SOAP Note 1 Comprehensive SOAP on Pediatrics HEENT

Home>Homework Answsers>Nursing homework help7 months ago17.01.202530Report issuefiles (3)SOAPNote1ComprehensiveSOAPonPediatricsHEENT.docxPediatricSOAPNoteExample.pdfPediatricSOAPTemplateandRubric-1.docxSOAPNote1ComprehensiveSOAPonPediatricsHEENT.docxPlease 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.pdfRunning head: STREPTOCOCCAL PHARYNGITIS 1First Name, Last NameFlorida International UniversityProfessorDateSTREPTOCOCCAL PHARYNGITIS 2SubjectiveInitials of Patient: C.TPatient Age: 8 years oldPatient Gender: FemalePatient Ethnicity: American-HaitianSource of information: Patient’s mother and patient, reliableChief Complaint: Sudden onset of sore throat started this morning, cough, fever started 2 days,and feeling malaiseHistory of Present Illness:C.T. is a 8-year old female who presents today accompanied by her mother due to suddenonset of sore throat, a recent fever, a cough, and feeling malaise. The mother reports that thechild 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 thefever and the child’s max temperature was 101.5. The mother verbalize that the child woke upthis morning with complaining of severe sore throat and the child complains of pain withswallowing. The mother states that she can see the child’s throat is red and irritated. She had thechild gargle with some warm salt water which did not help. In addition, she verbalized a decreasein the child’s appetite for about 2 days.Past Medical History:UnremarkablePast Surgical History:NoneFamily History:STREPTOCOCCAL PHARYNGITIS 3Mother, 34 years old, alive, unremarkableFather, 36 years old, alive, HTNBrother 3 years old, alive, unremarkableMaternal Grandmother 62 years old, alive, no health issuesMaternal Grandfather 65 years old, alive, Type 2 Diabetes mellitus, HyperlipidemiaPaternal Grandmother 66 years old), alive, Type 2 Diabetes mellitus, HTNPaternal Grandfather 70 years old, alive, HTNSocial History:C.T. is well develop and well-nourish 8 year old girl. She is fully immunized. C.T. liveswith both parents. Her mother is a teacher at a local elementary school. Her father is a realestate 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 oftenvisits her grandparents during the weekends. She loves to play outdoors and riding her bicycleMedications Taken at home:Medication Name IndicationAcetaminophen 1 tsp po every 4-6 hours PRN for feverAllergies:No known drug or food allergies.Immunizations:Immunizations: (vaccine & date given) – Patient is up-to-date on all immunizations as per CDCBirth- HepB2 months – HepB, DTaP, Hib, IPV, PCV, RV given (11/02/2010)STREPTOCOCCAL PHARYNGITIS 44 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 weightgain.Denies any rash. Denies itchiness, no bruises or lesions.Neurological: Denies dizziness, loss of consciousness, or seizure activity, numbnessor 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 nightsweats.STREPTOCOCCAL PHARYNGITIS 5GI: 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:MilestoneBehavior/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, andreading story books.Denies any mood swings, tantrums, behavioral disorders, sleepingproblems, psychotic disorders, or mental health problems.ObjectiveVital Signs and Other Measurements:Age Gender Ethnicity Height Weight BMI8 years old Female American-Haitian54inches65 lbs 9.8%Temp HR BP RR O2Sat102 F 98 100/54 24 98%Physical Exam:STREPTOCOCCAL PHARYNGITIS 6General: Patient is alert and calm, is properly dressed and appears well-nourished. No signs of acute distress. Her BMI is in the 47thpercentile. 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 andreflexes appear normal. All deep tendon reflexes 2+, no focaldeficits.Head:Eyes:Ears:Nose:Throat/Mouth:Head and characteristic facies symmetry noted. Hair distributioneven.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, normalappearing turbinate.Pharynx is severely erythematous with +2 tonsils outside of thepillars with white exudates. Submandibular glands are tender totouch, palatal petechia noted.Neck: Anterior cervical lymphadenopathy present. Trachea midline. Necksupple 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 alllobes.STREPTOCOCCAL PHARYNGITIS 7Cardio: HR: 98. S1 and S2 present, with normal rhythm and rate. No heartmurmurs, S3, or S4 noted. BP: 100/54. Capillary refill within normallimits. No peripheral edema. Radial and pedal pulses +2.GI: Abdomen is soft without organomegaly. Bowel sounds present x 4quadrants. 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 ROMagainst gravity with full resistance in all extremities noted. Noedema, ecchymosis or erythema noted.Integumentary: Skin texture is warm, smooth, and soft. No lesions, no rash, nobruising 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) yieldsresults in minutes (Borchardt, 2013).AssessmentCurrent Diagnosis: Streptococcal PharyngitisDifferential Diagnoses:STREPTOCOCCAL PHARYNGITIS 81. Upper respiratory infection (URI)2. Influenza3. Viral PharyngitisPlan1. Amoxicillin (400mg/5ml) 5ml PO every 12 hours x 10 days # 200ml no refills as perEpocrates, 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 vaccinationsand 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 benotified if positive. It will not change treatment plan.4. Complete antibiotics for full course even if symptoms disappear. Strep throat will becontagious until 24 hours of antibiotic use. Avoid sharing personal items with othersiblings or household members, change toothbrush out in 36 hours. Adequate andfrequent hand washing to avoid transmission of virus to others. Drink plenty of fluids toavoid 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 saltgargles for sore throat. Ensure that the patient drinks 6-8 glasses of water daily to stayhydrated and increase intake of fluids with a fever. Be sure that the patient eats anutritious diet (Cash & Glass, 2014).6. Preventive Care: Diet appropriate for child age, healthy eating habits, focus in school, noarguing in the presence of the child. Safety: helmet, seat belt, no gun in the house, noSTREPTOCOCCAL PHARYNGITIS 9smoking, stay active, adequate nutrition, fresh food and fruit, listen to parents andteachers, be respectful.Subjective AnalysisStreptococcal Pharyngitis, also known as strep throat is a bacterial infection caused byStreptococcus pyogenes, also known as group A streptococcus. Group A streptococci (GAS) aregram-positive bacteria which cause acute pharyngitis and is accountable for about 20-30% ofsore throat cases in children (Martin, 2015). GABHS pharyngitis is usually associated withpainful cervical adenopathy, chills, high fever, pharyngeal exudate, scarlatiniform rash, andheadache. 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 dropletswhen someone with the infection sneezes or coughs, also through shared drinks or foods. Inaddition, the bacteria can be transmitted through surfaces such as a doorknob or other surfacesand one can transfer the bacteria through your mucous membranes. GAS pharyngitis is verycommon amongst school-age children around the winter and spring time. Elementary schoolchildren 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. InC.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 AnalysisUpon physical exam, C.T. has a fever of 102, her tonsils size are 2+ with an overlyingwhite exudate and her throat is erythematous. In addition, C.T. has tender anterior cervicalSTREPTOCOCCAL PHARYNGITIS 10lymphadenopathy and palatal petechia. About 50% of children with Streptococcal pharyngitishave tender and enlarged cervical lymph nodes (Martin, 2015). Furthermore, 25% of cases ofstreptococcal pharyngitis, the tonsils and pharynx may appear erythematous withexudate (Martin, 2015). The history and physical examination solely cannot discern betweenstreptococcal pharyngitis versus an infection due to other causes. Laboratory confirmation is theaccurate method of making a diagnosis of GAS. In cases where GAS is suspected, it is essentialto obtain a rapid antigen test by swabbing the surface of the tonsils and posterior pharynx andsend the culture, which is the gold standard testing for GAS. Although the rapid antigen test hasa specificity of greater than 95%, the sensitivity of the test depends on the method used and thatis why a throat culture should be done to assess for GAS (Martin, 2015).Assessment AnalysisThe differential diagnoses for this patient are an upper respiratory infection (URI),influenza, and viral pharyngitis. In upper respiratory infection, which is a viral infection, theusual presenting symptoms include nasal congestion, headache, rhinorrhea, cough, and fever.With GABHS, the patient can also have symptoms of fever and headache, however nasalcongestion, cough, and rhinorrhea are uncommon (Burns et al., 2017). In addition, with URI noantibiotics 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 towardsGABHS versus influenza. Another differential diagnosis would be viral pharyngitis. When apatient is presented with a sore throat it can be difficult to differentiate between viral andbacterial causes (Burns et al., 2017). However, symptoms with a cough, conjunctivitis,STREPTOCOCCAL PHARYNGITIS 11rhinorrhea, and hoarseness are usually presented with viral pharyngitis instead of streptococcalpharyngitis.Plan AnalysisAntibiotic treatment is the first line of treatment for patients with streptococcalpharyngitis who are symptomatic and test positive for GABHS. The patient should be treatedwith an antibiotic that is sensitive to GAS. Antibiotics have shown to be effective in reducingsymptoms, prevent the spread to others and reduce the risk of developing complications suchas rheumatic fever, acute glomerulonephritis, and post-streptococcal reactive arthritis (Burns etal., 2017).Streptococcus pyogenes (Group A streptococcus), the bacteria that causes strep throathave remained sensitive to penicillin and overall when treating a bacterial infection, it isdesirable to use the most narrow-spectrum antibiotic that will treat the infection. Penicillin is anarrow spectrum antibiotic which is a good option since it is well tolerated, has minimal sideeffects, 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 frequentlysubstituted for penicillin for a more pleasant taste in liquid suspension and the efficacy is equalto penicillin.Supportive care such as antipyretic Acetaminophen, fluids, and rest are alsorecommended. Noncompliance with the full course of antibiotic treatment can lead to treatmentfailure and its vital that patient complete full course of antibiotic even though symptoms haveresolved. In addition, the patient’s toothbrush should be discarded within 24 hours after the use ofantibiotics (Burns et al., 2017). Personal items should not be shared with siblings or householdmembers. The child can return to school after 24 hours after taking antibiotics and is afebrile.STREPTOCOCCAL PHARYNGITIS 12Culture ComponentsC.T. is Haitian-American and was born and raised in Boynton Beach, Florida. Her fatheris White American and mother is Haitian. C.T. mostly speaks English with a few words ofCreole. C. T’s parent follows the Western cultural tradition since they reside in the United Statesmost of the lives. They have a strong family relationship and are Christians. In America, mostreligions are practiced which is originated on the basis of religious freedom, however, mostAmericans 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, theypractice preventive care, good health habits such as staying physically active and managingstress 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 theAmerican culture (Zimmermann, 2017).STREPTOCOCCAL PHARYNGITIS 13ReferencesBorchardt, R. A. (2013). Diagnosis and management of group A beta-hemolytic streptococcalpharyngitis. Journal of the American Academy of Physician Assistants, 26(9), 53-54.doi:10.1097/01.JAA.0000433876.39648.52Burns, 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 forchildren and adolescents aged 18 and younger, United States, 2017. Retrieved fromhttps://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdfFerri, F. F. (2016). Ferris clinical advisor: 5 books in 1. Philadelphia, PA: Elsevier.Martin, J. M. (2015). The mysteries of streptococcal pharyngitis. Current Treat OptionsPediatric, 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.pdfhttps://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdfhttps://www.livescience.com/28945-american-culture.htmlSTREPTOCOCCAL PHARYNGITIS 14PediatricSOAPTemplateandRubric-1.docxThis file is too large to display.View in new windowPediatricSOAPTemplateandRubric-1.docxThis file is too large to display.View in new windowSOAPNote1ComprehensiveSOAPonPediatricsHEENT.docxPlease 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.pdfRunning head: STREPTOCOCCAL PHARYNGITIS 1First Name, Last NameFlorida International UniversityProfessorDateSTREPTOCOCCAL PHARYNGITIS 2SubjectiveInitials of Patient: C.TPatient Age: 8 years oldPatient Gender: FemalePatient Ethnicity: American-HaitianSource of information: Patient’s mother and patient, reliableChief Complaint: Sudden onset of sore throat started this morning, cough, fever started 2 days,and feeling malaiseHistory of Present Illness:C.T. is a 8-year old female who presents today accompanied by her mother due to suddenonset of sore throat, a recent fever, a cough, and feeling malaise. The mother reports that thechild 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 thefever and the child’s max temperature was 101.5. The mother verbalize that the child woke upthis morning with complaining of severe sore throat and the child complains of pain withswallowing. The mother states that she can see the child’s throat is red and irritated. She had thechild gargle with some warm salt water which did not help. In addition, she verbalized a decreasein the child’s appetite for about 2 days.Past Medical History:UnremarkablePast Surgical History:NoneFamily History:STREPTOCOCCAL PHARYNGITIS 3Mother, 34 years old, alive, unremarkableFather, 36 years old, alive, HTNBrother 3 years old, alive, unremarkableMaternal Grandmother 62 years old, alive, no health issuesMaternal Grandfather 65 years old, alive, Type 2 Diabetes mellitus, HyperlipidemiaPaternal Grandmother 66 years old), alive, Type 2 Diabetes mellitus, HTNPaternal Grandfather 70 years old, alive, HTNSocial History:C.T. is well develop and well-nourish 8 year old girl. She is fully immunized. C.T. liveswith both parents. Her mother is a teacher at a local elementary school. Her father is a realestate 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 oftenvisits her grandparents during the weekends. She loves to play outdoors and riding her bicycleMedications Taken at home:Medication Name IndicationAcetaminophen 1 tsp po every 4-6 hours PRN for feverAllergies:No known drug or food allergies.Immunizations:Immunizations: (vaccine & date given) – Patient is up-to-date on all immunizations as per CDCBirth- HepB2 months – HepB, DTaP, Hib, IPV, PCV, RV given (11/02/2010)STREPTOCOCCAL PHARYNGITIS 44 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 weightgain.Denies any rash. Denies itchiness, no bruises or lesions.Neurological: Denies dizziness, loss of consciousness, or seizure activity, numbnessor 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 nightsweats.STREPTOCOCCAL PHARYNGITIS 5GI: 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:MilestoneBehavior/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, andreading story books.Denies any mood swings, tantrums, behavioral disorders, sleepingproblems, psychotic disorders, or mental health problems.ObjectiveVital Signs and Other Measurements:Age Gender Ethnicity Height Weight BMI8 years old Female American-Haitian54inches65 lbs 9.8%Temp HR BP RR O2Sat102 F 98 100/54 24 98%Physical Exam:STREPTOCOCCAL PHARYNGITIS 6General: Patient is alert and calm, is properly dressed and appears well-nourished. No signs of acute distress. Her BMI is in the 47thpercentile. 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 andreflexes appear normal. All deep tendon reflexes 2+, no focaldeficits.Head:Eyes:Ears:Nose:Throat/Mouth:Head and characteristic facies symmetry noted. Hair distributioneven.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, normalappearing turbinate.Pharynx is severely erythematous with +2 tonsils outside of thepillars with white exudates. Submandibular glands are tender totouch, palatal petechia noted.Neck: Anterior cervical lymphadenopathy present. Trachea midline. Necksupple 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 alllobes.STREPTOCOCCAL PHARYNGITIS 7Cardio: HR: 98. S1 and S2 present, with normal rhythm and rate. No heartmurmurs, S3, or S4 noted. BP: 100/54. Capillary refill within normallimits. No peripheral edema. Radial and pedal pulses +2.GI: Abdomen is soft without organomegaly. Bowel sounds present x 4quadrants. 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 ROMagainst gravity with full resistance in all extremities noted. Noedema, ecchymosis or erythema noted.Integumentary: Skin texture is warm, smooth, and soft. No lesions, no rash, nobruising 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) yieldsresults in minutes (Borchardt, 2013).AssessmentCurrent Diagnosis: Streptococcal PharyngitisDifferential Diagnoses:STREPTOCOCCAL PHARYNGITIS 81. Upper respiratory infection (URI)2. Influenza3. Viral PharyngitisPlan1. Amoxicillin (400mg/5ml) 5ml PO every 12 hours x 10 days # 200ml no refills as perEpocrates, 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 vaccinationsand 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 benotified if positive. It will not change treatment plan.4. Complete antibiotics for full course even if symptoms disappear. Strep throat will becontagious until 24 hours of antibiotic use. Avoid sharing personal items with othersiblings or household members, change toothbrush out in 36 hours. Adequate andfrequent hand washing to avoid transmission of virus to others. Drink plenty of fluids toavoid 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 saltgargles for sore throat. Ensure that the patient drinks 6-8 glasses of water daily to stayhydrated and increase intake of fluids with a fever. Be sure that the patient eats anutritious diet (Cash & Glass, 2014).6. Preventive Care: Diet appropriate for child age, healthy eating habits, focus in school, noarguing in the presence of the child. Safety: helmet, seat belt, no gun in the house, noSTREPTOCOCCAL PHARYNGITIS 9smoking, stay active, adequate nutrition, fresh food and fruit, listen to parents andteachers, be respectful.Subjective AnalysisStreptococcal Pharyngitis, also known as strep throat is a bacterial infection caused byStreptococcus pyogenes, also known as group A streptococcus. Group A streptococci (GAS) aregram-positive bacteria which cause acute pharyngitis and is accountable for about 20-30% ofsore throat cases in children (Martin, 2015). GABHS pharyngitis is usually associated withpainful cervical adenopathy, chills, high fever, pharyngeal exudate, scarlatiniform rash, andheadache. 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 dropletswhen someone with the infection sneezes or coughs, also through shared drinks or foods. Inaddition, the bacteria can be transmitted through surfaces such as a doorknob or other surfacesand one can transfer the bacteria through your mucous membranes. GAS pharyngitis is verycommon amongst school-age children around the winter and spring time. Elementary schoolchildren 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. InC.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 AnalysisUpon physical exam, C.T. has a fever of 102, her tonsils size are 2+ with an overlyingwhite exudate and her throat is erythematous. In addition, C.T. has tender anterior cervicalSTREPTOCOCCAL PHARYNGITIS 10lymphadenopathy and palatal petechia. About 50% of children with Streptococcal pharyngitishave tender and enlarged cervical lymph nodes (Martin, 2015). Furthermore, 25% of cases ofstreptococcal pharyngitis, the tonsils and pharynx may appear erythematous withexudate (Martin, 2015). The history and physical examination solely cannot discern betweenstreptococcal pharyngitis versus an infection due to other causes. Laboratory confirmation is theaccurate method of making a diagnosis of GAS. In cases where GAS is suspected, it is essentialto obtain a rapid antigen test by swabbing the surface of the tonsils and posterior pharynx andsend the culture, which is the gold standard testing for GAS. Although the rapid antigen test hasa specificity of greater than 95%, the sensitivity of the test depends on the method used and thatis why a throat culture should be done to assess for GAS (Martin, 2015).Assessment AnalysisThe differential diagnoses for this patient are an upper respiratory infection (URI),influenza, and viral pharyngitis. In upper respiratory infection, which is a viral infection, theusual presenting symptoms include nasal congestion, headache, rhinorrhea, cough, and fever.With GABHS, the patient can also have symptoms of fever and headache, however nasalcongestion, cough, and rhinorrhea are uncommon (Burns et al., 2017). In addition, with URI noantibiotics 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 towardsGABHS versus influenza. Another differential diagnosis would be viral pharyngitis. When apatient is presented with a sore throat it can be difficult to differentiate between viral andbacterial causes (Burns et al., 2017). However, symptoms with a cough, conjunctivitis,STREPTOCOCCAL PHARYNGITIS 11rhinorrhea, and hoarseness are usually presented with viral pharyngitis instead of streptococcalpharyngitis.Plan AnalysisAntibiotic treatment is the first line of treatment for patients with streptococcalpharyngitis who are symptomatic and test positive for GABHS. The patient should be treatedwith an antibiotic that is sensitive to GAS. Antibiotics have shown to be effective in reducingsymptoms, prevent the spread to others and reduce the risk of developing complications suchas rheumatic fever, acute glomerulonephritis, and post-streptococcal reactive arthritis (Burns etal., 2017).Streptococcus pyogenes (Group A streptococcus), the bacteria that causes strep throathave remained sensitive to penicillin and overall when treating a bacterial infection, it isdesirable to use the most narrow-spectrum antibiotic that will treat the infection. Penicillin is anarrow spectrum antibiotic which is a good option since it is well tolerated, has minimal sideeffects, 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 frequentlysubstituted for penicillin for a more pleasant taste in liquid suspension and the efficacy is equalto penicillin.Supportive care such as antipyretic Acetaminophen, fluids, and rest are alsorecommended. Noncompliance with the full course of antibiotic treatment can lead to treatmentfailure and its vital that patient complete full course of antibiotic even though symptoms haveresolved. In addition, the patient’s toothbrush should be discarded within 24 hours after the use ofantibiotics (Burns et al., 2017). Personal items should not be shared with siblings or householdmembers. The child can return to school after 24 hours after taking antibiotics and is afebrile.STREPTOCOCCAL PHARYNGITIS 12Culture ComponentsC.T. is Haitian-American and was born and raised in Boynton Beach, Florida. Her fatheris White American and mother is Haitian. C.T. mostly speaks English with a few words ofCreole. C. T’s parent follows the Western cultural tradition since they reside in the United Statesmost of the lives. They have a strong family relationship and are Christians. In America, mostreligions are practiced which is originated on the basis of religious freedom, however, mostAmericans 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, theypractice preventive care, good health habits such as staying physically active and managingstress 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 theAmerican culture (Zimmermann, 2017).STREPTOCOCCAL PHARYNGITIS 13ReferencesBorchardt, R. A. (2013). Diagnosis and management of group A beta-hemolytic streptococcalpharyngitis. Journal of the American Academy of Physician Assistants, 26(9), 53-54.doi:10.1097/01.JAA.0000433876.39648.52Burns, 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 forchildren and adolescents aged 18 and younger, United States, 2017. Retrieved fromhttps://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdfFerri, F. F. (2016). Ferris clinical advisor: 5 books in 1. Philadelphia, PA: Elsevier.Martin, J. M. (2015). The mysteries of streptococcal pharyngitis. Current Treat OptionsPediatric, 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.pdfhttps://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdfhttps://www.livescience.com/28945-american-culture.htmlSTREPTOCOCCAL PHARYNGITIS 14PediatricSOAPTemplateandRubric-1.docxThis file is too large to display.View in new windowSOAPNote1ComprehensiveSOAPonPediatricsHEENT.docxPlease 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.pdfRunning head: STREPTOCOCCAL PHARYNGITIS 1First Name, Last NameFlorida International UniversityProfessorDateSTREPTOCOCCAL PHARYNGITIS 2SubjectiveInitials of Patient: C.TPatient Age: 8 years oldPatient Gender: FemalePatient Ethnicity: American-HaitianSource of information: Patient’s mother and patient, reliableChief Complaint: Sudden onset of sore throat started this morning, cough, fever started 2 days,and feeling malaiseHistory of Present Illness:C.T. is a 8-year old female who presents today accompanied by her mother due to suddenonset of sore throat, a recent fever, a cough, and feeling malaise. The mother reports that thechild 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 thefever and the child’s max temperature was 101.5. The mother verbalize that the child woke upthis morning with complaining of severe sore throat and the child complains of pain withswallowing. The mother states that she can see the child’s throat is red and irritated. She had thechild gargle with some warm salt water which did not help. In addition, she verbalized a decreasein the child’s appetite for about 2 days.Past Medical History:UnremarkablePast Surgical History:NoneFamily History:STREPTOCOCCAL PHARYNGITIS 3Mother, 34 years old, alive, unremarkableFather, 36 years old, alive, HTNBrother 3 years old, alive, unremarkableMaternal Grandmother 62 years old, alive, no health issuesMaternal Grandfather 65 years old, alive, Type 2 Diabetes mellitus, HyperlipidemiaPaternal Grandmother 66 years old), alive, Type 2 Diabetes mellitus, HTNPaternal Grandfather 70 years old, alive, HTNSocial History:C.T. is well develop and well-nourish 8 year old girl. She is fully immunized. C.T. liveswith both parents. Her mother is a teacher at a local elementary school. Her father is a realestate 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 oftenvisits her grandparents during the weekends. She loves to play outdoors and riding her bicycleMedications Taken at home:Medication Name IndicationAcetaminophen 1 tsp po every 4-6 hours PRN for feverAllergies:No known drug or food allergies.Immunizations:Immunizations: (vaccine & date given) – Patient is up-to-date on all immunizations as per CDCBirth- HepB2 months – HepB, DTaP, Hib, IPV, PCV, RV given (11/02/2010)STREPTOCOCCAL PHARYNGITIS 44 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 weightgain.Denies any rash. Denies itchiness, no bruises or lesions.Neurological: Denies dizziness, loss of consciousness, or seizure activity, numbnessor 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 nightsweats.STREPTOCOCCAL PHARYNGITIS 5GI: 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:MilestoneBehavior/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, andreading story books.Denies any mood swings, tantrums, behavioral disorders, sleepingproblems, psychotic disorders, or mental health problems.ObjectiveVital Signs and Other Measurements:Age Gender Ethnicity Height Weight BMI8 years old Female American-Haitian54inches65 lbs 9.8%Temp HR BP RR O2Sat102 F 98 100/54 24 98%Physical Exam:STREPTOCOCCAL PHARYNGITIS 6General: Patient is alert and calm, is properly dressed and appears well-nourished. No signs of acute distress. Her BMI is in the 47thpercentile. 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 andreflexes appear normal. All deep tendon reflexes 2+, no focaldeficits.Head:Eyes:Ears:Nose:Throat/Mouth:Head and characteristic facies symmetry noted. Hair distributioneven.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, normalappearing turbinate.Pharynx is severely erythematous with +2 tonsils outside of thepillars with white exudates. Submandibular glands are tender totouch, palatal petechia noted.Neck: Anterior cervical lymphadenopathy present. Trachea midline. Necksupple 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 alllobes.STREPTOCOCCAL PHARYNGITIS 7Cardio: HR: 98. S1 and S2 present, with normal rhythm and rate. No heartmurmurs, S3, or S4 noted. BP: 100/54. Capillary refill within normallimits. No peripheral edema. Radial and pedal pulses +2.GI: Abdomen is soft without organomegaly. Bowel sounds present x 4quadrants. 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 ROMagainst gravity with full resistance in all extremities noted. Noedema, ecchymosis or erythema noted.Integumentary: Skin texture is warm, smooth, and soft. No lesions, no rash, nobruising 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) yieldsresults in minutes (Borchardt, 2013).AssessmentCurrent Diagnosis: Streptococcal PharyngitisDifferential Diagnoses:STREPTOCOCCAL PHARYNGITIS 81. Upper respiratory infection (URI)2. Influenza3. Viral PharyngitisPlan1. Amoxicillin (400mg/5ml) 5ml PO every 12 hours x 10 days # 200ml no refills as perEpocrates, 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 vaccinationsand 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 benotified if positive. It will not change treatment plan.4. Complete antibiotics for full course even if symptoms disappear. Strep throat will becontagious until 24 hours of antibiotic use. Avoid sharing personal items with othersiblings or household members, change toothbrush out in 36 hours. Adequate andfrequent hand washing to avoid transmission of virus to others. Drink plenty of fluids toavoid 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 saltgargles for sore throat. Ensure that the patient drinks 6-8 glasses of water daily to stayhydrated and increase intake of fluids with a fever. Be sure that the patient eats anutritious diet (Cash & Glass, 2014).6. Preventive Care: Diet appropriate for child age, healthy eating habits, focus in school, noarguing in the presence of the child. Safety: helmet, seat belt, no gun in the house, noSTREPTOCOCCAL PHARYNGITIS 9smoking, stay active, adequate nutrition, fresh food and fruit, listen to parents andteachers, be respectful.Subjective AnalysisStreptococcal Pharyngitis, also known as strep throat is a bacterial infection caused byStreptococcus pyogenes, also known as group A streptococcus. Group A streptococci (GAS) aregram-positive bacteria which cause acute pharyngitis and is accountable for about 20-30% ofsore throat cases in children (Martin, 2015). GABHS pharyngitis is usually associated withpainful cervical adenopathy, chills, high fever, pharyngeal exudate, scarlatiniform rash, andheadache. 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 dropletswhen someone with the infection sneezes or coughs, also through shared drinks or foods. Inaddition, the bacteria can be transmitted through surfaces such as a doorknob or other surfacesand one can transfer the bacteria through your mucous membranes. GAS pharyngitis is verycommon amongst school-age children around the winter and spring time. Elementary schoolchildren 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. InC.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 AnalysisUpon physical exam, C.T. has a fever of 102, her tonsils size are 2+ with an overlyingwhite exudate and her throat is erythematous. In addition, C.T. has tender anterior cervicalSTREPTOCOCCAL PHARYNGITIS 10lymphadenopathy and palatal petechia. About 50% of children with Streptococcal pharyngitishave tender and enlarged cervical lymph nodes (Martin, 2015). Furthermore, 25% of cases ofstreptococcal pharyngitis, the tonsils and pharynx may appear erythematous withexudate (Martin, 2015). The history and physical examination solely cannot discern betweenstreptococcal pharyngitis versus an infection due to other causes. Laboratory confirmation is theaccurate method of making a diagnosis of GAS. In cases where GAS is suspected, it is essentialto obtain a rapid antigen test by swabbing the surface of the tonsils and posterior pharynx andsend the culture, which is the gold standard testing for GAS. Although the rapid antigen test hasa specificity of greater than 95%, the sensitivity of the test depends on the method used and thatis why a throat culture should be done to assess for GAS (Martin, 2015).Assessment AnalysisThe differential diagnoses for this patient are an upper respiratory infection (URI),influenza, and viral pharyngitis. In upper respiratory infection, which is a viral infection, theusual presenting symptoms include nasal congestion, headache, rhinorrhea, cough, and fever.With GABHS, the patient can also have symptoms of fever and headache, however nasalcongestion, cough, and rhinorrhea are uncommon (Burns et al., 2017). In addition, with URI noantibiotics 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 towardsGABHS versus influenza. Another differential diagnosis would be viral pharyngitis. When apatient is presented with a sore throat it can be difficult to differentiate between viral andbacterial causes (Burns et al., 2017). However, symptoms with a cough, conjunctivitis,STREPTOCOCCAL PHARYNGITIS 11rhinorrhea, and hoarseness are usually presented with viral pharyngitis instead of streptococcalpharyngitis.Plan AnalysisAntibiotic treatment is the first line of treatment for patients with streptococcalpharyngitis who are symptomatic and test positive for GABHS. The patient should be treatedwith an antibiotic that is sensitive to GAS. Antibiotics have shown to be effective in reducingsymptoms, prevent the spread to others and reduce the risk of developing complications suchas rheumatic fever, acute glomerulonephritis, and post-streptococcal reactive arthritis (Burns etal., 2017).Streptococcus pyogenes (Group A streptococcus), the bacteria that causes strep throathave remained sensitive to penicillin and overall when treating a bacterial infection, it isdesirable to use the most narrow-spectrum antibiotic that will treat the infection. Penicillin is anarrow spectrum antibiotic which is a good option since it is well tolerated, has minimal sideeffects, 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 frequentlysubstituted for penicillin for a more pleasant taste in liquid suspension and the efficacy is equalto penicillin.Supportive care such as antipyretic Acetaminophen, fluids, and rest are alsorecommended. Noncompliance with the full course of antibiotic treatment can lead to treatmentfailure and its vital that patient complete full course of antibiotic even though symptoms haveresolved. In addition, the patient’s toothbrush should be discarded within 24 hours after the use ofantibiotics (Burns et al., 2017). Personal items should not be shared with siblings or householdmembers. The child can return to school after 24 hours after taking antibiotics and is afebrile.STREPTOCOCCAL PHARYNGITIS 12Culture ComponentsC.T. is Haitian-American and was born and raised in Boynton Beach, Florida. Her fatheris White American and mother is Haitian. C.T. mostly speaks English with a few words ofCreole. C. T’s parent follows the Western cultural tradition since they reside in the United Statesmost of the lives. They have a strong family relationship and are Christians. In America, mostreligions are practiced which is originated on the basis of religious freedom, however, mostAmericans 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, theypractice preventive care, good health habits such as staying physically active and managingstress 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 theAmerican culture (Zimmermann, 2017).STREPTOCOCCAL PHARYNGITIS 13ReferencesBorchardt, R. A. (2013). Diagnosis and management of group A beta-hemolytic streptococcalpharyngitis. Journal of the American Academy of Physician Assistants, 26(9), 53-54.doi:10.1097/01.JAA.0000433876.39648.52Burns, 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 forchildren and adolescents aged 18 and younger, United States, 2017. Retrieved fromhttps://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdfFerri, F. F. (2016). Ferris clinical advisor: 5 books in 1. Philadelphia, PA: Elsevier.Martin, J. M. (2015). The mysteries of streptococcal pharyngitis. Current Treat OptionsPediatric, 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.pdfhttps://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-combined-schedule.pdfhttps://www.livescience.com/28945-american-culture.htmlSTREPTOCOCCAL PHARYNGITIS 14PediatricSOAPTemplateandRubric-1.docxThis file is too large to display.View in new window123Bids(53)PROVEN STERLINGDr. Ellen RMEmily ClareMathProgrammingDr. Sarah Blakeabdul_rehman_Prof Double RSTELLAR GEEK A+WIZARD_KIMProWritingGurugrA+de plusfirstclass tutorDr. Adeline ZoePremiumnicohwilliamDr. Sophie MilesMUSYOKIONES A+Isabella HarvardDr CloverColeen AndersonShow All Bidsother Questions(10)CJA 474 Week 4 Individual Assignment Mergers Dont Always Lead to Culture Clashes PaperFor ExceptionalProfessor Only- Assignment 3 helpBUS620_ Managerial Marketing week 6_ final paperScreen Design Issues and Input designUnit VI Project 7- to 10-slide PowerPointHCS449 Week 2LAN-WANdiscussionhelpFOR TIM.WRITERS ONLY!!!!

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