nurs6512 week 5 discussion latest 2018 april

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Discussion: Assessing the 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 Discussion, 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.

Note: By Day 1 of this week, your Instructor will have
assigned you to one of the following specific case studies for this Discussion.
Also, your Discussion post should be in the Episodic/Focused SOAP Note format,
rather than the traditional narrative style Discussion posting 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.

Case 1: Nose Focused Exam

Richard is a 50-year-old male with nasal congestion,
sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an
itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat
for redness and inflammation, you notice him touch his fingers to the bridge of
his nose to press and rub there. He says he’s taken Mucinex OTC the past two nights
to help him breathe while he sleeps. When you ask if the Mucinex has helped at
all, he sneers slightly and gestures that the improvement is only minimal.
Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin
secretions and enlarged nasal turbinates, which obstruct airway flow but his
lungs are clear. His tonsils are not enlarged but his throat is mildly
erythematous.

Case 2: Focused Throat Exam

Lily is a 20-year-old student at the local community
college. When some of her friends and classmates told her about an outbreak of
flu-like symptoms sweeping her campus over the past two weeks, Lily figured she
shouldn’t take her three-day sore throat lightly. Your clinic has treated a few
cases similar to Lily’s. All the patients reported decreased appetite,
headaches, and pain with swallowing. As Lily recounts these symptoms to you,
you notice that she has a runny nose and a slight hoarseness in her voice but
doesn’t sound congested.

Case 3: Focused Ear Exam

Martha brings her 11-year old grandson, James, to your
clinic to have his right ear checked. He has complained to her about a mild
earache for the past two days. His grandmother believes that he feels warm but
did not verify this with a thermometer. James states that the pain was worse
while he was falling asleep and that it was harder for him to hear. When you
begin basic assessments, you notice that James has a prominent tan. When you
ask him how he’s been spending his summer, James responds that he’s been
spending a lot of time in the pool.

To prepare:

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 10 possible conditions that may be
considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the
subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying
the number of the case study you were assigned.

By Day 3

Post an episodic/focused note about the patient in the case
study to which you were assigned using the episodic/focused note template
provided in 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.

Note: For this Discussion, you are required to complete your
initial post before you will be able to view and respond to your colleagues’
postings. Begin by clicking on the “Post to Discussion Question” link
and then select “Create Thread” to complete your initial post.
Remember, once you click on Submit, you cannot delete or edit your own posts,
and you cannot post anonymously. Please check your post carefully before
clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different
days who were assigned different case studies than you. Analyze the possible
conditions from your colleagues’ differential diagnoses. Determine which of the
conditions you would reject and why. Identify the most likely condition and
justify your reasoning.