What are the key components to review and discuss during a wellness visit for an 11-year-old female with asthma, food allergies (Food Allergy), seasonal allergies (Allergic Rhinitis), and right-sided hearing loss (Unilateral Hearing Loss)?

Comprehensive Wellness Visit Plan for 11-Year-Old Female with Multiple Allergic Conditions and Hearing Loss

A comprehensive wellness visit for an 11-year-old female with asthma, food allergies, seasonal allergies, and right-sided hearing loss should prioritize assessment of symptom control, medication management, and evaluation of impact on quality of life, with special attention to hearing status and educational performance.

Asthma Management Assessment

• Symptom control evaluation:

  • Frequency of daytime symptoms, nighttime awakenings, activity limitations
  • Use of rescue medications (frequency and effectiveness)
  • History of exacerbations requiring oral corticosteroids, ED visits, or hospitalizations since last visit 1
  • Impact on school attendance, physical activities, and sleep quality

• Medication review:

  • Adherence to controller medications
  • Proper inhaler technique (demonstrate and verify)
  • Side effects of medications
  • Need for adjustment based on symptom control

• Asthma action plan:

  • Update written plan with current medications and emergency contacts
  • Review signs of worsening asthma and appropriate response steps
  • Ensure school has updated copy of asthma action plan 1

Food Allergy Management

• Current allergen assessment:

  • Confirm specific food allergens (most common: milk, egg, wheat, soy, peanut, tree nuts, fish, shellfish) 1
  • Review any new suspected food reactions since last visit
  • Assess for cross-reactivity concerns between food allergens

• Emergency preparedness:

  • Verify prescription for epinephrine auto-injector is current
  • Check expiration dates of current auto-injectors
  • Confirm patient and caregivers know how to use auto-injector
  • Review food allergy action plan 1

• School management:

  • Update school documentation for food allergies
  • Review school accommodations (lunch seating, classroom activities)
  • Ensure school has emergency medications and action plan 1

Seasonal Allergies (Allergic Rhinitis) Assessment

• Symptom pattern evaluation:

  • Classify as intermittent vs. persistent and mild vs. moderate-severe 1
  • Document seasonal patterns and specific triggers
  • Assess for nasal congestion, rhinorrhea, sneezing, itching
  • Evaluate for impact on sleep, school performance, and daily activities 1

• Medication review:

  • Effectiveness of current medications (antihistamines, nasal corticosteroids)
  • Adherence and proper administration technique
  • Consider montelukast for patients with both allergic rhinitis and asthma 2
  • Need for referral to allergist for immunotherapy consideration

• Environmental control measures:

  • Review home environment for allergen exposure (pets, dust mites, mold)
  • Discuss practical avoidance strategies for identified triggers 1

Hearing Loss Assessment

• Hearing status evaluation:

  • Current status of right-sided hearing loss
  • Any changes in hearing function
  • Impact on communication, learning, and social interactions
  • Screening for potential allergic contribution to hearing issues 3, 4

• Educational accommodations:

  • Classroom seating arrangements (left ear toward teacher)
  • Need for assistive listening devices
  • IEP or 504 plan status and effectiveness
  • Academic performance review

Comorbidity Screening

• Sleep quality assessment:

  • Screen for sleep disturbances related to allergic conditions
  • Evaluate for mouth breathing, snoring, or sleep apnea
  • Impact on daytime functioning and school performance 5

• Mental health screening:

  • Assess for anxiety or depression related to chronic conditions
  • Evaluate social functioning and peer relationships
  • Screen for bullying or teasing related to medical conditions

• Growth and development:

  • Plot height, weight, and BMI on growth charts
  • Assess pubertal development (Tanner staging)
  • Review nutrition status, especially with food restrictions

Preventive Care

• Immunizations:

  • Review and update routine immunizations per schedule
  • Annual influenza vaccination (especially important with asthma)
  • No contraindications to standard vaccines with allergic conditions

• Vision screening:

  • Annual screening recommended at this age
  • Especially important with unilateral hearing loss

• Dental health:

  • Confirm regular dental visits
  • Assess for oral allergy syndrome symptoms (itching of mouth with certain raw fruits/vegetables) 1

Coordination of Care

• Specialist communication:

  • Review recent visits with allergist, pulmonologist, audiologist
  • Coordinate care plans and medication adjustments
  • Consider referral to allergist if not already established 1

• School coordination:

  • Update all school health forms and emergency action plans
  • Ensure communication between school nurse and healthcare providers
  • Address any concerns about school accommodations

Practical Tips for the Visit

• Bring all current medications, including inhalers and auto-injectors
• Have school forms ready for completion
• Prepare questions about medication management during school, sports, and other activities
• Consider scheduling visit during allergy season to better assess symptom control

Common Pitfalls to Avoid

• Overlooking the interaction between conditions: Allergic rhinitis can worsen asthma control, and both can impact sleep quality and hearing function 5
• Focusing only on the most prominent condition: All conditions require active management and monitoring
• Neglecting quality of life impact: These conditions significantly affect daily functioning, school performance, and social development
• Missing hearing-related educational needs: Unilateral hearing loss requires specific classroom accommodations
• Underestimating psychological impact: Chronic conditions and dietary restrictions can affect self-esteem and social interactions

By addressing all these components systematically, you'll provide comprehensive care that addresses both the medical management and quality of life aspects for this patient with multiple allergic conditions and hearing loss.