70 years old, alive, HTN
Social History:
C.T. is well develop and well-nourish 8 year old girl. She is fully immunized. C.T. lives
with both parents. Her mother is a teacher at a local elementary school. Her father is a real
estate agent. The maternal set of grandparents live nearby and visit the children on often. C.T.
enjoys playing with her little brother after school and she in gymnastic after school. She often
visits her grandparents during the weekends. She loves to play outdoors and riding her bicycle
Medications Taken at home:
Medication Name Indication
Acetaminophen 1 tsp po every 4-6 hours PRN for fever
Allergies:
No known drug or food allergies.
Immunizations:
Immunizations: (vaccine & date given) – Patient is up-to-date on all immunizations as per CDC
Birth- HepB
2 months – HepB, DTaP, Hib, IPV, PCV, RV given (11/02/2010)
STREPTOCOCCAL PHARYNGITIS 4
4 months – DtaP, Hib, IPV, PCV, RV given (01/06/2011)
6 months – HepB, DtaP, Hib, IPV, PCV, RV given (03/04/2011)
12 months – Hib, PCV, Varicella, MMR, HepA given (09/05/2011)
16 months – DtaP, Influenza given (01/05/2012)
18 months – HepA given (04/06/2012)
28 months – Influenza given (02/07/2013)
40 months – Influenza given (02/06/2014)
48 months – DtaP IPV, MMR, Varicella given (12/05/2014)
Review of Systems:
General:
Integumentary:
Recent fever, fatigue, and malaise. Denies weight loss or poor weight
gain.
Denies any rash. Denies itchiness, no bruises or lesions.
Neurological: Denies dizziness, loss of consciousness, or seizure activity, numbness
or tingling.
Head:
Eyes:
Ears:
Nose/Mouth/Throat:
Normocephalic. Denies any hair loss, no lesions.
Denies any blurred vision, no difficulty focusing, vision 20/20.
Denies any ear pain, hearing loss, ringing in ears, discharge.
Positive for sore throat, swollen glands, and redness to pharynx.
Denies nose bleed, dysphagia, hoarseness, or nasal congestion.
Cardio: Denies chest pain, no palpitations or peripheral edema.
Respiratory: Non-productive cough. Denies shortness of breath, wheezing or night
sweats.
STREPTOCOCCAL PHARYNGITIS 5
GI: Decrease appetite for the past 2 days. Patient denies abdominal pain,
nausea, vomiting, or change in stool pattern or color.
GU: Denies dysuria, urgency, frequency, hematuria or suprapubic pain.
Musculoskeletal:
Developmental:
Milestone
Behavior/Psychiatric:
Patient denies muscle or joint pain, paralysis, or ataxia.
C.T. is in third grade gifted program. She can bathe and dress herself,
and brush her teeth independently. She enjoys gymnastic, singing, and
reading story books.
Denies any mood swings, tantrums, behavioral disorders, sleeping
problems, psychotic disorders, or mental health problems.
Objective
Vital Signs and Other Measurements:
Age Gender Ethnicity Height Weight BMI
8 years old Female American-
Haitian
54
inches
65 lbs 9.8%
Temp HR BP RR O2Sat
102 F 98 100/54 24 98%
Physical Exam:
STREPTOCOCCAL PHARYNGITIS 6
General: Patient is alert and calm, is properly dressed and appears well-
nourished. No signs of acute distress. Her BMI is in the 47th
percentile. There are no concerns for abuse.
Neurological: Patient is alert & oriented x 4. Cranial nerves II-XII grossly intact,
has normal speech, no difficulty in concentration. Muscle tone and
reflexes appear normal. All deep tendon reflexes 2+, no focal
deficits.
Head:
Eyes:
Ears:
Nose:
Throat/Mouth:
Head and characteristic facies symmetry noted. Hair distribution
even.
PERRLA. Corneal light reflex and red reflex present. No strabismus.
Canals patent, TM’s are normal. No purulent drainage noted.
Nares symmetrical. Nasal mucosa with no inflammation, normal
appearing turbinate.
Pharynx is severely erythematous with +2 tonsils outside of the
pillars with white exudates. Submandibular glands are tender to
touch, palatal petechia noted.
Neck: Anterior cervical lymphadenopathy present. Trachea midline. Neck
supple with full ROM.
Lungs: RR: 24. O2 sat: 98% on room air. Breaths are regular and unlabored.
Chest movement is symmetrical. Clear breath sounds bilaterally in all
lobes.
STREPTOCOCCAL PHARYNGITIS 7
Cardio: HR: 98. S1 and S2 present, with normal rhythm and rate. No heart
murmurs, S3, or S4 noted. BP: 100/54. Capillary refill within normal
limits. No peripheral edema. Radial and pedal pulses +2.
GI: Abdomen is soft without organomegaly. Bowel sounds present x 4
quadrants. No masses, no rebound tenderness. No distention noted.
GU: Bladder is non-distended. No costovertebral angle tenderness noted.
Musculoskeletal: Spine is straight with no scoliosis or kyphosis noted. Full ROM
against gravity with full resistance in all extremities noted. No
edema, ecchymosis or erythema noted.
Integumentary: Skin texture is warm, smooth, and soft. No lesions, no rash, no
bruising or scars noted. Capillary refill less than 2 seconds.
Behavior/Psychiatric: Alert and oriented. No distress. Behavior appropriate for age.
Exams:
Rapid strep swab administered in the office, the test is positive (sent for culture).
The gold standard for diagnosing group A beta-hemolytic streptococcal
(GABHS) pharyngitis is a throat swab culture. The sensitivity is 90% to 95%
but results are delayed. The Rapid Antigen Detection Test (RADT) yields
results in minutes (Borchardt, 2013).
Assessment
Current Diagnosis: Streptococcal Pharyngitis
Differential Diagnoses:
STREPTOCOCCAL PHARYNGITIS 8
1. Upper respiratory infection (URI)
2. Influenza
3. Viral Pharyngitis
Plan
1. Amoxicillin (400mg/5ml) 5ml PO every 12 hours x 10 days # 200ml no refills as per
Epocrates, weight dosing at 40mg/kg per day.
2. Use acetaminophen or ibuprofen to treat pain and fever as ordered.
3. No vaccines administered this visit. Parent counseled on yearly influenza vaccinations
and on the next set of recommended vaccinations due at ages 11-12 per CDC guidelines
(CDC, 2017). Strep swab sent for culture for pyrogenic types of strep and parent to be
notified if positive. It will not change treatment plan.
4. Complete antibiotics for full course even if symptoms disappear. Strep throat will be
contagious until 24 hours of antibiotic use. Avoid sharing personal items with other
siblings or household members, change toothbrush out in 36 hours. Adequate and
frequent hand washing to avoid transmission of virus to others. Drink plenty of fluids to
avoid dehydration. Return to school once fever free for at least 24 hours (Ferri, 2016).
5. Be sure that the patient gets plenty of rest and increase activity as tolerated. Warm salt
gargles for sore throat. Ensure that the patient drinks 6-8 glasses of water daily to stay
hydrated and increase intake of fluids with a fever. Be sure that the patient eats a
nutritious diet (Cash & Glass, 2014).
6. Preventive Care: Diet appropriate for child age, healthy eating habits, focus in school, no
arguing in the presence of the child. Safety: helmet, seat belt, no gun in the house, no
STREPTOCOCCAL PHARYNGITIS 9
smoking, stay active, adequate nutrition, fresh food and fruit, listen to parents and
teachers, be respectful.
Subjective Analysis
Streptococcal Pharyngitis, also known as strep throat is a bacterial infection caused by
Streptococcus pyogenes, also known as group A streptococcus. Group A streptococci (GAS) are
gram-positive bacteria which cause acute pharyngitis and is accountable for about 20-30% of
sore throat cases in children (Martin, 2015). GABHS pharyngitis is usually associated with
painful cervical adenopathy, chills, high fever, pharyngeal exudate, scarlatiniform rash, and
headache. While viral pharyngitis is accompanied by symptoms of cough, sneezing hoarseness,
and rhinorrhea (Martin, 2015).
Streptococcal bacteria are highly contagious. They can spread through airborne droplets
when someone with the infection sneezes or coughs, also through shared drinks or foods. In
addition, the bacteria can be transmitted through surfaces such as a doorknob or other surfaces
and one can transfer the bacteria through your mucous membranes. GAS pharyngitis is very
common amongst school-age children around the winter and spring time. Elementary school
children often develop one to three new streptococcal infections each school year (Martin,
2015). Furthermore, it is most commonly found in ages 5 years to 15 years old children. In
C.T.’s scenario, she is complaining of sudden onset of sore throat, fever, pain with swallowing,
and generalized malaise. These symptoms point to streptococcal pharyngitis.
Objective Analysis
Upon physical exam, C.T. has a fever of 102, her tonsils size are 2+ with an overlying
white exudate and her throat is erythematous. In addition, C.T. has tender anterior cervical
STREPTOCOCCAL PHARYNGITIS 10
lymphadenopathy and palatal petechia. About 50% of children with Streptococcal pharyngitis
have tender and enlarged cervical lymph nodes (Martin, 2015). Furthermore, 25% of cases of
streptococcal pharyngitis, the tonsils and pharynx may appear erythematous with
exudate (Martin, 2015). The history and physical examination solely cannot discern between
streptococcal pharyngitis versus an infection due to other causes. Laboratory confirmation is the
accurate method of making a diagnosis of GAS. In cases where GAS is suspected, it is essential
to obtain a rapid antigen test by swabbing the surface of the tonsils and posterior pharynx and
send the culture, which is the gold standard testing for GAS. Although the rapid antigen test has
a specificity of greater than 95%, the sensitivity of the test depends on the method used and that
is why a throat culture should be done to assess for GAS (Martin, 2015).
Assessment Analysis
The differential diagnoses for this patient are an upper respiratory infection (URI),
influenza, and viral pharyngitis. In upper respiratory infection, which is a viral infection, the
usual presenting symptoms include nasal congestion, headache, rhinorrhea, cough, and fever.
With GABHS, the patient can also have symptoms of fever and headache, however nasal
congestion, cough, and rhinorrhea are uncommon (Burns et al., 2017). In addition, with URI no
antibiotics are required and symptoms usually decrease or resolved in 7-10 days. With influenza,
the patient can present with similar symptoms that may resemble GABHS which are malaise,
fever, and sore throat. In C.T. case, the sudden onset of severe sore throat yields more towards
GABHS versus influenza. Another differential diagnosis would be viral pharyngitis. When a
patient is presented with a sore throat it can be difficult to differentiate between viral and
bacterial causes (Burns et al., 2017). However, symptoms with a cough, conjunctivitis,
STREPTOCOCCAL PHARYNGITIS 11
rhinorrhea, and hoarseness are usually presented with viral pharyngitis instead of streptococcal
pharyngitis.
Plan Analysis
Antibiotic treatment is the first line of treatment for patients with streptococcal
pharyngitis who are symptomatic and test positive for GABHS. The patient should be treated
with an antibiotic that is sensitive to GAS. Antibiotics have shown to be effective in reducing
symptoms, prevent the spread to others and reduce the risk of developing complications such
as rheumatic fever, acute glomerulonephritis, and post-streptococcal reactive arthritis (Burns et
al., 2017).
Streptococcus pyogenes (Group A streptococcus), the bacteria that causes strep throat
have remained sensitive to penicillin and overall when treating a bacterial infection, it is
desirable to use the most narrow-spectrum antibiotic that will treat the infection. Penicillin is a
narrow spectrum antibiotic which is a good option since it is well tolerated, has minimal side
effects, is not expensive, and has proven to be effective in treating streptococcal pharyngitis
(Burns et al., 2017). However, in treating children with GABHS, amoxicillin is frequently
substituted for penicillin for a more pleasant taste in liquid suspension and the efficacy is equal
to penicillin.
Supportive care such as antipyretic Acetaminophen, fluids, and rest are also
recommended. Noncompliance with the full course of antibiotic treatment can lead to treatment
failure and its vital that patient complete full course of antibiotic even though symptoms have
resolved. In addition, the patient's toothbrush should be discarded within 24 hours after the use of
antibiotics (Burns et al., 2017). Personal items should not be shared with siblings or household
members. The child can return to school after 24 hours after taking antibiotics and is afebrile.
STREPTOCOCCAL PHARYNGITIS 12
Culture Components
C.T. is Haitian-American and was born and raised in Boynton Beach, Florida. Her father
is White American and mother is Haitian. C.T. mostly speaks English with a few words of
Creole. C. T’s parent follows the Western cultural tradition since they reside in the United States
most of the lives. They have a strong family relationship and are Christians. In America, most
religions are practiced which is originated on the basis of religious freedom, however, most
Americans are Christians (Zimmermann, 2017). Although certain foods such as hamburgers,
potato chips, macaroni and cheese, and meatloaf are commonly considered American dishes, C.
T.’s family practice healthy eating habits which consist of heart-healthy foods. In addition, they
practice preventive care, good health habits such as staying physically active and managing
stress effectively. Western culture refers mainly to the United States and Europe (Zimmermann,
2017). With the United States becoming more diverse, the U.S. is referred to as the “melting pot”
at times in which various cultures have contributed to their own diversity of flavors to the
American culture (Zimmermann, 2017).
STREPTOCOCCAL PHARYNGITIS 13
References
Borchardt, R. A. (2013). Diagnosis and management of group A beta-hemolytic streptococcal
pharyngitis. Journal of the American Academy of Physician Assistants, 26(9), 53-54.
doi:10.1097/01.JAA.0000433876.39648.52
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017).
Pediatric primary care. (6th ed.). St. Louis, MI: Elsevier.
Cash, J. C., & Glass, C. A. (2014). Family practice guidelines. (3rd ed.). New York, NY:
Springer Publishing Company, LLC.
Center for Disease Control and Prevention. (2017). Recommended immunization schedule for
children and adolescents aged 18 and younger, United States, 2017. Retrieved from
https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-
schedule.pdf
Ferri, F. F. (2016). Ferris clinical advisor: 5 books in 1. Philadelphia, PA: Elsevier.
Martin, J. M. (2015). The mysteries of streptococcal pharyngitis. Current Treat Options
Pediatric, 1(2): 180–189. doi:10.1007/s40746-015-0013-9.
Zimmermann, K. A. (2017). American culture: Traditions and customs of the United States.
Retrieved from https://www.livescience.com/28945-american-culture.html.
[https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf](https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf)
[https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf](https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf)
[https://www.livescience.com/28945-american-culture.html](https://www.livescience.com/28945-american-culture.html)
STREPTOCOCCAL PHARYNGITIS 14
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**## SOAPNote1ComprehensiveSOAPonPediatricsHEENT.docx**
**Please follow APA format, add citations and references. Document will be verified for plagiarism and AI use. Thank you!**
**Directions:** Read over the SOAP note and formulate a primary diagnosis. Based on the diagnosis complete the SOAP note with the details that would be expected for the diagnosis. Use UptoDate and/or Dyna MedPlus to find out what is expected from the history and physical, diagnostic workup and management for the diagnosis. Include other peer review resources and and journal articles to support the development of your SOAP note. Complete and attach the evaluation & management score sheet to show how you coded the note for billing in each section.
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**Case Study:** A 3-year-old girl is brought to your office by her mother because she has a fever and complains that her right ear hurts. She has no significant medical history. The child is not pleased to be in the PCP's office and has been crying. Her mother explains that she developed a “cold” about 3 days ago with sniffles. Her temperature is 37.8°C (100°F). Physical exam was completed with some difficulty because of the child's irritability. The only abnormalities are slight redness of the throat, a nose full of thick green mucus, and injected tympanic membranes. She denies nausea, vomiting, diarrhea, headache, or change in urine output.
**## PediatricSOAPNoteExample.pdf**
Running head: STREPTOCOCCAL PHARYNGITIS 1
First Name, Last Name
Florida International University
Professor
Date
STREPTOCOCCAL PHARYNGITIS 2
Subjective
Initials of Patient: C.T
Patient Age: 8 years old
Patient Gender: Female
Patient Ethnicity: American-Haitian
Source of information: Patient’s mother and patient, reliable
Chief Complaint: Sudden onset of sore throat started this morning, cough, fever started 2 days,
and feeling malaise
History of Present Illness:
C.T. is a 8-year old female who presents today accompanied by her mother due to sudden
onset of sore throat, a recent fever, a cough, and feeling malaise. The mother reports that the
child has been sick for about two days, the child started with a fever of 101.0 and a non-
productive cough. For the fever, she has been giving the child Tylenol which helps in reducing the
fever and the child’s max temperature was 101.5. The mother verbalize that the child woke up
this morning with complaining of severe sore throat and the child complains of pain with
swallowing. The mother states that she can see the child’s throat is red and irritated. She had the
child gargle with some warm salt water which did not help. In addition, she verbalized a decrease
in the child’s appetite for about 2 days.
Past Medical History:
Unremarkable
Past Surgical History:
None
Family History:
STREPTOCOCCAL PHARYNGITIS 3
Mother, 34 years old, alive, unremarkable
Father, 36 years old, alive, HTN
Brother 3 years old, alive, unremarkable
Maternal Grandmother 62 years old, alive, no health issues
Maternal Grandfather 65 years old, alive, Type 2 Diabetes mellitus, Hyperlipidemia
Paternal Grandmother 66 years old), alive, Type 2 Diabetes mellitus, HTN
Paternal Grandfather 70 years old, alive, HTN
Social History:
C.T. is well develop and well-nourish 8 year old girl. She is fully immunized. C.T. lives
with both parents. Her mother is a teacher at a local elementary school. Her father is a real
estate agent. The maternal set of grandparents live nearby and visit the children on often. C.T.
enjoys playing with her little brother after school and she in gymnastic after school. She often
visits her grandparents during the weekends. She loves to play outdoors and riding her bicycle
Medications Taken at home:
Medication Name Indication
Acetaminophen 1 tsp po every 4-6 hours PRN for fever
Allergies:
No known drug or food allergies.
Immunizations:
Immunizations: (vaccine & date given) – Patient is up-to-date on all immunizations as per CDC
Birth- HepB
2 months – HepB, DTaP, Hib, IPV, PCV, RV given (11/02/2010)
STREPTOCOCCAL PHARYNGITIS 4
4 months – DtaP, Hib, IPV, PCV, RV given (01/06/2011)
6 months – HepB, DtaP, Hib, IPV, PCV, RV given (03/04/2011)
12 months – Hib, PCV, Varicella, MMR, HepA given (09/05/2011)
16 months – DtaP, Influenza given (01/05/2012)
18 months – HepA given (04/06/2012)
28 months – Influenza given (02/07/2013)
40 months – Influenza given (02/06/2014)
48 months – DtaP IPV, MMR, Varicella given (12/05/2014)
Review of Systems:
General:
Integumentary:
Recent fever, fatigue, and malaise. Denies weight loss or poor weight
gain.
Denies any rash. Denies itchiness, no bruises or lesions.
Neurological: Denies dizziness, loss of consciousness, or seizure activity, numbness
or tingling.
Head:
Eyes:
Ears:
Nose/Mouth/Throat:
Normocephalic. Denies any hair loss, no lesions.
Denies any blurred vision, no difficulty focusing, vision 20/20.
Denies any ear pain, hearing loss, ringing in ears, discharge.
Positive for sore throat, swollen glands, and redness to pharynx.
Denies nose bleed, dysphagia, hoarseness, or nasal congestion.
Cardio: Denies chest pain, no palpitations or peripheral edema.
Respiratory: Non-productive cough. Denies shortness of breath, wheezing or night
sweats.
STREPTOCOCCAL PHARYNGITIS 5
GI: Decrease appetite for the past 2 days. Patient denies abdominal pain,
nausea, vomiting, or change in stool pattern or color.
GU: Denies dysuria, urgency, frequency, hematuria or suprapubic pain.
Musculoskeletal:
Developmental:
Milestone
Behavior/Psychiatric:
Patient denies muscle or joint pain, paralysis, or ataxia.
C.T. is in third grade gifted program. She can bathe and dress herself,
and brush her teeth independently. She enjoys gymnastic, singing, and
reading story books.
Denies any mood swings, tantrums, behavioral disorders, sleeping
problems, psychotic disorders, or mental health problems.
Objective
Vital Signs and Other Measurements:
Age Gender Ethnicity Height Weight BMI
8 years old Female American-
Haitian
54
inches
65 lbs 9.8%
Temp HR BP RR O2Sat
102 F 98 100/54 24 98%
Physical Exam:
STREPTOCOCCAL PHARYNGITIS 6
General: Patient is alert and calm, is properly dressed and appears well-
nourished. No signs of acute distress. Her BMI is in the 47th
percentile. There are no concerns for abuse.
Neurological: Patient is alert & oriented x 4. Cranial nerves II-XII grossly intact,
has normal speech, no difficulty in concentration. Muscle tone and
reflexes appear normal. All deep tendon reflexes 2+, no focal
deficits.
Head:
Eyes:
Ears:
Nose:
Throat/Mouth:
Head and characteristic facies symmetry noted. Hair distribution
even.
PERRLA. Corneal light reflex and red reflex present. No strabismus.
Canals patent, TM’s are normal. No purulent drainage noted.
Nares symmetrical. Nasal mucosa with no inflammation, normal
appearing turbinate.
Pharynx is severely erythematous with +2 tonsils outside of the
pillars with white exudates. Submandibular glands are tender to
touch, palatal petechia noted.
Neck: Anterior cervical lymphadenopathy present. Trachea midline. Neck
supple with full ROM.
Lungs: RR: 24. O2 sat: 98% on room air. Breaths are regular and unlabored.
Chest movement is symmetrical. Clear breath sounds bilaterally in all
lobes.
STREPTOCOCCAL PHARYNGITIS 7
Cardio: HR: 98. S1 and S2 present, with normal rhythm and rate. No heart
murmurs, S3, or S4 noted. BP: 100/54. Capillary refill within normal
limits. No peripheral edema. Radial and pedal pulses +2.
GI: Abdomen is soft without organomegaly. Bowel sounds present x 4
quadrants. No masses, no rebound tenderness. No distention noted.
GU: Bladder is non-distended. No costovertebral angle tenderness noted.
Musculoskeletal: Spine is straight with no scoliosis or kyphosis noted. Full ROM
against gravity with full resistance in all extremities noted. No
edema, ecchymosis or erythema noted.
Integumentary: Skin texture is warm, smooth, and soft. No lesions, no rash, no
bruising or scars noted. Capillary refill less than 2 seconds.
Behavior/Psychiatric: Alert and oriented. No distress. Behavior appropriate for age.
Exams:
Rapid strep swab administered in the office, the test is positive (sent for culture).
The gold standard for diagnosing group A beta-hemolytic streptococcal
(GABHS) pharyngitis is a throat swab culture. The sensitivity is 90% to 95%
but results are delayed. The Rapid Antigen Detection Test (RADT) yields
results in minutes (Borchardt, 2013).
Assessment
Current Diagnosis: Streptococcal Pharyngitis
Differential Diagnoses:
STREPTOCOCCAL PHARYNGITIS 8
1. Upper respiratory infection (URI)
2. Influenza
3. Viral Pharyngitis
Plan
1. Amoxicillin (400mg/5ml) 5ml PO every 12 hours x 10 days # 200ml no refills as per
Epocrates, weight dosing at 40mg/kg per day.
2. Use acetaminophen or ibuprofen to treat pain and fever as ordered.
3. No vaccines administered this visit. Parent counseled on yearly influenza vaccinations
and on the next set of recommended vaccinations due at ages 11-12 per CDC guidelines
(CDC, 2017). Strep swab sent for culture for pyrogenic types of strep and parent to be
notified if positive. It will not change treatment plan.
4. Complete antibiotics for full course even if symptoms disappear. Strep throat will be
contagious until 24 hours of antibiotic use. Avoid sharing personal items with other
siblings or household members, change toothbrush out in 36 hours. Adequate and
frequent hand washing to avoid transmission of virus to others. Drink plenty of fluids to
avoid dehydration. Return to school once fever free for at least 24 hours (Ferri, 2016).
5. Be sure that the patient gets plenty of rest and increase activity as tolerated. Warm salt
gargles for sore throat. Ensure that the patient drinks 6-8 glasses of water daily to stay
hydrated and increase intake of fluids with a fever. Be sure that the patient eats a
nutritious diet (Cash & Glass, 2014).
6. Preventive Care: Diet appropriate for child age, healthy eating habits, focus in school, no
arguing in the presence of the child. Safety: helmet, seat belt, no gun in the house, no
STREPTOCOCCAL PHARYNGITIS 9
smoking, stay active, adequate nutrition, fresh food and fruit, listen to parents and
teachers, be respectful.
Subjective Analysis
Streptococcal Pharyngitis, also known as strep throat is a bacterial infection caused by
Streptococcus pyogenes, also known as group A streptococcus. Group A streptococci (GAS) are
gram-positive bacteria which cause acute pharyngitis and is accountable for about 20-30% of
sore throat cases in children (Martin, 2015). GABHS pharyngitis is usually associated with
painful cervical adenopathy, chills, high fever, pharyngeal exudate, scarlatiniform rash, and
headache. While viral pharyngitis is accompanied by symptoms of cough, sneezing hoarseness,
and rhinorrhea (Martin, 2015).
Streptococcal bacteria are highly contagious. They can spread through airborne droplets
when someone with the infection sneezes or coughs, also through shared drinks or foods. In
addition, the bacteria can be transmitted through surfaces such as a doorknob or other surfaces
and one can transfer the bacteria through your mucous membranes. GAS pharyngitis is very
common amongst school-age children around the winter and spring time. Elementary school
children often develop one to three new streptococcal infections each school year (Martin,
2015). Furthermore, it is most commonly found in ages 5 years to 15 years old children. In
C.T.’s scenario, she is complaining of sudden onset of sore throat, fever, pain with swallowing,
and generalized malaise. These symptoms point to streptococcal pharyngitis.
Objective Analysis
Upon physical exam, C.T. has a fever of 102, her tonsils size are 2+ with an overlying
white exudate and her throat is erythematous. In addition, C.T. has tender anterior cervical
STREPTOCOCCAL PHARYNGITIS 10
lymphadenopathy and palatal petechia. About 50% of children with Streptococcal pharyngitis
have tender and enlarged cervical lymph nodes (Martin, 2015). Furthermore, 25% of cases of
streptococcal pharyngitis, the tonsils and pharynx may appear erythematous with
exudate (Martin, 2015). The history and physical examination solely cannot discern between
streptococcal pharyngitis versus an infection due to other causes. Laboratory confirmation is the
accurate method of making a diagnosis of GAS. In cases where GAS is suspected, it is essential
to obtain a rapid antigen test by swabbing the surface of the tonsils and posterior pharynx and
send the culture, which is the gold standard testing for GAS. Although the rapid antigen test has
a specificity of greater than 95%, the sensitivity of the test depends on the method used and that
is why a throat culture should be done to assess for GAS (Martin, 2015).
Assessment Analysis
The differential diagnoses for this patient are an upper respiratory infection (URI),
influenza, and viral pharyngitis. In upper respiratory infection, which is a viral infection, the
usual presenting symptoms include nasal congestion, headache, rhinorrhea, cough, and fever.
With GABHS, the patient can also have symptoms of fever and headache, however nasal
congestion, cough, and rhinorrhea are uncommon (Burns et al., 2017). In addition, with URI no
antibiotics are required and symptoms usually decrease or resolved in 7-10 days. With influenza,
the patient can present with similar symptoms that may resemble GABHS which are malaise,
fever, and sore throat. In C.T. case, the sudden onset of severe sore throat yields more towards
GABHS versus influenza. Another differential diagnosis would be viral pharyngitis. When a
patient is presented with a sore throat it can be difficult to differentiate between viral and
bacterial causes (Burns et al., 2017). However, symptoms with a cough, conjunctivitis,
STREPTOCOCCAL PHARYNGITIS 11
rhinorrhea, and hoarseness are usually presented with viral pharyngitis instead of streptococcal
pharyngitis.
Plan Analysis
Antibiotic treatment is the first line of treatment for patients with streptococcal
pharyngitis who are symptomatic and test positive for GABHS. The patient should be treated
with an antibiotic that is sensitive to GAS. Antibiotics have shown to be effective in reducing
symptoms, prevent the spread to others and reduce the risk of developing complications such
as rheumatic fever, acute glomerulonephritis, and post-streptococcal reactive arthritis (Burns et
al., 2017).
Streptococcus pyogenes (Group A streptococcus), the bacteria that causes strep throat
have remained sensitive to penicillin and overall when treating a bacterial infection, it is
desirable to use the most narrow-spectrum antibiotic that will treat the infection. Penicillin is a
narrow spectrum antibiotic which is a good option since it is well tolerated, has minimal side
effects, is not expensive, and has proven to be effective in treating streptococcal pharyngitis
(Burns et al., 2017). However, in treating children with GABHS, amoxicillin is frequently
substituted for penicillin for a more pleasant taste in liquid suspension and the efficacy is equal
to penicillin.
Supportive care such as antipyretic Acetaminophen, fluids, and rest are also
recommended. Noncompliance with the full course of antibiotic treatment can lead to treatment
failure and its vital that patient complete full course of antibiotic even though symptoms have
resolved. In addition, the patient's toothbrush should be discarded within 24 hours after the use of
antibiotics (Burns et al., 2017). Personal items should not be shared with siblings or household
members. The child can return to school after 24 hours after taking antibiotics and is afebrile.
STREPTOCOCCAL PHARYNGITIS 12
Culture Components
C.T. is Haitian-American and was born and raised in Boynton Beach, Florida. Her father
is White American and mother is Haitian. C.T. mostly speaks English with a few words of
Creole. C. T’s parent follows the Western cultural tradition since they reside in the United States
most of the lives. They have a strong family relationship and are Christians. In America, most
religions are practiced which is originated on the basis of religious freedom, however, most
Americans are Christians (Zimmermann, 2017). Although certain foods such as hamburgers,
potato chips, macaroni and cheese, and meatloaf are commonly considered American dishes, C.
T.’s family practice healthy eating habits which consist of heart-healthy foods. In addition, they
practice preventive care, good health habits such as staying physically active and managing
stress effectively. Western culture refers mainly to the United States and Europe (Zimmermann,
2017). With the United States becoming more diverse, the U.S. is referred to as the “melting pot”
at times in which various cultures have contributed to their own diversity of flavors to the
American culture (Zimmermann, 2017).
STREPTOCOCCAL PHARYNGITIS 13
References
Borchardt, R. A. (2013). Diagnosis and management of group A beta-hemolytic streptococcal
pharyngitis. Journal of the American Academy of Physician Assistants, 26(9), 53-54.
doi:10.1097/01.JAA.0000433876.39648.52
Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L. (2017).
Pediatric primary care. (6th ed.). St. Louis, MI: Elsevier.
Cash, J. C., & Glass, C. A. (2014). Family practice guidelines. (3rd ed.). New York, NY:
Springer Publishing Company, LLC.
Center for Disease Control and Prevention. (2017). Recommended immunization schedule for
children and adolescents aged 18 and younger, United States, 2017. Retrieved from
https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-
schedule.pdf
Ferri, F. F. (2016). Ferris clinical advisor: 5 books in 1. Philadelphia, PA: Elsevier.
Martin, J. M. (2015). The mysteries of streptococcal pharyngitis. Current Treat Options
Pediatric, 1(2): 180–189. doi:10.1007/s40746-015-0013-9.
Zimmermann, K. A. (2017). American culture: Traditions and customs of the United States.
Retrieved from https://www.livescience.com/28945-american-culture.html.
[https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf](https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf)
[https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf](https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdf)
[https://www.livescience.com/28945-american-culture.html](https://www.livescience.com/28945-american-culture.html)
STREPTOCOCCAL PHARYNGITIS 14
**PediatricSOAPTemplateandRubric-1.docx**
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