URS 6512 Week 5 Discussion

URS 6512 Week 5 Discussion

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Assessing the Ears, Nose, and Throat

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.

In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

Note: By Day 1 of this week, your instructor will have assigned you to one of the following case studies to review for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

URS 6512 Week 5 Discussion

Case 1: Nose Focused Exam

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

Case 2: Focused Throat Exam

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

Case 3: Focused Ear Exam

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

To prepare:

With regard to the case study you were assigned:

• Review this week’s Learning Resources and consider the insights they provide.
• Consider what history would be necessary to collect from the patient.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least 10 possible conditions that may be considered in a differential diagnosis for the patient.

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

URS 6512 Week 5 Discussion

By Day 3

Post a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

Read a selection of your colleagues’ responses.

By Day 6

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

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

Address the following in the SOAP Note:

1. A description of the health history you would need to collect from the patient in the case study to which you were assigned.
2. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis.
3. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

Assessing the Ears, Nose, and Throat REFERENCES:

Assessing the Ears, Nose, and Throat Readings

• Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015).Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

o    Chapter 10, “Head and Neck” (pp. 184-203)

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.

o    Chapter 11, “Eyes” (pp. 204-230)

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.

o    Chapter 12, “Ears, Nose, and Throat” (pp. 231-259)

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. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

o    Chapter 15, “Earache” (pp. 174–183)

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.

o    Chapter 21, “Hoarseness” (pp. 248-255)

This chapter focuses on the most common causes of hoarseness. It provides strategies for evaluating the patient both through questions and through physical exams.

o    Chapter 25, “Nasal Symptoms and Sinus Congestion” (pp.301-309)

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.

o    Chapter 30, “Red Eye” (pp. 357-368)

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.

o    Chapter 32, “Sore Throat” (pp. 381-389)

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.

o    Chapter 38, “Vision Loss” (pp. 446-457)

This chapter highlights the causes of vision loss and how the causes of the condition can be diagnosed.

• Sullivan, D. D. (2012).Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.

o    Chapter 5, “SOAP Notes” (pp. 91–118)

Note: Download the seven documents (Adult Examination Checklists and Physical Exam Summaries) below, and use them as you practice conducting assessments of the head, neck, eyes, ears, nose, and throat.

• Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for head, face, and neck. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.This Adult Examination Checklist: Guide for Head, Face, and Neck was published as a companion to Seidel’s guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). Fromhttps://evolve.elsevier.com/
• Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011).Adult examination checklist: Guide for eye assessment. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.This Adult Examination Checklist: Guide for Eye Assessment was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). Fromhttps://evolve.elsevier.com/
• Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for ear assessment. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.This Adult Examination Checklist: Guide for Ear Assessment was published as a companion to Seidel’s guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). Fromhttps://evolve.elsevier.com/
• Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011).Adult examination checklist: Guide for nose, paranasal sinuses, mouth, oropharynx. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.This Adult Examination Checklist: Guide for Nose, Paranasal Sinuses, Mouth, Oropharynx was published as a companion toSeidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
• Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Ears, nose, and throat. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.This Ears, Nose, and Throat Physical Exam Summary was published as a companion to Seidel’s guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). Fromhttps://evolve.elsevier.com
• Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Eyes. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.This Eyes Physical Exam Summary was published as a companion to Seidel’s guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/
• Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Head, face, and neck. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.This Head and Neck Physical Exam Summary was published as a companion to Seidel’s guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). Fromhttps://evolve.elsevier.com/
• Browning, S. (2009). Ear, nose, and throat problems.General Practice Update, 2(9), 9–13.Retrieved from the Walden Library databases.This article contains a question and answer session on ear, nose, and throat problems. The article reviews specific topics, such as when to use eardrops and new post-nasal drip treatments, and the referral of persisting cough cases by general practitioners.
• Lloyd, A., & Pinto, G. L. (2009). Common eye problems.Clinician Reviews, 19(11), 24–29.Retrieved from the Walden Library databases.The authors of this article describe different eye problems, their symptoms, and recommended treatments. The authors also emphasize the need to conduct an eye exam and take an ocular history.
• Otolaryngology Houston. (2014).Imaging of maxillary sinusitis (X-ray, CT, and MRI). Retrieved fromhttp://www.ghorayeb.com/ImagingMaxillarySinusitis.htmlThis website provides medical images of sinusitis, including X-rays, CT scans, and MRIs (magnetic resonance imaging).

Assessing the Ears, Nose, and Throat Media

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 Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/.

Assessing the Ears, Nose, and Throat Optional Resources

• LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2009).DeGowin’s diagnostic examination (9th ed.). New York, NY: McGraw Hill Medical.

o    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.

NURS 6512 Week 5 quiz

Question 1 Mrs. Britton brings her 16-year-old son in with a complaint that he is not developing correctly into adolescence. Which structures disproportionately enlarge in the male during adolescence?

Question 2 Self-analysis assists providers in giving proper context to:

Question 3 You are using a pneumonic attachment on the otoscope while assessing tympanic membrane movement. You gently squeeze the bulb but see no movement of the membrane. Your next action should be to:

Question 4 Which of the following is true regarding cephalhematoma?

Question 5 The thyroid gland should:

Question 6 To approximate vocal frequencies, which tuning fork should be used to assess hearing?

Question 7 Expected physical changes associated with older adults include:

Question 8 L.G., age 58, has a chief complaint of diffuse, crampy abdominal pain, which has progressed to a severity scale of 7 out of 10. He is afebrile and denies nausea and vomiting and diarrhea. Family history is positive for intestinal polyps, diabetes mellitus, and Alzheimer disease. His past medical history is positive for kidney stones, gastroesophageal reflux disease, and hypercholesterolemia. Physical examination is positive for guarding and tenderness in the epigastric region but is otherwise normal. In an effort to confirm your hypothesis, you should schedule a(n):

Question 9 In the presence of otitis externa, tympanic membrane perforation, or myringotomy tubes you should:

Question 10 When hearing is evaluated, which cranial nerve is being tested?

Question 11 A newborn whose serum bilirubin is greater than 20 mg/100 mL risks later:

Question 12 Which of the following is not a component of a management plan?

Question 13 Which of the following recreational drugs is commonly associated with nasal septum perforation?

Question 14 For best results, an otoscopic and oral examination in a child should be:

Question 15 A patient has come in with a chief complaint of facial pain and “sinus issues.” Transillumination of the right sinus produces no light. You consulted your preceptor to order a sinus x-ray and she agreed. Which of the following findings on x-ray would support your diagnosis of sinusitis?

Question 16 An increased level of lysozyme in the tears will occur normally during which life stage?

Question 17 Xanthelasma may suggest that the patient has an abnormality of:

Question 18 When testing corneal sensitivity controlled by cranial nerve V, you should expect the patient to respond by:

Question 19 You are attempting to examine the eyes of a newborn. To facilitate eye opening, you would first:

Question 20 Cotton wool spots are most closely associated with:

URS 6512 Week 5 Discussion

URS 6512 Week 5 Discussion

 

 

MORE INFO 

Assessing the Ears, Nose, and Throat

Introduction

The human ear, nose, and throat all work together to detect sound. When you listen to music, the musician can use this complex arrangement of organs to create a unique sound that we call music. In this article we’ll look at how these three parts of the body interact with each other so that sound is produced.

The ear

The ear is a complex structure. It consists of three parts: the outer ear, middle ear, and inner ear. The outer portion of the human body is responsible for collecting sound waves and funneling them into the eardrum. The auricle (also known as pinna) plays an important role in determining how you hear sound—if it’s bent or torn out of shape, then you may be able to hear better or worse than someone else!

The middle meatus acts as a receiver for air flowing through your nose; it also helps protect your hearing by dampening sounds coming from behind you when you talk on your phone during a conversation with someone else close by who isn’t listening closely enough either!

The innermost part inside our skull houses all sorts of tiny bones called otoliths which act like sensors for balance control systems within our bodies such as balance reflexes – these are located behind each eye socket area where they serve primarily two functions: help keep us upright while walking around so both eyes remain focused forward at all times; secondly they help determine whether or not something moves towards us quickly enough before reaching max speed potential if there’s anything nearby worth avoiding contact with first thing tomorrow morning while coming outta bed after having slept late last night due too much partying hardcore fun times before going home early this morning.”

The nose

The nose is a passageway for air, food and drink, mucus, blood and tears.

The nasal passages are directly connected to the mouth through a tube called the nasopharyngeal (or “nose”) tube. This connects with your throat at the bottom of your mouth so that you can breathe when you’re sleeping or eating something very hot or spicy. It also helps keep your stomach acid from hurting when it comes in contact with food or drink—which might be why I always feel like I have an upset stomach after eating something new!

The throat

The throat is a passage that connects the mouth and nose to the lungs. It’s made up of three parts:

• The pharynx, which connects your nose to your esophagus

• The larynx, which is located in front of your trachea (the part of your windpipe that leads to your lungs) and vocal folds (or “vocal cords”). This area has two important jobs: it allows air from outside airways in order to inflate vocal folds so that you can make sound; it also helps control how much air moves through these muscles by opening or closing openings between them called glottis during breathing cycles

Takeaway:

You may be thinking, “I don’t need to worry about my ears, nose and throat. They’re all connected!” Well, you would be wrong. The ear is responsible for hearing; the nose is responsible for smelling; and the throat is responsible for swallowing. If any one of these three organs fails to function properly—or if they become swollen due to infection—it can cause serious problems that could affect other parts of your body as well.

Now that we have covered what each organ does in detail let’s look at some common conditions related to them:

Conclusion

Now that you know how to assess these areas of the body, let’s get started!