NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
Walden University NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
Whether one passes or fails an academic assignment such as the Walden University NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
The introduction for the Walden University NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
How to Write the Body for NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
After the introduction, move into the main part of the NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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Sample Answer for NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
SUBJECTIVE DATA:
Chief Complaint (CC): “I guess I’m kind of sick. . . I’ve been coughing a lot’
History of Present Illness (HPI): The affected person A young boy named Danny Riviera, who is only 8 years old, visits the medical center because he has been coughing for the past few days. According to what he says, the cough is very clear and has a watery quality to it. His cough is worse at night, which prevents him from getting adequate rest. As a consequence of this, he has trouble concentrating in class and often comes home exhausted. It’s painful in his right ear. The decision his mother made to use over-the-counter cough medicine, which only provided temporary relief, was made. Danny claims that he has a cold and that he suffers from a runny nose on a regular basis. Additionally, he inhales his father’s secondhand smoke on a regular basis. Within the past year, he has also been diagnosed with pneumonia. However, he does not have a fever, difficulty breathing, abdominal pain, chest tightness, or chills. He also does not have chest tightness.
Medications: The patient acknowledges that they do take their medications at home. In addition to that, he takes a vitamin every day. In addition to that, he takes a medication for coughing that is purple.
Allergies: NKDA
Past Medical History (PMH): Denies asthma diagnosis. Identifies immunizations as being up to date. Previous symptoms include chronic coughing and pneumonia.
Past Surgical History (PSH): None reported.
Sexual/Reproductive History:
Personal/Social History: Identifies himself as a member of a household that also includes his parents and grandparents. avers having a sense of well-being while at home. Describes a park with a playground in the neighborhood. It is reported that the father smokes in the house.
Immunization History: Immunizations are current.
Significant Family History: He is supported by his biological parents as well as both sets of grandparents.
Review of Systems:
General: During the course of the interview, the patient appears exhausted and coughs several times. Additionally, he seems to be steady.
HEENT: The mucus membrane is wet, and the discharge from the nose is clear. However, the back of his throat is red and clogged with mucus. His eyes are lifeless, and the conjunctiva around them is a pinkish hue. It seems as though the right tympanic membrane is inflamed and red. The lymph nodes in the patient’s right cervical region appear enlarged, and they have a certain degree of tenderness.
Respiratory: Lacks acute distress, has an increased respiratory rate at the age of 28, clear breath sounds on auscultation, and speaks in complete sentences; bronchoscopy is negative. When you percussed his chest wall, you could hear a resonant tone, and his fremitus was normal and bilaterally consistent.
Cardiovascular/Peripheral Vascular:
Psychiatric:
Neurological:
Lymphatics:
OBJECTIVE DATA:
Physical Exam:
Vital signs:
| Blood Pressure | 120/76 |
| O2 Sat | 96% |
| Pulse | 100 |
| Resp. Rate | 28 |
| Temperature | 37.2 c |
General: During the course of the interview, the patient appears exhausted and coughs several times. Additionally, he seems to be steady.
HEENT: The head is atraumatic and has a normocephalic shape. The mucus membrane is wet, and the discharge from the nose is clear. However, the back of his throat is red and clogged with mucus. His eyes are lifeless, and the conjunctiva around them is a pinkish hue. It seems as though the right tympanic membrane is inflamed and red. The lymph nodes in the patient’s right cervical region appear enlarged, and they have a certain degree of tenderness.
Respiratory: Lacks acute distress, has an increased respiratory rate at the age of 28, clear breath sounds on auscultation, and speaks in complete sentences; bronchoscopy is negative. When you percussed his chest wall, you could hear a resonant tone, and his fremitus was normal and bilaterally consistent.
Cardiology: In S1 and S2, there were no murmurs, gallops, or rubs.
Lymphatics: When palpated, the lymph nodes in the right cervical region are tender.
Psychiatric: No mental issues noted.
Diagnostics/Labs (Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses.)
ASSESSMENT:
Based on the findings of the completed physical examination and the observations that were made, the following possible diagnoses can be made.
- Common cold: The patient complains of having a stuffy nose and a sore throat, which are both symptoms of a common cold. This observation was also supported by the findings of a physical examination, which showed that the patient had swollen lymph nodes.
- Streptococcus throat infection: The patient’s complaint of a sore throat suggests that they may have strep throat. On the other hand, symptoms like nausea, vomiting, headaches, and fever did not present themselves at any point.
iii. Rhinitis is another condition that could have been causing the patient’s symptoms, as they included stuffy nose, sore throat, and drainage from the nose. In addition to this, the patient has a history of recurrent ear infections throughout their lifetime.
- Allergies and asthma: The patient does not have a history of allergic reactions. Nevertheless, it is possible that this condition will occur. This condition may have been the cause of the persistent cough. On the other hand, the patient does not exhibit any symptoms of wheezing, chest pain or tightness, or difficulty breathing.
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 Case Study Assignment, 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.
Sample Answer for NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
Patient Information:
Initials: R.T Age: 50 years
Sex: Male Race: White
S.
CC (chief complaint): “My nose, eyes, palate, and ears are itchy.”
HPI: R.T is a 50-year-old White male presenting with a chief complaint of itchy nose, eyes, palate, and ears. He reports that the symptoms began five days ago. In addition to this complaint, he reports having nasal congestion, sneezing, rhinorrhea, and postnasal drainage. He describes the postnasal drainage as thin, watery nasal secretions. The symptoms have no associated aggravating factors. He reports using OTC Mucinex in the past two nights to help him breathe while he sleeps. However, he states that the Mucinex has had only minimal improvement in the symptoms.
Current Medications: OTC Mucinex to relieve nasal drainage.
Allergies: Allergic to pollen and dust mites. No known food or drug allergies.
PMHx: Immunization is up-to-date. The last Influenza shot was 8 months ago, and TT was 9 years ago. No history of chronic illnesses. Hospitalized at 42 years due to Iron, had blood transfusion- 2 pints. History of Appendectomy at 28 years.
Soc Hx: The patient is a High school History teacher and the coach to the soccer team. He is married and has three children aged 23, 18, and 15 years. His hobbies include reading articles and visiting museums. He reports taking alcohol occasionally, mostly on weekends 2-3 beers. He denies tobacco smoking or using illegal substances. The patient reports having an active lifestyle with about 1 hour of physical exercise a day. His last annual exam was two years ago.
Fam Hx: The mother had HTN and Alzheimer’s disease, died from Stroke. Father had Diabetes, HTN, and Renal failure. The elder brother has HTN. Children are alive and well.
ROS:
GENERAL: Denies fever, chills, body weakness, fatigue, or weight changes.
HEENT: Head: Denies headaches or head injury. Eyes: Positive for itchy eyes. Denies visual loss, double vision, blurred vision, or yellow sclera. Ears: Positive for itchy ears. Denies ear discharge or hearing loss. Nose: Positive for itchy nose, nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Denies nasal bleeding. Throat: Positive for itchy palate. Denies sore throat or swallowing difficulties.
NECK: Denies neck pain or stiffness.
SKIN: Denies skin-color changes, itchiness, rashes, or bruises.
CARDIOVASCULAR: Denies palpitations, edema, chest pain, chest pressure, chest discomfort, SOB on exertion, or fatigue.
RESPIRATORY: Denies cough, sputum production, shortness of breath, or chest pain.
ALLERGIES: Allergic to pollen and dust mites. Denies history of asthma, hives, or eczema.
O.
Vital Signs: BP- 128/76, HR- 86, RR-20, Temp-98.42F
HT- 5’5, Wt- 158 pounds.
General: The patient is alert and oriented and in no acute distress. He is well-groomed and appropriately dressed for the weather. Maintains eye contact and has clear speech. Has normal gait and posture.
HEENT: Head: Normocephalic and atraumatic. Eyes: Dark circles around the eyes. Positive for excessive lacrimation. The sclera is white; the conjunctiva is pink, and PERRLA. Ears: No ear discharge, Tympanic membranes are shiny and intact. Mastoid bone is non-tender. Nose: Pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates obstructing airway flow. Throat: Positive for throat clearing. The throat is mildly erythematous, but the tonsils are not enlarged.
NECK: Non-palpable lymph nodes. Thyroid gland normal on palpation.
SKIN: Skin is fair and smooth with no hyper/hypo-pigmentation. No erythema, rashes, or lesions present.
RESPIRATORY: Smooth respirations with uniform chest rise and fall on respirations. Lungs clear on auscultation.
CARDIOVASCULAR: No edema or neck vein distension. Regular heart rate and rhythm. S1 and S2 present. No gallop sounds, heart murmurs, or rubs present.
Diagnostic results:
Complete blood count (CBC): To indicate the presence of an allergic response when there is an increase in eosinophils (Greiwe & Bernstein, 2019).
Allergy skin tests (immediate hypersensitivity testing): To determine the patient’s allergy to a particular allergen (Greiwe & Bernstein, 2019).
A.
Differential Diagnoses
Allergic Rhinitis
Allergic rhinitis is an inflammation of the nasal membranes characterized by sneezing, nasal itching, nasal congestion, and rhinorrhea. It is triggered by reactions to airborne allergens such as dust, plant pollens, molds, animal dander, wool, and air pollutants (Bjermer et al., 2019). Clinical features of Allergic rhinitis include itching nose, eyes, ears, and palate, sneezing, rhinorrhea, postnasal drip, nasal congestion, loss of smell, headache, earache, excessive tearing, red eyes, eye swelling, fatigue, drowsiness, and malaise (Bjermer et al., 2019). Physical exam findings in allergic rhinitis include nasal crease, thin, watery nasal secretions, deviation or perforation of the nasal septum (Crisci & Ardusso, 2020). Besides, the patient may have mouth breathing, frequent sniffling or throat clearing, and dark circles under the eyes referred to as allergic shiners. Anterior rhinoscopy typically reveals swelling of the nasal mucosa and thin, clear secretions (Bjermer et al., 2019). The mucosa of the nasal turbinates may be swollen or boggy and have a pale, bluish-gray appearance.
Allergic rhinitis is the presumptive diagnosis based on pertinent positive subjective findings of itchy nose, eyes, palate, and ears, nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Objective findings in line with Allergic rhinitis include dark circles around the eyes, excessive lacrimation, pale boggy nasal mucosa, clear thin secretions, and enlarged nasal turbinates obstructing airway flow. Furthermore, the patient is allergic to pollen and dust mites which are documented triggers of Allergic rhinitis.
Vasomotor Rhinitis:
Vasomotor rhinitis refers to non-inflammatory rhinitis triggered by a change in temperature, odors, or humidity. It is thought to result from disturbed regulation of the parasympathetic and sympathetic systems whereby the parasympathetic system dominates, causing vasodilation and edema of the nasal vasculature (Crisci & Ardusso, 2020). The resulting symptoms include rhinorrhea, sneezing, congestion, headache, facial pressure, postnasal drip, coughing, and throat clearing. Physical exam findings in vasomotor rhinitis include boggy edematous mucosa with clear mucoid secretions (Crisci & Ardusso, 2020). In addition, mucosal injection and lymphoid hyperplasia involving the adenoids, tonsils, and lingual tonsils may be present.
Pertinent positive findings consistent with vasomotor rhinitis include nasal congestion, sneezing, rhinorrhea, postnasal drainage, boggy nasal mucosa, clear thin nasal secretions, and throat clearing.
Common Cold:
Common cold is caused by Rhinoviruses, which mainly cause upper respiratory tract infections. Clinical features of Rhinovirus infection include nasal dryness or irritation and sore throat or throat irritation, which are often the initial symptoms (Jaume, Valls-Mateus & Mullol, 2020). Nasal discharge, nasal congestion, and sneezing then occur and intensify over 2-3 days. Other signs and symptoms include headache, facial and ear pressure, loss of sense of smell and taste, cough, hoarseness, post-tussive vomiting, irritability, and in some cases, low-grade fever.
Physical exam findings in the common cold include A red nose with a profuse and dripping nasal discharge. Nasal discharge may be clear and watery or mucopurulent with a yellow or green appearance (Jaume et al., 2020). Examination of the nose reveals nasal mucous membranes with a glistening, glassy appearance, usually without erythema or edema. In addition, mildly enlarged, non-tender cervical lymph nodes are present, and chest auscultation chest may reveal rhonchi (Jaume et al., 2020). Common cold is a differential diagnosis based on pertinent positive findings of postnasal discharge, rhinorrhea, nasal congestion, sneezing, throat clearing, and clear thin secretions.
Influenza Infection
Influenza is a highly contagious airborne disease that occurs in seasonal epidemics. It manifests as an acute febrile illness with variable severity of systemic symptoms, ranging from mild fatigue to respiratory failure and death (Gaitonde, Moore & Morgan, 2019). Signs and symptoms of Influenza infection include fever, sore throat, nasal discharge, muscle pain, frontal or retro-orbital headache, weakness and severe fatigue, cough, tachycardia, and red, watery eyes (Gaitonde et al., 2019). Influenza is a differential diagnosis based on positive symptoms of nasal discharge, sneezing, and excessive lacrimation.
Acute Sinusitis
Sinusitis is characterized by inflammation of the paranasal sinuses lining. Acute Sinusitis presents with pain over the cheek, which radiates to the frontal region or teeth and increases with straining or bending down (Jaume et al., 2020). Symptoms include postnasal discharge, blocked nose, persistent coughing or pharyngeal irritation, facial pain, and a diminished sense of smell (Jaume et al., 2020). Physical exam findings include redness of the nose, cheeks, or eyelids and tenderness over the floor of the frontal sinus, purulent nasal secretions, purulent posterior pharyngeal secretions, mucosal erythema, and periorbital edema.
Pertinent positives consistent with Acute Sinusitis include nasal congestion, throat clearing, and postnasal drainage. However, the absence of facial pain or pressure and sinus tenderness symptoms makes Acute Sinusitis an unlikely primary diagnosis.
References
Bjermer, L., Westman, M., Holmström, M., & Wickman, M. C. (2019). The complex pathophysiology of allergic rhinitis: scientific rationale for the development of an alternative treatment option. Allergy, Asthma & Clinical Immunology, 15(1), 1-15. https://doi.org/10.1186/s13223-018-0314-1
Crisci, C. D., & Ardusso, L. (2020). A Precision Medicine Approach to Rhinitis Evaluation and Management. Current treatment options in allergy, 7(1), 93–109. https://doi.org/10.1007/s40521-020-00243-1
Gaitonde, D. Y., Moore, F. C., & Morgan, M. K. (2019). Influenza: Diagnosis and treatment. American family physician, 100(12), 751-758.
Greiwe, J. C., & Bernstein, J. A. (2019). Allergic and Mixed Rhinitis: Diagnosis and Natural Evolution. Journal of clinical medicine, 8(11), 2019. https://doi.org/10.3390/jcm8112019
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(7), 28. https://doi.org/10.1007/s11882-020-00917-5
To Prepare
• 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.
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
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
• Please save your Assignment using the naming convention “WK5Assgn1+last name+first initial.(extension)” as the name.
• Click the Week 5 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
• Click the Week 5 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
• Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK5Assgn1+last name+first initial.(extension)” and click Open.
• If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
• Click on the Submit button to complete your submission.
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Grading Criteria
To access your rubric:
Week 5 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 5 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 6 of Week 5
To participate in this Assignment:
Week 5 Assignment 1
Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat
Emily, age 15, is brought to your clinic complaining of chills, aches, and a sore throat. Without any testing, consider all of the possible diagnoses. It could be a cold, the flu, bronchitis, or even something more serious, such as meningitis or mononucleosis. Assessing the actual cause will involve much more than simple visual inspection. Some conditions are so subtle that they require the use of special instruments and tests in addition to a trained eye and ear.
This week, you will explore how to assess the head, neck, eyes, ears, nose, and throat. Whether dealing with a detached retina, sinusitis, meningitis, or even cough, advanced practice nurses need to know the proper assessment techniques in order to form accurate diagnoses.
Learning Objectives
Students will:
• Apply assessment skills to diagnose eye, ear, and throat conditions
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the head, neck, eyes, ears, nose, and throat
________________________________________
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
• Chapter 11, “Head and Neck”
This chapter reviews the anatomy and physiology of the head and neck. The authors also describe the procedures for conducting a physical examination of the head and neck.
• Chapter 12, “Eyes”
In this chapter, the authors describe the anatomy and function of the eyes. In addition, the authors explain the steps involved in conducting a physical examination of the eyes.
• Chapter 13, “Ears, Nose, and Throat”
The authors of this chapter detail the proper procedures for conducting a physical exam of the ears, nose, and throat. The chapter also provides pictures and descriptions of common abnormalities in the ears, nose, and throat.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 15, “Earache”
This chapter covers the main questions that need to be asked about the patient’s condition prior to the physical examination as well as how these questions lead to a focused physical examination.
Chapter 21, “Hoarseness”
This chapter focuses on the most common causes of hoarseness. It provides strategies for evaluating the patient, both through questions and through physical exams.
Chapter 25, “Nasal Symptoms and Sinus Congestion”
In this chapter, the authors highlight the key questions to ask about the patients symptoms, the key parts of the physical examination, and potential laboratory work that might be needed to provide an accurate diagnosis of nasal and sinus conditions.
Chapter 30, “Red Eye”
The focus of this chapter is on how to determine the cause of red eyes in a patient, including key symptoms to consider and possible diagnoses.
Chapter 32, “Sore Throat”
A sore throat is one most common concerns patients describe. This chapter includes questions to ask when taking the patient’s history, things to look for while conducting the physical exam, and possible causes for the sore throat.
Chapter 38, “Vision Loss”
This chapter highlights the causes of vision loss and how the causes of the condition can be diagnosed.
Note: Download the six documents (Student Checklists and Key Points) below, and use them as you practice conducting assessments of the head, neck, eyes, ears, nose, and throat.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., & Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.
Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis.
Credit Line: Advanced practice nursing procedures, 1st Edition by Colyar, M. R. Copyright 2015 by F. A. Davis Company. Reprinted by permission of F. A. Davis Company via the Copyright Clearance Center.
• Chapter 71, “Visual Function Evaluation: Snellen, Illiterate E, Pictorial
This section explains the procedural knowledge needed to perform eyes, ears, nose, and mouth procedures.
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
• Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1, 3, 4, and 5)
Bedell, H. E., & Stevenson, S. B. (2013). Eye movement testing in clinical examination. Vision Research 90, 32–37. doi:10.1016/j.visres.2013.02.001. Retrieved from https://www.sciencedirect.com/science/article/pii/S0042698913000217
Rubin, G. S. (2013). Measuring reading performance. Vision Research, 90, 43–51. doi:10.1016/j.visres.2013.02.015. Retrieved from http://www.sciencedirect.com/science/article/pii/S0042698913000436
Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Harrison, R. V., & Passamani, P. P. (2013). Otitis media: Diagnosis and treatment. American Family Physicians, 88(7), 435–440.
Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
Otolaryngology Houston. (2014). Imaging of maxillary sinusitis (X-ray, CT, and MRI). Retrieved from http://www.ghorayeb.com/ImagingMaxillarySinusitis.html
This website provides medical images of sinusitis, including X-rays, CT scans, and MRIs (magnetic resonance imaging).
Document: Episodic/Focused SOAP Note Exemplar (Word document)
Document: Episodic/Focused SOAP Note Template (Word document)
Document: Midterm Exam Review (Word document)
Shadow Health Support and Orientation Resources
Frey, C. [Chris Frey]. (2015, September 4). Student orientation [Video file]. Retrieved from https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Document: DCE (Shadow Health) Documentation Template for Focused Exam: Cough (Word document)
Use this template to complete your Assignment 2 for this week.
Optional Resource
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
• Chapter 7, “The Head and Neck” (pp. 178–301)
This chapter describes head and neck examinations that can be made with general clinical resources. Also, the authors detail syndromes of common head and neck conditions.
Required Media (click to expand/reduce)
Assessment of the Head, Neck, Eyes, Ears, Nose, and Throat – Week 5 (29m)
Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 10, 11, and 12 that relate to the assessment of the head, neck, eyes, ears, nose, and throat. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.
University of Iowa Ophthalmology. (2016, December 19). Fluorescein staining of the cornea. Retrieved from https://vimeo.com/198695974
Credit Line: University of Iowa Ophthalmology. (n.d.). Fluorescein staining of the cornea [Video file]. Retrieved from https://vimeo.com/198695974. The author(s) and publishers acknowledge the University of Iowa and EyeRounds.org for permission to reproduce this copyrighted material.
Note: Approximate length of this media program is 25 seconds.
Rubric Detail
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Name: NURS_6512_Week_5_Assignment_1_Rubric
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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. Points Range: 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. Points Range: 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. Points Range: 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. Points Range: 0 (0%) – 32 (32%)
The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study. 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. Points Range: 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. Points Range: 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. Points Range: 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. Points Range: 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. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. Points Range: 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. Points Range: 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. Points Range: 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. Points Range: 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 Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. Points Range: 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. Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors. Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors. Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) APA format errors.
Total Points: 100
Sample Answer 2 for NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
CC: “My eyes are bulging and I feel fatigued.”
HPI:
Kali is a 44-year-old White woman on physical exam with primary symptoms of protruding eyes and fatigue. The symptoms began about four months ago, and the fatigue has worsened. The fatigue has no aggravating factors, but resting alleviated it to some degree. The symptoms have significantly affected her occupational functioning since she always feels tired.
Current Medications: Atorvastatin 40 mg OD for hyperlipidemia.
Allergies: No allergies.
PMHx: Vaccination is current. The last TT was four years ago, and she received a FLU shot 5 months ago. Positive history of dyslipidemia diagnosed 12 months ago. No history of surgery.
Soc Hx: Kali is a corporate secretary working in an insurance firm. She is a Certified Professional Secretary and has a Diploma in Business Administration. She is married and has two children, 20 and 17 years old. Her hobbies include baking and reading magazines. She takes 3-4 beers on weekends but denies smoking or using illicit substances. Her souse and sister are the support system.
Fam Hx: The grandmother had Diabetes, and the grandfather succumbed to Lung cancer. Her elder sister also has Diabetes. The children are well.
ROS:
Vital signs: BP- 132/84; HR-94; RR- 20; Temp- 98.4F
Wt-188 lbs; Ht-5’6; BMI- 30.3
GENERAL: Reports fatigue and weight gain. Denies fever/chills.
HEENT: Eyes: Positive for bulged eyes. Negative for other eye symptoms. Ears: Denies ear symptoms. Nose: Negative for sneezing, nose bleed, nasal discharge. Throat: Negative for sore throat or swallowing difficulties.
SKIN: Negative for skin symptoms.
CARDIOVASCULAR: Negative for edema, neck vein distension, chest pain, palpitations, or SOB.
RESPIRATORY: Negative for respiratory symptoms.
GASTROINTESTINAL: Denies abdominal symptoms.
GENITOURINARY: Denies genitourinary symptoms.
NEUROLOGICAL: Positive for fatigue. Negative for headaches, dizziness, muscle weakness, syncope, or burning sensations.
MUSCULOSKELETAL: Denies musculoskeletal symptoms.
HEMATOLOGIC: Denies hematologic symptoms.
LYMPHATICS: Denies lymphatic symptoms.
PSYCHIATRIC: Negative for mood symptoms.
ENDOCRINOLOGIC: Denies endocrine symptoms.
ALLERGIES: Negative for allergic symptoms.
O.
Physical exam:
GENERAL: Female patient in her early 40s. She appears overweight, alert, and oriented. Her speech is clear and goal-directed, and she maintains eye contact throughout the session.
HEENT: Head: Atraumatic and normocephalic. Eyes: Bulging eyes bilaterally, lid lag, lid retraction, PERRLA. Ears: Tympanic membranes are intact and shiny, with minimal pus. Nose: Moist mucous membranes, patent nostrils. Throat: Tongue is midline, and tonsillar glands are non-inflamed.
NECK: Swollen; The thyroid gland is smooth and; thyroid bruits present.
CARDIOVASCULAR: Regular heart rate and rhythm. Audible S1 and S2 with no murmurs.
RESPIRATORY: Uniform chest rise and fall; smooth respirations; Chest is clear.
Diagnostic results:
TSH levels- elevated.
A.
Differential Diagnoses
Graves disease: Grave’s disease is the most prevalent form of hyperthyroidism. The typical clinical features of Grave’s disease are increased levels of Thyroxine (T4) and enlargement of the thyroid gland. Ophthalmopathy is the hallmark of Graves disease and manifests with eye redness, swelling, upper eyelid retraction, lid lag, conjunctivitis, and bulging eyes Davies et al., 2020). Clinical symptoms include fatigue, general body weakness, sweating, warm, moist, fine skin, eye pain, photophobia, protruding eyes, double vision, heat intolerance, and weight loss despite increased appetite (Davies et al., 2020). Physical exam of the neck reveals a diffusely enlarged and smooth thyroid gland. Graves disease is a presumptive diagnosis based on positive symptoms of bulging eyes, fatigue, elevated TSH levels, thyroid bruits, and diffusely enlarged and smooth thyroid gland.
Subacute thyroiditis: Subacute thyroiditis is diagnosed based on a history of neck tenderness, respiratory tract infection, increased sedimentation rate, and inadequate or absent radioactive iodine consumption. It has a self-limited course. Local thyroid symptoms include dysphagia, pain over the thyroid area (gradual or sudden onset), and hoarseness (Stasiak & Lewiński, 2021). Constitutional clinical symptoms include fever, anorexia, malaise, fatigue, and myalgia. In stage three of the disease, TSH levels are usually elevated. Subacute thyroiditis is a differential diagnosis based on positive symptoms of swollen neck, fatigue, and elevated TSH levels.
Hashimoto Thyroiditis: Hashimoto Thyroiditis occurs due to the damage of thyroid cells by immune processes mediated by cells and antibodies. It is the most common cause of hypothyroidism. Symptoms include fatigue, energy loss, constipation, dry skin, weight gain, and bulging/protruding eyes (Ragusa et al., 2019). In addition, the TSH levels are invariably elevated. Positve clinical features of fatigue, bulging eyes, weight gain, and increased TSH levels support Hashimoto Thyroiditis as a differential diagnosis.
Goiter: Goiter presents with a distended thyroid gland (diffuse or nodular). The thyroid gland causes compresses adjacent organs causing shortness of breath, painful swallowing, stridor, nd voice hoarseness (Ragusa et al., 2019). The findings of a distended thyroid gland mae==ke Goiter a possible diagnosis.
Exophthalmos: Exophthalmos is an abnormal bulging of the eyeball. It is characterized by pupillary abnormalities. Patients also report pain, double vision, pulsation, change in effect or size with position, and disturbance in visual acuity (Topilow et al., 2020). Exophthalmos is a likely diagnosis owing to protruding eyes.
References
Davies, T. F., Andersen, S., Latif, R., Nagayama, Y., Barbesino, G., Brito, M., Eckstein, A. K., Stagnaro-Green, A., & Kahaly, G. J. (2020). Graves’ disease. Nature reviews. Disease primers, 6(1), 52. https://doi.org/10.1038/s41572-020-0184-y
Ragusa, F., Fallahi, P., Elia, G., Gonnella, D., Paparo, S. R., Giusti, C., Churilov, L. P., Ferrari, S. M., & Antonelli, A. (2019). Hashimotos’ thyroiditis: Epidemiology, pathogenesis, clinic, and therapy. Best practice & research. Clinical endocrinology & metabolism, 33(6), 101367. https://doi.org/10.1016/j.beem.2019.101367
Stasiak, M., & Lewiński, A. (2021). New aspects in the pathogenesis and management of subacute thyroiditis. Reviews in Endocrine and Metabolic Disorders, 1-13. https://doi.org/10.1007/s11154-021-09648-y
Topilow, N. J., Tran, A. Q., Koo, E. B., & Alabiad, C. R. (2020). Etiologies of Proptosis: A review. Internal medicine review (Washington, D.C.: Online), 6(3), 10.18103/imr.v6i3.852. https://doi.org/10.18103/imr.v6i3.852
Sample Answer 3 for NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
Patient Information:
Initials: CH
Age: 28 years
Sex: Female
S.
CC (chief complaint): Runny nose and itchy eyes
HPI: Charlotte is a 28-year-old lady who presented with complaints of a runny nose and itchy eyes for 9 days. These symptoms are intermittent and occur every spring for approximately six to eight weeks. The nasal discharge is of clear mucus. There is an associated fullness and popping of ears, on-and-off sneezes throughout the day, and a tickle in the throat. There is a history of partial relief with Claritin. There is no reported cough, hotness of the body, or hearing loss.
Location: Nose and eyes.
Onset: 9 days ago.
Character: Intermittent.
Associated signs and symptoms: On and off sneezing, tickle in the throat, fullness, and popping of the ears.
Timing: Every spring for six to eight weeks.
Exacerbating/ relieving factors: Partial relief by Claritin. There is no known exacerbating factor.
Severity: Unknown.
Current Medications: The patient is currently not on any medication.
Allergies: There is no known allergy to any medication, food, or environmental components. The patient’s symptoms, however, recur every spring thus there is a possible allergy to pollen which could be the major trigger of the patient’s seasonality of symptoms.
PMH: The patient is neither hypertensive nor diabetic. There is no other reported significant chronic medical condition. The patient has never undergone any surgical procedure.
Soc Hx: The patient is an accountant. She likes traveling and photography. She is recently married with one child. There is no reported history of smoking or chronic alcohol use. She is currently lactating and is not on any contraception.
Fam Hx: The patient has a positive history of similar presentations in her grandfather. There is no family history of diabetes or hypertension.
ROS:
GENERAL: She reports no recent unintended weight loss, fever, or generalized body malaise.
SKIN: She reports no pruritus, abnormal skin discoloration, or skin rash.
CARDIOVASCULAR: She reports no left-sided chest pains, palpitations, easy fatigability, or shortness of breath even on exertion or lying flat.
RESPIRATORY: She reports no dyspnea, no chest pain, no cough, and no chest tightness.
ABDOMINAL: She reports no abdominal swelling, abdominal pain, nausea, vomiting, diarrhea, or constipation.
GENITOURINARY: She denies discomfort or burning sensation on urination, no blood in urine, and no frequency. Her menstrual cycle is regular with her last experienced menstrual period occurring two weeks ago.
NEUROLOGICAL: She denies headaches, dizziness, seizures, tingling sensation, numbness, weakness, loss of bladder and bowel control, or loss of consciousness.
MUSCULOSKELETAL: She has a history of joint swelling and tenderness with a diagnosis of gout that has since resolved with treatment.
HEMATOLOGIC: She reports no anemia, no excessive bleeding, and no easy bruising.
LYMPHATICS: She denies any lymphadenopathy, splenomegaly, or past splenectomy.
PSYCHIATRIC: She has no psychiatric history of depression, psychosis, or other mental disorder.
ENDOCRINOLOGIC: She denies excessive diaphoresis and heat or cold intolerance. She experiences polydipsia and polyuria.
ALLERGIES: She reports no history of allergic reactions.
O.
Physical exam:
VITALS: BP 102/80 mmHg, HR 72 bpm, RR 14, Temperature 98.0 F, BMI 22.0
GENERAL: The patient is in good general condition and not distressed. She is mildly dehydrated. The patient is obese.
HEENT: The head is atraumatic. Extraocular movements are intact with pupils being equally and bilaterally reactive to light. There is no scleral jaundice but there is redness of the eyes. The tonsils are not swollen but her throat is mildly erythematous. The external ear canals are free of foreign bodies or wax. The nasal mucosa is pale, boggy, and has clear thin secretions. The nasal turbinates are enlarged with resultant airway obstruction.
RESPIRATORY: The chest moves with respiration. It is resonant on percussion. There are normal vesicular breath sounds and good bilateral air entry on auscultation.
CARDIOVASCULAR: The point of maximal pulsation is in the fifth intercostal space midclavicular line. There is a normal cardiac activity in the precordium. S1 and S2 heart sounds were present with no murmurs or thrills.
ABDOMINAL: The abdomen is no abdominal distension. There is minimal tenderness in the right upper quadrant. There are no elicited masses or organomegaly. Bowel sounds are present.
MUSCULOSKELETAL: There is joint swelling, joint stiffness, or tenderness. There is no limitation in the range of motion.
NEUROLOGICAL: The patient is alert and oriented. There are no focal neurological deficits, weakness, or loss of sensation.
SKIN: The skin is warm and dry.
PSYCHIATRIC: The mood is stable with congruent affect.
Diagnostic results:
A complete blood count showed elevated eosinophilic cell count with the other differential cell count being within normal ranges. This suggests an allergic process or parasitic infestation which is unlikely based on the patient’s presentations.
Rhinoscopy showed a pale and boggy nasal mucosa covered with clear mucus. The absence of purulent nasal discharge rules out an infective process.
Skin prick test was positive for allergic reaction.
A CT scan of the head showed no evidence of basal skull fracture, chronic sinusitis, or nasal polyposis.
A.
Differential Diagnoses:
- Allergic rhinitis: This is the most likely diagnosis. This is because the patient presented with typical nasal and non-nasal symptoms. The nasal symptoms included a runny nose and sneezing whereas non-nasal symptoms included itchy eyes, redness of the eyes, and tickling of the throat (Nur Husna et al., 2022). Allergic rhinitis can also present with eustachian tube dysfunction which manifests with features such as aural fullness, aural pressure, ear pain, and popping (Juszczak et al., 2020). The patient reported fullness of the ears and popping of the ears thus there is a possibility of eustachian tube dysfunction attributed to existing allergic rhinitis. Allergic rhinitis can be seasonal, perennial, or episodic (Emeryk et al., 2019). The patient probably has seasonal allergic rhinitis due to the recurrence of symptoms during spring which is associated with the abundance of triggering pollens. The presence of a positive family history of similar presentation may point to the genetic predisposition of the atopic condition. The effectiveness of Claritin in symptomatic relief suggests an allergic process. This is because Claritin is an antihistamine that can effectively reduce allergic reactions through the suppression of proinflammatory reactions.
- Non-allergic rhinitis: Non-allergic rhinitis is another possible diagnosis. This is because some of the presenting complaints are similar to those of allergic rhinitis. This includes rhinorrhea, sneezing, and nasal congestion. However, non-allergic rhinitis does not display seasonality of symptoms as witnessed in the patient in this case. The presence of non-nasal symptoms such as itchy eyes makes allergic rhinitis more probable than non-allergic rhinitis. Non-allergic rhinitis of inflammatory and non-inflammatory etiologies such as post-infectious rhinitis, eosinophilic rhinitis, and medication-induced rhinitis should thus be excluded through further workups (Agnihotri et al., 2019). This will enable the formulation of a tailored appropriate management plan.
- Eustachian tube dysfunction: This is a likely differential diagnosis. The aural fullness and popping sounds reported by the patient are characteristic of eustachian tube dysfunction (Hamrang-Yousefi et al., 2022). The presence of additional seasonal features such as itchy eyes and runny nose rules out eustachian tube dysfunction as the only diagnosis. Serious complications such as otitis media with effusion should be assessed.
This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Agnihotri, N. T., & McGrath, K. G. (2019). Allergic and nonallergic rhinitis. Allergy and asthma proceedings, 40(6), 376–379. https://doi.org/10.2500/aap.2019.40.4251
Emeryk, A., Emeryk-Maksymiuk, J., & Janeczek, K. (2019). New guidelines for the treatment of seasonal allergic rhinitis. Advances in Dermatology and Allergology, 36(3), 255–260. https://doi.org/10.5114/ada.2018.75749
Hamrang-Yousefi, S., Ng, J., & Andaloro, C. (2022). Eustachian Tube Dysfunction. In StatPearls. StatPearls Publishing.
Juszczak, H. M., & Loftus, P. A. (2020). Role of Allergy in Eustachian Tube Dysfunction. Current allergy and asthma reports, 20(10), 54. https://doi.org/10.1007/s11882-020-00951-3
Nur Husna, S. M., Tan, H.-T. T., Md Shukri, N., Mohd Ashari, N. S., & Wong, K. K. (2022). Allergic rhinitis: A clinical and pathophysiological overview. Frontiers in Medicine, 9. https://doi.org/10.3389/fmed.2022.874114