Week 2 discussion
Discussion – Week 2
Diagnosing Skin, Eye, Ear, and Throat Disorders
When entering examination rooms, advanced practice nurses
often immediately begin assessing patients by looking for external
abnormalities such as skin irritations or cloudy eyes. By making these simple
observations, they can determine how to proceed with their patient evaluations.
During the patient evaluation, advanced practice nurses will use initial
observations to guide them in acquiring the necessary medical history,
performing additional assessments, and ordering the appropriate diagnostics.
The information obtained during this evaluation process will help in the
development of a differential diagnosis. Once a diagnosis is made, the advanced
practice nurse can consider potential treatment options and work with the
patient to develop a plan of care. For this Discussion, consider the following
four case studies of patients presenting with skin, eye, ear, and throat
Case Study 1:
A 46-year-old male presents to the office complaining of a
pruritic skin rash that has been present for a few weeks. He initially noted
the rash on his chest, but it then spread to his back and arms. He notes that
it does not seem to be on his legs. He recently came home from a trip to
Florida, but denies fever, chills, new soaps or detergents, other travel, or
known insect bites. He takes occasional ibuprofen for knee pain, but denies
taking other medications or having other health problems. He has no known drug
allergies. The physical examination reveals a male with a deep tan and notable
scattered 1â€“1.5-centimeter, flat, circular, light-colored patches on his chest,
back, and upper extremities.
Case Study 2:
An 86-year-old widowed female is brought to the office by
her daughter-in-law. The patient complains of constant tearing and an itchy,
burning sensation in both eyes. The patient states this is not a new problem,
but it has worsened in the past week and is affecting her vision. The patient complains that her eyes are dry.
She thinks the problem must be caused by one of her medications. Her patient medical history is positive for
hypertension, atrial fibrillation, and heart failure. She has an allergy to
erythromycin that causes rash and elevated liver enzymes. Medications currently
prescribed include Furosemide 40 milligrams po twice a day, diltiazem 240 milligrams
po daily, lisinopril 20 milligrams po daily, and warfarin 3 milligrams po
daily. The physical examination reveals a frail older female with some facial
dryness and slight scaling. Her visual
acuity is 20/60 OU, 20/40 OD, 20/60 OS. The eyelids are erythematous and
edematous with yellow crusting around the lashes. Sclera are injected,
conjunctiva are pale, and pupils are equal and reactive to light and
Case Study 3:
A middle-aged male presents to the office complaining of a
two-day history of a left earache. The onset was gradual, but has steadily been
increasing. It has been constantly aching since last night, and his hearing
seems diminished to him. Today he thinks the left side of his face may even be
swollen. He denies upper respiratory infection, known fever, or chills. His
patient medical history is positive for Type 2 diabetes mellitus, hypertension,
and hyperlipidemia. The patient has a known allergy to Amoxicillin that results
in pruritus. Medications currently prescribed include Metformin 1,000
milligrams po twice a day, lisinopril 20 milligrams po daily, Aspirin 81
milligrams po daily, and simvastatin 40 milligrams po daily. The physical exam
reveals a middle aged male at a weight of 160 pounds, height of 5â€™8â€,
temperature of 98.8 degrees Fahrenheit, heart rate of 88, respiratory rate of
18, and blood pressure of 138/76. Further examination reveals the following:
Face: Faint asymmetry with left periauricular area slightly
Eyes: sclera clear, conj wnl
L ear: + tenderness L pinna, + edema, erythema, exudates
left external auditory canal, TM not visible
R ear: no tenderness, R external auditory canal clear
without edema, erythema, exudates
+ tenderness L preauricular node, otherwise no
Cardiac: S1 S2 regular. No S3 S4 or murmur.
Lungs: CTA w/o rales, wheezes, or rhonchi.
Case Study 4:
A middle-aged female presents to the office complaining of
strep throat. She states she suddenly developed a sore throat yesterday
afternoon, and it has gotten worse since then. During the night she felt like
she was chilled and feverish. She denies known recent contact with anyone else
who had strep throat, but states she has had strep before and it feels like she
has strep now. She takes no medications, but is allergic to penicillin. The
physical examination reveals a slender female lying on the examination table.
She has a temperature of 101 degrees Fahrenheit, heart rate of 112, respiratory
rate of 22, and blood pressure of 96/64. The head, eyes, ears, nose, and throat
evaluation is positive for bilateral tonsillar swelling without exudates. Her
neck is supple with bilateral, tender, enlarged anterior cervical nodes.
Review this weekâ€™s media presentations and Parts 5â€“8 of the
Buttaro et al. text.
Select one of the four case studies provided. Reflect on the
provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the
patient history and physical exam played in your diagnosis.
Reflect on potential treatment options based on your
Post on or before Day 3 an explanation of the differential
diagnosis for the patient in the case study that you selected. Describe the
role the patient history and physical exam played in the diagnosis. Then,
suggest potential treatment options based on your patient diagnosis
Read a selection of your colleaguesâ€™ responses.
Respond on or before Day 6 to at least two of your
colleagues on two different days who selected a different case study than you
did. Based on information missing from the patient history, suggest other
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