Discussion postings of Uniformed Public Expectations

I am attaching the Discussion postings for your response on the discussion about whether you agree or disagree with what they have said and why you agree or disagree. 1) I would first ask the mother what exactly the NP said to her so that I could elaborate or reiterate on what was said and then ask if they swabbed her throat. Sometimes in a stressful situation you do not hear everything that is being said to you. I would then begin to explain that a common cold is caused by a number of different viruses that cause a group of symptoms. Nasal congestion with clear ,yellow, or green colored drainage that can cause a sore throat and cough, fever, sometimes higher than 100.4, irritability, trouble sleeping and decreased appetite. These symptoms can linger as long as two weeks sometimes. Also, explaining to her to keep her daughter well hydrated to prevent further complications or worsening symptoms. You can treat the symptoms but you can not treat the virus. I would also stress the importance of hand washing by all the family members and teach her daughter how to cough into her elbow or tissue to decrease the likely hood of spreading the virus. Sometimes the common cold can lead to a bacterial infection such as sinusitis, ear infection, or pneumonia. This type of infection is what the purpose of antibiotic treatment is used for. Studies have shown that the misuse of antibiotics has created antibiotic resistant bacteria which is one of the worlds most pressing health problem according to the CDC. When you put unnecessary antibiotics or too many antibiotics in your body the bacteria itself changes to become resistance. (http://www(dot)webmd(dot)com/cold-and-flu/cold-guide/antibiotic-colds) Depending on her knowledge of our conversation the discussion could go deeper with me stating "maybe you should talk to her doctor" or she will verbalize understanding of why antibiotics we not prescribe. 2) I can actually relate well to this scenario. I would think that most nurses will have seen this scenario with friends, family, and/or neighbors at least once in the past several years since the research came out that we were actually harming our children by demanding they receive antibiotics every time the get a cold or flu. It has been a common practice for parents to call their doctor and have antibiotics called in for their sick children for quite a few years. As parents it is hard to watch our children suffer through these things and most parents work so they want their children to be able to return to day care or school as quickly as possible when they are sick. Parents are also reluctant to want to take off work or to pay a doctor several times before getting their children well. This puts a lot of pressure on the healthcare provider to take the easy route an just prescribe antibiotics prophylactically. The first thing I would tell my neighbor is that it seems the nurse practitioner is following the latest Centers for Disease Control guidelines for treating colds. Although this is a very scary and frustrating time for both the mom and daughter the nurse is actually looking out for her daughters best interests. According to the CDC “Antibiotics are needed only if your healthcare provider tells you that you or your child has a bacterial infection. Your healthcare provider may prescribe other medicine or give tips to help with a colds symptoms, but antibiotics are not needed to treat a cold or runny nose (CDC, 5/1/2012).” I would also inform my neighbor that antibiotics are not recommended for colds and most upper respiratory infections because they have not been proven to decrease the severity or cure the common cold or most URI's since they are only effective in fighting bacterial infection (CDC, 5/1/2012). Colds and the flu are mainly viral infections not bacterial. I would tell her that not only does the unnecessary prescribing of antibiotics increase the chance that her daughter could have an adverse reaction to the antibiotic it also increases the chance that her body will develop a resistance to the antibiotic which would mean that stronger antibiotics will have to be used for other bacterial infections she may get in the future. I would reassure the mom that most colds get worse in the first 3-4 days before they get better but OTC's like tylenol can be given to her daughter to help with the body aches and sore throat while her body is fighting the virus. I would also reinforce with the parent to keep the child well hydrated and allow her to rest so that her body will be able to fight this more effectively. If the child still has symptoms after 10 days or if she develops other symptoms like a fever over 100.4 then I would take her back to the clinic to see if she has developed a secondary bacterial infection (CDC, 5/1/2012). 3) It is very common for an anxious parent to become upset with a healthcare provider because they did not get the response they anticipated regarding their sick child. When my children were younger, I was always running to the pediatric clinic looking for antibiotics for my children even though I was a nurse working at the hospital on the post-surgical floor. It wasn't until I took a position at the hospital's urgent care clinic that I began to learn about everyday illness. I learned about parental anxiety in relation to a child's illness and how you can easy their anxiety by teaching them about an illness and how it is adequately treated. The situation at hand: a neighbor who is upset with a nurse practitioner because she did not prescribe an antibiotic for her 5 year who has had a cough for days, sore throat and body aches. My plan would be to sit my neighbor down and go through the child's symptoms one by one and explain what was happening. A cold virus entered the sinus's and created irritation. This irritation in return created increase mucus and began to constantly run down the back of the throat thus creating irritation to the throat causing a sore throat and cough. The body aches are a result of the immune system responding to the virus. I would then have the mother look into the back of her child's throat with a flashlight and have her describe what she saw, (this way she get's a visual and basic understanding what throat irritation looks like). After explaining each sign, I would tell her what the sign would look like if it was bacterial. For instance: nasal drainage would be thick yellow/green and not thin and clear; the throat would be bright red with pus pockets or raspberry texture and not light red in color. I would then be able to take the mother back through the visit with the nurse practitioner and explain why the nurse practitioner came to her conclusion. The nurse practitioner listened to the child's lungs = clear, because the cough was caused by the irritation of the increase mucus and not because of mucus in the lungs; the nasal passages were examined and were found to be irritated and have thin clear mucus; and the tissue in the back of the throat was light red in color. I would finalize the teaching with my neighbor by explaining that the nurse practitioner did what was right by her child and that she did know what she was doing. Virus's are treated differently than bacteria. With this type of a virus, antihistamines or decongestants are prescribed to decrease the irritation and mucus production thus giving relief to the sore throat and cough. It would have been inappropriate for antibiotics to have prescribe due the fact that antibiotics have no effect on a virus. Over use of antibiotics are the cause of drug resistant bacteria and have become less effective. Discussion_postings_on_Uniformed_Public_Expectations.docx