Overview
Take a moment to imagine a child and family you might meet. Based on the Learning Resources for this week, consider eye, ear, nose, and throat (EENT); and respiratory conditions you may identify frequently as a Family Nurse Practitioner and those that may be more unusual. Also consider what aspects of the exam process might be more challenging for you—assessing, evaluating, providing multiple diagnoses, treatments, or offering the patient and family management advice.
In this Assignment, you demonstrate clinical reasoning by building a decision-making pathway that a provider would use when evaluating a child with a HEENT complaint. Your goal is to show systematic thinking from history to diagnosis to management using current evidence-based guidelines.
To prepare:
- Review this week’s Learning Resources and consider how to apply knowledge of EENT and respiratory conditions and understanding of socio-cultural family needs in assessing, diagnosing, and treating pediatric patients.
Assignment:
Step 1: Select Your Chief Complaint
Choose ONE pediatric HEENT presenting complaint from the list below. You will build your entire pathway around this complaint.
- Ear pain
- Sore throat
- Red eye
- Nasal congestion or sinus symptoms
- Hearing concerns
- Vision changes
Step 2: Build Your Clinical Decision Pathway
Create a visual flowchart or algorithm that shows how a pediatric primary care provider evaluates and manages your chosen complaint. Your pathway must move logically from the patient's arrival through history, exam, diagnosis, and management.
Your pathway must include all eight of the following components:
- Initial Assessment
- Key history questions using OLDCARTS plus pediatric-specific factors
- Age-specific considerations — how does your approach differ for an infant versus a toddler versus an adolescent?
- Relevant risk factors such as daycare exposure, immunization status, sick contacts, and secondhand smoke
- Red Flag Identification
- Clearly identify urgent and emergent signs that require immediate action
- For each red flag, specify the action: immediate referral, ED, or emergent consult
- Example: Periorbital swelling with fever → concern for orbital cellulitis → ED now
- Focused Physical Examination
- List the essential HEENT exam components for your chosen complaint
- Include expected findings that point toward each major diagnosis
- Note relevant tools and techniques — otoscope, pneumatic otoscopy, vision screening, etc.
- Differential Diagnosis (Prioritized)
- List at least 3 to 5 possible diagnoses
- Organize your differential into three categories:
- Most likely
- Cannot miss
- Less likely but worth considering
- Diagnostic Decision Points
For each branch of your pathway, be explicit about when the provider should:
- Treat clinically without further workup
- Order labs or imaging — specify which and why
- Observe with watchful waiting and return precautions
- Management Plan
For each major diagnosis in your pathway, include:
- First-line treatment with dosing where applicable — all dosing must be weight-based and age-appropriate
- Non-pharmacologic management and supportive care
- Patient and family education specific to the diagnosis
- Follow-up timeline
- Referral Criteria
Specify the clinical criteria that would prompt referral to:
- ENT (Otolaryngology)
- Ophthalmology
- Audiology
- Emergency services
- Evidence-Based Support
- All clinical decisions in your pathway must be grounded in current guidelines
- Acceptable sources: AAP Clinical Practice Guidelines, CDC recommendations, USPSTF guidelines, peer-reviewed literature within the last 5 years
- Include a reference list of at least 3 to 5 scholarly sources in APA 7th edition format
- References should appear at the bottom of your flowchart document or on a separate final slide/page
Format Requirements
- Your pathway must be logical, easy to follow, and clinically realistic
- Use clear directional flow — arrows, branches, decision diamonds, or boxes
- Label all branches clearly — do not assume the reader will infer the logic
- Use professional formatting — avoid clip art, decorative fonts, or informal language
- There is no required length, but every component listed in Step 2 must be present and complete