NU-664B Week 1 Discussion 1: Telehealth/Transgender

NU-664B Week 1 Discussion 1: Telehealth/Transgender

The differential diagnosis for this patient would include acute viral rhinosinusitis, acute bacterial rhinosinusitis, allergic rhinitis, hormonal related rhinitis, nasal polyps, foreign body, septal deviation, or covid-19.  Acute viral rhinosinusitis, acute bacterial rhinosinusitis, covid-19, rhinitis medicamentosa, and allergic rhinitis all need to be considered because these are the common causes of inflammation of the nasal and sinus mucosa which lead to the presentation of the symptoms the patient is experiencing including rhinitis and sinus pressure (Goldsobel et al., 2019). The other consideration with this particular patient would be rhinitis due to the fact that the patient is on hormonal therapy because fluctuations in estrogen levels may cause rhinitis (Dunphy et al.,2019). Nasal polyps, foreign bodies, or septal deviation can lead to a feeling of pressure or blockage (Dunphy,2019).  Acute viral rhinosinusitis would be at the top of the list of differentials because 95 percent of acute rhinosinusitis cases are caused by viruses that are responsible for uncomplicated upper respiratory infections (Dunphy et al.,2019). According to Dunphy (2019), ruling in the diagnosis of rhinosinusitis is based off a history of upper respiratory symptoms for at least 7 days with the presence of two or more of the following: headache, sinus or facial pain, lack of response to decongestants, and nasal secretions that are colored. The differentiation between viral sinusitis and the possibility that the condition is complicated by bacterial rhinosinusitis is made based on presentation of symptom severity in addition to length of duration of symptoms. When the duration of symptoms has been over a week to ten days the chances of bacterial sinusitis are more likely (Dunphy, 2019). The only definitive way of identifying the causative organism would be a sinus aspiration however, this is not commonly done in practice due to the invasive nature of the procedure (Dunphy,2019). At this time covid-19 testing is readily availably so I would use a covid-19 rapid antigen test to help rule in or out that diagnosis.  A physical examination would help to rule out nasal polyps, septal deviation, or foreign body contributing to symptoms (Dunphy,2019). Physical exam would also be useful in ruling in or out allergic rhinitis. Typically, in allergic rhinitis the nasal mucosa is pale and edematous or may have a bluish hue and the conjunctiva of the eyes may also be inflamed. In the history the patient may report itching, frequent sneezing, or a cyclic pattern to symptoms.  The patient history and hormone screening labs would help rule in or out the possibility of rhinitis caused by hormonal fluctuations (Dunphy,2019). Rhinitis medicamentosa would be ruled out by taking a careful history that involves inquiring about the use of any over the counter or prescription topical vasoconstrictive medications (Dunphy,2019). The patient in this case has not used any over the counter or prescription medications which rules out the diagnosis of rhinitis medicamentosa.

After assessing this patient based on the history provided including the duration and severity of symptoms, I would treat this patient for viral rhinosunisitis. I would recommend that the patient use saline nasal spray twice a day to improve sinus drainage (Dunphy, 2019). The patient should also increase fluid intake and rest. Using heated mist from a hot shower or bath for steam inhalations can help liquefy secretions which will improve nasal and sinus pain. I would also recommend the use of a neti pot for nasal irrigation.  For the nasal congestion I would recommend that the patient use afrin one to two sprays in each nostril three time a day as needed to be used for 3-4 days only (Dunphy,2019). Due to this patient’s history of elevated blood pressure readings, I would prefer to try a nasal spray prior to Sudafed due to the fact that Sudafed can elevate blood pressure. I would advise the patient to use guaifenesin 400 mg every 4 hours as needed because this help will to facilitate drainage of sinus secretions by liquefying them (Dunphy, 2019). For this patient I would educate that the majority of cases of rhinosinusitis are caused by viral infection and that only about 0.5% of all upper respiratory infections are complicated by bacterial infection therefore, there is no medical benefit to antibiotics in this case and there are risks involved with taking unnecessary antibiotics. I would instruct the patient to notify the office if symptoms failed to improve by 7-10 days or if symptoms worsen. I would instruct the patient to also contact the office with worsening facial pain, fever, or if purulent nasal discharge occurred (Dunphy, 2019). I would discuss with the patient that viruses are contagious so I would recommend avoiding contact with others to reduce the spread of the illness (Dunphy,2019). I would recommend that the patient should follow up with the specialist that is providing hormone therapy as levels should be checked. I would not recommend labs or imaging at this time however, if symptoms continued for more than 10 days and were worsened, I would consider antibiotic therapy. Referral to an ENT specialist would be indicated if symptoms still failed to resolve with antibiotic therapy (Dunphy,2019).

In addressing health maintenance, the patient reported using recreational marijuana and I would encourage the patient to refrain from smoking as the inhaled smoke can be an irritant and exacerbate the symptoms that are being reported and lead to developing nasal and sinus symptoms more frequently (Dunphy, 2019). I would also take this opportunity to review the patient’s immunizations and if covid-19 vaccinations and/ or influenza vaccinations were not up to date I would recommend receiving them when symptoms resolve to prevent development of illness in the future.

NU 664B Week 1 Discussion 1 Telehealth Transgender

NU 664B Week 1 Discussion 1 Telehealth Transgender

In addressing the social determinants of health, I would consider the fact that transgender women may be more prone to experience homelessness, unemployment, and poverty (Garcia & Crosby, 2020). Environmental factors can predispose patients to frequent sinus and nasal problems due to contact with allergens and irritants (Dunphy,2019). I would ask about any problems with the home environment and refer the patient to appropriate resources to assist with housing problems if necessary.


Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. J. (2019). Primary Care (5th

            ed.). F. A. Davis Company.

Garcia, J., & Crosby, R. A. (2020). Social Determinants of discrimination and access to health

care among transgender women in Oregon. Transgender Health, 5(4), 225–233.

Goldsobel, A. B., Prabhakar, N., & Gurfein, B. T. (2019). Prospective trial examining safety and

efficacy of microcurrent stimulation for the treatment of sinus pain and congestion. Bioelectronic Medicine, 5(1).


Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NU-664B Week 1 Discussion 1: Telehealth/Transgender

Lopes Write Policy

For assignments that need to be submitted to Lopes Write, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.

Once you have received your report, please review it. This report will show you grammatical, punctuation, and spelling errors that can easily be fixed. Take the extra few minutes to review instead of getting counted off for these mistakes.

Review your similarities. Did you forget to cite something? Did you not paraphrase well enough? Is your paper made up of someone else’s thoughts more than your own?

Visit the Writing Center in the Student Success Center, under the Resources tab in LoudCloud for tips on improving your paper and SI score.

Late Policy

The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.

Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances.

If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

I do not accept assignments that are two or more weeks late unless we have worked out an extension.

As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.


Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

  • Your response needs to be a minimum of 150 words (not including your list of references)
  • There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
  • Include in-text citations in your response
  • Do not include quotes—instead summarize and paraphrase the information
  • Follow APA-7th edition
  • Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

  • A minimum of 6 responses per week, on at least 3 days of the week.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed
  • Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
  • Here are some helpful links
  • Student paper example
  • Citing Sources
  • The Writing Center is a great resource