Discussion: Assessing the Ears, Nose, and Throat

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

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

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case. 

Case 1: Nose Focused Exam
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he’s taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.

Case 2: Focused Throat Exam
Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn’t take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily’s. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn’t sound congested.

Case 3: Focused Ear Exam
Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past two days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he’s been spending his summer, James responds that he’s been spending a lot of time in the pool.

To prepare:

With regard to the case study you were assigned:

· Review this week’s Learning Resources and consider the insights they provide.

· Consider what history would be necessary to collect from the patient.

· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

· Identify at least 5 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.

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each. 

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Gastrointestinal (GI) and hepatobiliary disorders affect the structure and function of the GI tract. Many of these disorders often have similar symptoms such as abdominal pain, cramping, constipation, nausea, bloating, and fatigue. Since multiple disorders can be tied to the same symptoms, it is important for advanced practice nurses to carefully evaluate patients and prescribe treatment that targets the cause rather than the symptom. Once the underlying cause is identified, an appropriate drug therapy plan can be recommended based on medical history and individual patient factors. In this Discussion, you examine a case study of a patient who presents with symptoms of a possible GI/hepatobiliary disorder, and you design an appropriate drug therapy plan.

Consider the following case study:

Patient HL comes into the clinic with the following symptoms: nausea, vomiting, and diarrhea. The patient has a history of drug abuse and possible Hepatitis C. HL is currently taking the following prescription drugs:

• Synthroid 100 mcg daily
• Nifedipine 30 mg daily
• Prednisone 10 mg daily

To prepare:

• Review this week’s media presentation on pharmacology for the gastrointestinal system.
• Review the provided case study. Reflect on the patient’s symptoms, medical history, and drugs currently prescribed.
• Think about a possible diagnosis for the patient. Consider whether the patient has a disorder related to the gastrointestinal and hepatobiliary system or whether the symptoms are the result of a disorder from another system or other factors such as pregnancy, drugs, or a psychological disorder.
• Consider an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

With these thoughts in mind:

Post an explanation of your diagnosis for the patient including your rationale for the diagnosis. Then, describe an appropriate drug therapy plan based on the patient’s history, diagnosis, and drugs currently prescribed.

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Assignment:
                              Antimicrobial Agents                            

Antimicrobial agents are essential components in the treatment of various bacterial infections as they help to kill or prevent the growth of microbes such as bacteria, fungi, and protozoans. Prior to the discovery of antimicrobial agents, treatment options for patients with bacterial infections were limited. For many patients, treatment often resulted in the amputation of limbs or even death. Today, treatment options for bacterial infections typically have a more positive prognosis. Due to the various types of infections presented in patients, it is essential to be able to identify the underlying cause of the infection—whether bacterial or viral—before recommending drug treatments. This will help you identify whether or not an antimicrobial agent would be appropriate and which specific agent would target the infection. In this Assignment, you consider the appropriate use of antimicrobial agents for infections.

To prepare:

• Review this week’s media presentation on principles of antimicrobial therapy, as well as Chapter 8 of the Arcangelo and Peterson text.
• Consider the categories of antimicrobial agents.
• Think about differences between viral and bacterial infections.
• Reflect on why proper identification of the infection is key to selecting the proper antimicrobial agent.

Write a 2- to 3- page paper that addresses the following:

• Describe the categories of antimicrobial agents.
• Describe differences between viral and bacterial infections.
• Explain why proper identification of viral and bacterial infections is key to selecting the proper antimicrobial agent.

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 CANCER AND WOMEN’S AND MEN’S HEALTH:

The American Cancer Society estimates that by the end of 2012, more than 226,000 women will be diagnosed with breast cancer and more than 241,000 men will be diagnosed with prostate cancer (American Cancer Society, 2012a; American Cancer Society 2012b). With such prevalence of women’s and men’s cancers, patient education and preventive services are essential. In clinical settings, advanced practice nurses must assist physicians in educating patients on risk factors, preventive services, and for patients diagnosed with cancer, on potential drug treatments. The clinical implications of women’s and men’s cancer greatly depend on early detection, which is primarily achieved through preventive services. In this Assignment, you consider the short-term and long-term implications of cancer and drug treatments associated with women’s and men’s health, as well as appropriate preventive services.

To prepare:

• Select a type of cancer associated with women’s or men’s health such as breast, cervical, or ovarian cancer in women and prostate cancer in men.
• Locate and review articles examining the type of cancer you selected.
• Review the U.S. Preventive Services Task Force article in the Learning Resources. Think about available preventive services that providers might recommend for patients at risk of this type of cancer.
• Select two of the following factors: genetics, gender, ethnicity, age, or behavior. Reflect on how these factors might impact decisions related to preventive services.
• Consider drug treatment options for patients diagnosed with the type of cancer you selected including short-term and long-term implications of the treatments.

Write a 2- to 3- page paper that addresses the following:

• Describe available preventive services that providers might recommend for patients at risk of the type of cancer you selected.
• Explain how the factors you selected might impact decisions related to preventive services.
• Describe drug treatment options for patients diagnosed with the type of cancer you selected. Explain the short-term and long-term implications of these treatments.

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Assignment:
The Ethics and Legalities of Medication Error Disclosure 

American writer Nikki Giovanni once said: “Mistakes are a fact of life. It is the response to the error that counts” (Goodreads, 2012). Whenever you make an error when writing a prescription, you must consider the ethical and legal implications of your error—no matter how seemingly insignificant it might be. You may fear the possible consequences and feel pressured not to disclose the error. Regardless, you need to consider the potential implications of non-disclosure. How you respond to the prescription error will affect you, the patient, and the health care facility where you practice. In this Assignment, you examine ethical and legal implications of disclosure and nondisclosure of personal error.

Consider the following scenario:

· You are working as an advanced practice nurse at a community health clinic. You make an error when prescribing a drug to a patient. You do not think the patient would know that you made the error, and it certainly was not intentional.

To prepare:

· Consider the ethical implications of disclosure and nondisclosure.

· Research federal and state laws for advanced practice nurses. Reflect on the legal implications of disclosure and nondisclosure for you and the health clinic.

· Consider what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error.

· Review the Institute for Safe Medication Practices website in the Learning Resources. Consider the process of writing prescriptions. Think about strategies to avoid medication errors.

Write a 2- to 3- page paper that addresses the following:

· Explain the ethical and legal implications of disclosure and nondisclosure. Be sure to reference laws specific to your state.

· Describe what you would do as the advanced practice nurse in this scenario including whether or not you would disclose your error. Provide your rationale.

· Explain the process of writing prescriptions including strategies to minimize medication errors.

Link:

https://www.ismp.org/recommendations/error-prone-abbreviations-list

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