Assignment: NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
Walden University Assignment: NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University Assignment: 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 Assignment: NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
Whether one passes or fails an academic assignment such as the Walden University Assignment: 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 Assignment: NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
The introduction for the Walden University Assignment: 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 Assignment: NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
After the introduction, move into the main part of the Assignment: 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 Assignment: 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 Assignment: 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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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.
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.
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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.
Sample Answer for Assignment 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
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Sample Answer 2 for Assignment NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
Assessment of patients to determine conditions on the head, the eyes, the ears, the nose, and the throat ought to be properly done, which would then inform the appropriate treatment. Different formats can be used to assess the patient, and this essay considers Lily’s case, which is assessed using the SOAP Note format.
Patient Information: the patient is Lily, aged 20 y/o Sex: Female
S
CC: Lily indicated that she had a sore throat for the previous three days, and a headache accompanies this, a lot of pain while swallowing, and a decrease in appetite. She indicates that she is worried that the symptoms could be related to the current flu outbreak in her school.
HPI: Lily, a 20 y/o Female Caucasian, presented with a sore throat that had lasted for three days. The presentation was not really concerning initially, but following the flu outbreak in her school, two weeks made her really get concerned as they could be related. The patient also reported having a headache, pain during swallowing, and appetite loss alongside the sore throat.
The current medication indicated that the patient was taking an oral daily dose of multivitamin for six months.
Allergies: the patient is allergic to bee stings and hives
PMH: the patient did not report any previous hospitalizations or any underlying medical condition. She noted that there was a report of immunization against the flu in October 2017.
Social History: Lily attends school in the local community college and lives with her parents and a younger brother. There is no report of using any drugs, and she also denies smoking and alcohol use history.
Family Hx: there was no report of any significant family history from Lily’s assessment.
Review of Systems
General: the patient was alert in all spheres and was totally cooperative throughout the assessment. There was no indication of distress and no report of loss or gain of weight, no fever, no fatigue, and no weakness.
HEENT: the patient indicated that she had a headache, there were no challenges with vision, no problems with hearing, but a running nose and pain while swallowing, and there was a sore throat.
Skin: there were rashes or itching on the skin. No observable bruises on the skin.
Cardiovascular: the patient did not report any chest pain, no report of palpitations, no pressure in the chest, and no edema reported.
Respiratory: the patient indicated that she had a running nose, but there was no shortness of breath, there was nasal congestion, and no cough was reported.
Gastrointestinal: no report of abdominal discomfort/ pain, no nausea, no vomiting but a decrease in appetite. There were observed abnormal bowel movements.
Genitourinary: there were no changes in the patterns of urination, no urinary urgency, no increase in urine frequency, no report of blood in the urine. There was no report of any sexually transmitted diseases.
Neurological: the patient reported a headache that had persisted for three days but no indication of dizziness or fainting.
Hematologic: no report of a history of blood transfusion, and the patient did not have any history of anemia.
Lymphatics: the patient did not have enlarged lymph nodes
Psychiatric: patient did not indicate any history of psychiatric condition.
Endocrinologic: no report of sweating, no heat or cold intolerance, and no reports of polydipsia.
Allergies: patient allergic to bee stings and hives.
O
Physical Exam: the patient had blood pressure, pulse, and temperature within the normal ranges with adequate oxygen saturation. Blood Pressure 112/72, the pulse 65 (very regular); temperature 96.8 F; respiratory rate 20; the SpO2: 98% under room air; weight: 125 lbs; height: 5’4
General: the patient was oriented in four spheres and very cooperative, and not under any duress.
Diagnostic results
Lab results: the CBC: WBC was 7.8; RBC 5.0; H/H 12.4/38.8.
Swab culture: there were no conclusive results, but the intermediate findings could indicate group A strep infections. There was also a need to conduct a throat swab to determine if viral infections were present.
A
Differential Diagnoses:
Influenza infection: this is a viral infection that attacks the throat, nose, and lungs, commonly known as flu. In most cases, it would resolve on its own, but when complications occur, they are deadly (Boggess, 2019). This condition is contagious and could easily spread with a lot of ease in Lily’s case due to the closeness with which students live with each other and the different social amenities that they share (Sellers, Hagan, Hayden, & Fischer, 2017). When it occurs, the condition is associated with a high fever, runny nose, and sore throat alongside headache, body aches, and even fatigue.
Acute Laryngitis: this is a condition that is self-limiting, and it is caused by viral infections, postnasal drainage, irritants from the environment, and complicated allergic rhinitis (She, et al., 2020). In most cases, the condition would be less than three weeks but could become chronic beyond three weeks. Voice hoarseness, weak voice, sore throat, and a dry cough are symptoms associated with the condition (Jaworek et al., 2018). This diagnosis would easily be ruled out because the patient did not have any cough evidence, although there was hoarseness of voice.
Postnasal drip: this is one of the common causes of a persistent cough, and there is often excessive production of mucus, which results in a scratchy throat. The voice’s hoarseness is associated with mucus getting plugged into the Eustachian tube, a connection between the throat and the middle ear, and this could potentially cause an ear infection (Wolf, n.d.). Other symptoms associated with the condition include a blocked or running nose, having a hoarse voice, tickling sensation in the throat, and wheezing while breathing. There were other presentations like headache, difficulties swallowing, and therefore, postnasal drip cannot be ascertained as the diagnosis.
Acute Epiglottitis: this is a condition that is progressive and leads to an inflammation of the epiglottis and the tissues which surround the epiglottis, a situation that leads to blockage of the upper airway and challenges in breathing (Tsai et al., 2018). This condition is, in most cases, caused by bacterial colonization. Some of the symptoms associated with this condition include a very severe sore throat, having difficulties while swallowing, high fever, drooling, and abnormal sounds while breathing (Lindquist, Zachariah, & Kulkarni, 2017). The patient did not present with a high fever, and this condition can hence be ruled out.
Infectious mononucleosis: The Epstein Barr virus causes this condition, and it is most commonly diagnosed among teenagers, although it could occur at any age. The virus is spread through saliva, and it is therefore referred to as the kissing virus. The condition symptoms include sore throat, fever, and enlargement of the lymph nodes (Zhang et al., 2018). The condition would also be associated with body aches, including headaches and a rash.
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There is a need to complete the physical examination of the patient of the ear, nose throat to determine further presentations associated with the condition. Since there is a recent outbreak of influenza in the college, there would be a need for a nasopharyngeal swab to determine if she has the infection. A throat culture would also be needed to isolate the specific microorganisms responsible for the current clinical symptoms. If the hoarse voice persists, then there would be a need for a laryngoscopy to check the larynx’s shape and therefore rule out other potential complicated conditions.
Examining the laryngeal structure is also important to eliminate possible underlying conditions that would cause long term problems with the voice. Since the patient had some disturbing symptoms, it would be necessary for symptomatic management. For instance, she would be put on analgesics to manage the headache and possible body aches. NSAIDs would also be an ideal choice to manage the inflammation, which is currently the reason for swallowing difficulties. It would also be necessary to expedite the tests to prevent complications for the patient.
Conclusion
During the assessment of patients, it is possible that several conditions can be associated with the presentation. Therefore, as a result, careful examination of the differentials helps to narrow down to a diagnosis and therefore initiate the appropriate interventions. SOAP Note provides an ideal approach to the assessment of patients and therefore informs diagnosis and treatment.
References
Boggess, K. (2019). The Deadly Influenza Virus and Its Changing Forms. D.U.Quark, 3(2). Retrieved from https://dsc.duq.edu/duquark/vol3/iss2/3
Jaworek, A. J., Earasi, K., Lyons, K. M., Daggumati, S., Hu, A., & Sataloff, R. T. (2018). Acute infectious laryngitis: A case series. Ear, Nose and Throat Journal, 97(9), 306–313. https://doi.org/10.1177/014556131809700920
Lindquist, B., Zachariah, S., & Kulkarni, A. (2017). Adult Epiglottitis: A Case Series. The Permanente Journal, 21, 16–089. https://doi.org/10.7812/TPP/16-089
Sellers, S. A., Hagan, R. S., Hayden, F. G., & Fischer, W. A. (2017, September 1). The hidden burden of influenza: A review of the extra-pulmonary complications of influenza infection. Influenza and Other Respiratory Viruses, Vol. 11, pp. 372–393. https://doi.org/10.1111/irv.12470
She, C., Wang, L., Liu, Y., Liu, J., Ahmad, F., Hamulati, H., … & Jiao, F. (2020). Acute Laryngitis in Children: A Study of 121 Cases. Clinical Research in Pediatrics, 3(1), 1-4.
Tsai, Y.-T., Huang, E. I., Chang, G.-H., Tsai, M.-S., Hsu, C.-M., Yang, Y.-H., … Li, H.-Y. (2018). Risk of acute epiglottitis in patients with preexisting diabetes mellitus: A population-based case-control study. PLOS ONE, 13(6), e0199036. https://doi.org/10.1371/journal.pone.0199036
Wolf. (n.d.). THI NA NAMIN TURUT HADITATE US009801752B2 ( 12 ) United States Patent.
Zhang, L., Zhou, P., Meng, Z., Pang, C., Gong, L., Zhang, Q., … Song, K. (2018). Infectious mononucleosis and hepatic function. Experimental and Therapeutic Medicine, 15(3), 2901–2909. https://doi.org/10.3892/etm.2018.5736
Sample Answer 3 for Assignment 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
Sample Answer for Assignment NURS 6512 Assessing the Head, Eyes, Ears, Nose, and Throat
Patient Information
Patient: Kali
Age: 44years old
Gender: Female
CC: She complains of proptosis and feeling fatigued. Her TSH levels are elevated, she has hyperlipidemia, her neck appears swollen, and is overweight.
HPI
Since the patient has complained of proptosis and is also feeling fatigued, the patient has eye problems. According to research, proptosis has been caused by thyroid eye disease. Additionally, proptosis is associated with redness in the eye and blurred vision. Therefore, if such symptoms are visible during the assessment, it is likely that the patient has proptosis (Patel et al., 2019). Moreover, the patient also has hyperlipidemia. Researchers have been able to identify the various causes of hyperlipidemia, such as high-fat diets, diabetes, obesity, among others (Roos & Murthy, 2019). As a result, hyperlipidemia is associated with cramping in the toes while walking, sores in the toes and one faces problems while speaking, which might be why the patient neck appears swollen. The patient might have been struggling to talk hence stretching the neck muscles. If this continues for a long time, the neck might get swollen. However, the patient has not had any double vision problems and has not suffered a heart attack or cramping in the calves while walking.
Current medications (list with daily dosages)
The patient has not been prescribed any medication. This might be because she has never taken the condition seriously, and therefore, it might be her first time to be in the hospital for diagnosis and treatment.
ROS
The patient is suffering from thyroid eye disease and throat problem which is not severe as thyroid eye disease. The thyroid eye disease is serious since it has led to the blurred vision for the patient (Patel et al., 2019). Again, the patient’s eyes are reddish. If not treated well, it might make the patient also develop one eye problem. Additionally, the patient was also diagnosed with;
- Hyperlipidemia
- Blurred vision, proptosis
- Swollen neck
- Overweight
Physical Examination
After carrying out physical examinations, the patient’s eyes were reddish. This implied that her complaints were valid; she had proptosis. Again, when some medium-sized words were written on paper, she could not identify the words clearly, which implied that she had blurred vision. Also, the patient was asked about her daily foods. On assessing her, the patient reported that she has been consuming a lot of avocado and eggs (Chin et al., 2020). The two types of food are affluent in fat. This implied that the patient had suffered from hyperlipidemia. However, after blood tests were carried out in the lab, the patient’s TSH level was 6 mU/L, implying that the patient had an elevated TSH level. Besides, the patient did not have any sores on the toes.
In addition, thyroid eye disease occurs in two stages: the active phase, whereby one has dry and red eyes stage, and the inactive phase, whereby it has settled down although one may have some long-term problems. In this case, the patient’s problem is in the active stage (Dolman, 2018). Therefore, thionamides medicines will be prescribed to the patient since she had a high TSH level of 6mU/L. The treatment will prevent the thyroid gland from producing excess thyroid hormones. Besides, this will prevent other problems which are associated with thyroid levels (Chin et al., 2020). In addition, the patient should use the extra pillow in bed, which will prevent her from puffiness around her eyes. Furthermore, she should reduce the consumption of fatty diets. As a result, she should visit the healthcare facility every two months until the problem ceases.
References
Chin, Y. H., Ng, C. H., Lee, M. H., Koh, J. W. H., Kiew, J., Yang, S. P., Sundar, G., & Khoo, C. M. (2020). Prevalence of thyroid eye disease in Graves’ disease: A meta-analysis and systematic review. Clinical Endocrinology, 93(4), 363–374.
Dolman, P. J. (2018). Grading severity and activity in thyroid eye disease. Ophthalmic Plastic & Reconstructive Surgery, 34(4S), S34–S40.
Patel, A., Yang, H., & Douglas, R. S. (2019). A new era in the treatment of thyroid eye disease. American Journal of Ophthalmology, 208, 281–288.
Roos, J. C., & Murthy, R. (2019). Update on the clinical assessment and management of thyroid eye disease. Current Opinion in Ophthalmology, 30(5), 401–406.