NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat – E

NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat – Episodic/Focused SOAP Note Example

Patient Information:

CL, 28, Female, White American

S.

CC: Runny nose, itchy eyes, itchy throat, fullness of ears, and sneezing

HPI: Mrs C.L., a 28-year-old female, came to the hospital and was well until nine days ago when she developed a runny nose, itchy eyes, and her ears felt full. The nasal drainage is clear mucus, and she sneezes all day. The patient reports that the symptoms are seasonal and last about six to eight weeks every spring. She also sneezes all day, her eyes have severe itch, and her throat is usually itchy during these attacks. The ears also pop sometimes, which is quite uncomfortable. The symptoms are often self-limiting, do disappear without intervention, and are recurrent during spring, and she decided to seek treatment this time. The patient claims that colds during the morning and evenings worsen the symptoms. Chlorpheniramine taken provides temporary symptom relief.

Current Medications:
Chlorpheniramine 12mg twice daily for two days

Green tea 300ml twice daily

Vitamin C supplement 50 ml daily

Allergies: She is allergic to dust and cold and develops a runny nose, nasal congestion, and sneezes. Allergic to penicillin and develops itchiness and hives. No other known drug or food allergies

PMHx:  Diagnosed with severe pneumonia in 8th grade and was admitted for treatment for a week. No surgery or intubation history was performed during the admission. Diagnosed with nephritis five years ago and was admitted for four days during the treatment period. She denies a history of surgery or blood transfusion. Childhood immunizations are up to date. The last tetanus dose was two years ago. Covid-19 vaccine booster was given one year ago. Last flu vaccine seven years ago she was in college.
Soc Hx: Mrs C. L. is a teacher who teaches fourth-grade students at a local school. She loves playing with the children and doubles up as the hockey coach in the school. She also loves bible study and fellowship services. She is married with one 3-year-old child. She lives with her husband and child, with whom they have a good relationship. She denies smoking or alcohol use. She reports using seatbelts when driving, denies participating in extreme sports, and has safety measures at home, such as smoke detectors and a home phone for emergency calls.

Fam Hx: Her paternal grandparents died in a road accident. Her maternal grandfather is an alcoholic, hypertensive, and was recently diagnosed with BPH. Her maternal grandmother is asthmatic. Her maternal uncle is asthmatic. She has three brothers. The eldest brother, Tim, is obese and hypertensive. The other siblings are alive and well

ROS:

GENERAL:  Patient denies weight loss, malaise, fever, or fatigue.

HEENT:  Eyes:  Reports eye itchiness and denies eye discharge or changes in vision acuity. Ears: Reports popping and fullness of ears. Denies pain, discharge or hearing acuity changes. Nose: Reports a runny nose with clear discharge and occasional sneezing. Throat: Reports an occasionally itchy throat.

SKIN:  Denies rash or itching.

CARDIOVASCULAR:  Denies chest pain, pressure, discomfort, palpitations, or edema.

RESPIRATORY: Reports mild difficulty in breathing due to nasal congestion. Denies cough or sputum production.

GASTROINTESTINAL: Denies nausea or vomiting, diarrhea, blood in stool, or diarrhea.

GENITOURINARY:  Denies urine retention, burning on urination, urine odor or color change, or lower abdominal pain. LMP: 12/18/2023

NEUROLOGICAL:  Reports mild headache and denies dizziness, numbness or tingling sensation in limbs. Reports adequate bowel and bladder control.

MUSCULOSKELETAL:  Denies muscle, pain, or joint injury, stiffness, pain

HEMATOLOGIC:  Denies easy bruising or uncontrollable bleeding

LYMPHATICS:  Denies lymph node enlargement or history of splenectomy.

PSYCHIATRIC:  Denies depression or anxiety

ENDOCRINOLOGIC:  Denies profuse sweating, cold or heat intolerance, polyuria, polyphagia, or polyuria.

ALLERGIES:  Reports runny nose, nasal congestion, and sneezing on exposure to dust. Reports hives and skin rashes on exposure to penicillin.

O.

Physical exam:

HEENT: Head: Normocephalic, hair evenly distributed, no receding hairline, scalp moist and shiny. Eyes: Erythematous and teary. Ears: No drainage, pain or changes in hearing acuity. Nose: Clear, thin nasal discharge, nasal mucosa boggy, enlarged nasal turbinates, obstructed airway. Throat: Mildly erythematous

Neck: No enlarged lymph nodes, trachea midline, and tonsils non-palpable

Chest: symmetrical rising with breathing in and out. No accessory muscle use in breathing., no rashes or lesions. Lungs clear to auscultation, no crackles or wheezes. Apical pulse 74bpm, S1 and S2 auscultated. No murmurs or gallops

Abdomen: Globular in shape, well hydrated, no scars, lesions or rashes. No organomegaly. Moderate bowel sounds in all abdomen quadrants. No tenderness on light and deep palpation.

Neurological: All cranial nerves intact. Good plantar and knee-jerk reflexes. Good muscle tone on all extremities.

Vitals

Temp: 37.1oC, Blood pressure 132/77, Pulse Rate- 74, RR- 19, SpO2 94%

Diagnostic results:

The strep test is an ideal test for this patient. The strep test is a simple procedure that will help rule out or confirm streptococci infection (Ball et al., 2023). Nasal allergen challenge is a test that can be used to identify the offending allergens and help differentiate between allergic and non-allergic conditions, as Eguiluz-Gracia et al. (2019) support.

A.

Differential Diagnoses

Seasonal Allergic Rhinitis: Allergic rhinitis, a condition caused by a reaction to environmental allergens, is the most presumptive diagnosis; the duration of illness, history of allergic attacks, and recurrence of the condition in early spring support the diagnosis. Unlike most upper respiratory tract infections, allergic rhinitis can persist long without management and easily recur. Allergic rhinitis symptoms include a runny nose, nasal stuffiness, itchy nose, watery and itchy eyes, headache, coughing, and an itchy palate, coinciding with the patient’s symptoms (Eguiluz-Gracia et al., 2019).

Non-Allergic Rhinitis: In non-allergic rhinitis, the nasal mucosa is inflamed by not from an allergen cause. The symptoms include nasal congestion, sneezing, runny nose, and a post-nasal drip. A post-nasal drip can precipitate a cough or sore throat. Eguiluz-Gracia et al. (2019) note that non-allergic rhinitis is often chronic and not seasonal. Non-allergic rhinitis causes are unknown and primarily affects individuals above 20 years. Non-allergic rhinitis is often challenging to manage  because it lacks a cause and thus can persist for longer than most upper respiratory tract infections (Patel et al., 2020)

Acute nasopharyngitis (Common Cold). The condition is a self-limiting infection lasting 7-10 days. However, a cough that follows untreated cases may last up to four weeks. Common cold often occurs in the colder seasons, and transmissions are higher in winter. Common cold presents with symptoms of nasal stuffiness, cough, mild headache, malaise, fever, sore throat and a runny nose, as Jaume et al. (2020) state. However, common cold symptoms do not last beyond ten days, ruling it out as the primary diagnosis.

Seasonal Hemophilus Influenza (Flu). Hemophilus influenza is a viral whose symptoms last 3-7 days and are severe, warranting medical treatment. Uyeki et al. (2019) note that flu symptoms develop rapidly and are often severe, especially in children, making it difficult to persevere without seeking treatment. An individual can contract the flu anytime, but seasonal transmission is often high in the fall. However, Mrs C.L. has had her symptoms for about nine days. She also reports that these symptoms can last six to eight weeks, ruling out the flu. More so, the flu is also more common in the fall than spring and spring is associated with many environmental changes, including treas blossoming in preparation for spring. These differential diagnoses can help diagnose and treat the client promptly and eliminate recurrences.

NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel’s guide to physical examination: An interprofessional approach (10th ed.). St. Louis, MO: Elsevier Mosby. https://www.amazon.com/Seidels-Guide-Physical-Examination-Interprofessional/dp/0323481957

Eguiluz-Gracia, I., Pérez-Sánchez, N., Bogas, G., Campo, P., & Rondón, C. (2019). How to diagnose and treat local allergic rhinitis: a challenge for clinicians. Journal of Clinical Medicine, 8(7), 1062. https://doi.org/10.3390/jcm8071062

Jaume, F., Valls-Mateus, M., & Mullol, J. (2020). Common cold and acute rhinosinusitis: up-to-date management in 2020. Current allergy and asthma reports, 20, 1-10. https://doi.org/10.1007/s11882-020-00917-5

Patel, G. B., Kern, R. C., Bernstein, J. A., Hae-Sim, P., & Peters, A. T. (2020). Current and future treatments of rhinitis and sinusitis. The Journal of Allergy and Clinical Immunology: In Practice, 8(5), 1522-1531. https://doi.org/10.1016/j.jaip.2020.01.031

Uyeki, T. M., Bernstein, H. H., Bradley, J. S., Englund, J. A., File, T. M., Fry, A. M., Gravenstein, S., Hayden, F. G., Harper, S. A., Hirshon, J. M ., Ison, M. G., Johnston, B. L.,  Knight, S. L., McGeer, A., Riley, L. E., Wolfe, C. R., Alexander, P. E., & Pavia, A. T. (2019). Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clinical Infectious Diseases, 68(6), e1-e47. https://doi.org/10.1093/cid/ciy866

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NURS6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.

Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer.

With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.

In this NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

To Prepare for NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat

• By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
• Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case.

With regard to the case study you were assigned:

• Review this week’s Learning Resources and consider the insights they provide.
• Consider what history would be necessary to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat: The Assignment

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

By Day 6 of Week 5 of NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat

Submit your Assignment.

NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat Case Study Example Solution 2

The patient is a 28-year-old woman who has been experiencing a runny nose and itchy eyes for about nine days. These symptoms typically last for six to eight weeks and occur every spring. Besides the runny nose, she reports having itchy eyes that she feels the urge to scratch, a tickling sensation in her throat, and a feeling of fullness in her ears that sometimes causes them to pop. Last year, she took Claritin with relief. Upon examination, the patient is alert and oriented and has pale nasal mucosa with clear thin secretions and enlarged nasal turbinates that obstruct airway flow, but her lungs are clear. Her tonsils are not enlarged, but her throat is mildly red.

Diagnostic Tests Justification

Based on the patient’s symptoms of a runny nose, itchy eyes, and ears that feel full, a few possible diagnostic tests that could be appropriate for this case are listed and justified below.

1. Allergy testing: The patient’s symptoms of a runny nose, itchy eyes, and ears that feel full are consistent with allergic rhinitis, which is an allergic reaction to environmental allergens such as pollen, mold, or pet dander (McCance & Huether, 2019). Allergy testing can help confirm whether the patient has an allergy and identify the specific allergens causing the patient’s symptoms.
2. Nasal endoscopy: A nasal endoscopy involves inserting a thin, flexible tube with a camera into the patient’s nose to visualize the inside of the nasal passages and sinuses. This test can help identify any structural abnormalities or inflammation in the nasal passages that may contribute to the patient’s symptoms.
3. Sinus imaging: Sinus imaging tests such as CT scans or MRIs provide detailed images of the patient’s sinuses and help identify any blockages or infections that may be causing the patient’s symptoms.
4. Throat culture: A throat culture involves taking a sample of the patient’s throat secretions and growing them in a laboratory to identify any bacterial or viral infections that may be causing the patient’s symptoms.
5. Complete blood count (CBC): A CBC would give a depiction of the white blood cells and their differentials and show whether there is an excess of or any deficiency of the cells. Elevated eosinophils upon doing a CBC may be suggestive of an allergic condition.

Differential Diagnoses

Based on the patient’s symptoms and the diagnostic tests described above, the following five conditions should be considered in the differential diagnosis:

1. Allergic rhinitis: As mentioned above, the patient’s symptoms of a runny nose, itchy eyes, and ears that feel full are consistent with allergic rhinitis, which is an allergic reaction to environmental allergens (Emeryk et al., 2019). Allergy testing can help confirm this diagnosis.
2. Sinusitis: The patient’s symptoms of a runny nose and ears that feel full, as well as the presence of pale, boggy nasal mucosa and enlarged nasal turbinates, suggest the possibility of sinusitis, which is an inflammation of the sinuses (Hammer & McPhee, 2018). A nasal endoscopy or sinus imaging test can help confirm this diagnosis.
3. Common cold: The patient’s symptoms of a runny nose, itchy eyes, and a tickle in the throat are consistent with the common cold, a viral infection of the upper respiratory tract. A throat culture can help confirm this diagnosis.
4. Influenza: The patient’s symptoms of a runny nose, itchy eyes, and a tickle in the throat are also consistent with influenza, which is a viral infection of the respiratory tract. A throat culture or blood test can help confirm this diagnosis.
5. Adenovirus infection: Adenovirus respiratory infection could also manifest as a runny nose, itchy eyes, and a tickle in the throat. A throat culture or blood test can help confirm this diagnosis.

Conclusion

In sum, the patient in this case study is a 28-year-old woman who is experiencing a runny nose and itchy eyes, which occur every spring and last for six to eight weeks. She also has a tickling sensation in her throat, and her ears feel full and sometimes pop. Possible diagnostic tests for her symptoms include allergy testing, nasal endoscopy, sinus imaging, throat culture, and a complete blood count. Differential diagnoses for her condition include allergic rhinitis, sinusitis, the common cold, influenza, and adenovirus infection.

NURS6512 Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat References

Emeryk, A., Emeryk-Maksymiuk, J., & Janeczek, K. (2019). New guidelines for the treatment of seasonal allergic rhinitis. Postepy Dermatologii i Alergologii, 36(3), 255–260. https://doi.org/10.5114/ada.2018.75749

Hammer, G. D., & McPhee, S. J. (2018). Pathophysiology of disease: An introduction to clinical medicine 8E (8th ed.). McGraw-Hill Education. https://www.mheducation.co.uk/ise-pathophysiology-of-disease-an-introduction-to-clinical-medicine-8e-9781260288513-emea#:~:text=The%20goal%20of%20this%20trusted%20text%20is%20to

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Mosby. https://books.google.co.uk/books?id=3QgyAgAAQBAJ&printsec=frontcover#v=onepage&q&f=false

Submission and Grading Information for NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat

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NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS 6512 Week 5 Assignment 1 Rubric

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• Excellent
• Good
• Fair
• Poor

Using the Episodic/Focused SOAP Template:

• Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.
• Provide evidence from the literature to support diagnostic tests that would be appropriate for your case.

45 (45%) – 50 (50%)

• The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study.
• The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.

39 (39%) – 44 (44%)

• The response accurately follows the SOAP format to document the patient in the assigned case study.
• The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.

33 (33%) – 38 (38%)

• The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy.
• The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected.

0 (0%) – 32 (32%)

• The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat.
• The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.
  ·

List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

30 (30%) – 35 (35%)

• The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the five conditions selected NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat.

24 (24%) – 29 (29%)

• The response lists four or five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected.

18 (18%) – 23 (23%)

The response lists three to five possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

0 (0%) – 17 (17%)

• The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.

Written Expression and Formatting – Paragraph Development and Organization:

Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance NURS 6512 Assignment 1 Case Study Assignment Assessing the Head, Eyes, Ears, Nose, and Throat. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 (5%) – 5 (5%)

• Paragraphs and sentences follow writing standards for flow, continuity, and clarity.
• A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 (4%) – 4 (4%)

• Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.
• Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 (3%) – 3 (3%)

• Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.
• Purpose, introduction, and conclusion of the assignment are vague or off topic.

0 (0%) – 2 (2%)

• Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.
• No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation

5 (5%) – 5 (5%)

• Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

• Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3 (3%) – 3 (3%)

• Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 (0%) – 2 (2%)

• Contains many (? 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.

5 (5%) – 5 (5%)

• Uses correct APA format with no errors.

4 (4%) – 4 (4%)

• Contains a few (1 or 2) APA format errors.

3 (3%) – 3 (3%)

• Contains several (3 or 4) APA format errors.

0 (0%) – 2 (2%)

• Contains many (? 5) APA format errors.

Total Points: 100

Name: NURS 6512 Week 5 Assignment 1 Rubric.

NURS 6512 Week 11: Exam

Question 11 pts

You are conducting a preparticipation physical examination for a 10-year-old girl with Down syndrome who will be playing basketball. She has slight torticollis and mild ankle clonus. What additional diagnostic testing would be required for her?

Group of answer choices

Cervical spine radiograph

Mini-Mental State Examination

Nerve conduction studies

Visual acuity

Question 21 pts

In the adult, the apical impulse should be most visible when the patient is in what position?

Group of answer choices

Supine

Lithotomy

Right lateral recumbent

Upright

Question 31 pts

Recent unilateral inversion of a previously everted nipple suggests:

Group of answer choices

cancer.

benign breast disease.

pregnancy.

mastitis.

Question 41 pts

Loss of immediate and recent memory with retention of remote memory suggests:

Group of answer choices

attention-deficit/hyperactivity disorder (ADHD).

impaired judgment.

stupor.

dementia.

Question 51 pts

It is especially important to test for ankle clonus if:

Group of answer choices

deep tendon reflexes are hyperactive.

the patient has a positive Kernig sign.

the Romberg sign is positive.

the patient has peripheral neuropathy.

Question 61 pts

If a patient cannot shrug the shoulders against resistance, which cranial nerve (CN) requires further evaluation?

Group of answer choices

CN I, olfactory

CN V, trigeminal

CN IX, glossopharyngeal

CN XI, spinal accessory

Question 71 pts

A grade IV mitral regurgitation murmur would:

Group of answer choices

be described as a diastolic murmur.

not be expected to have a thrill.

radiate to the axilla.

be heard best at the base.

Question 81 pts

To hear diastolic heart sounds, you should ask patients to:

Group of answer choices

lie on their back.

lie on their left sides.

lie on their right side.

sit up and lean forward.

Question 91 pts

If your patient has nipple discharge, you will most likely need a:

Group of answer choices

Vacutainer tube.

glass slide and fixative.

specimen jar with formaldehyde.

tape strip to test pH.

Question 101 pts

You are examining Mr. S., a 79-year-ol