Case_Study_3.docx (14.11 KB)

NURS6531 week 3 discussion latest 2018 September Week 3 discussion Discussion: Diagnosing HEENT Disorders

Discussion: Diagnosing HEENT Disorders

In clinical settings, advanced practice nurses may initiate
a physical examination of a patient by examining the components of the HEENT
system. Assessing primary diagnoses and differential diagnoses as they concern
the HEENT system are important in informing your practice in providing optimal
care.

For this Discussion, consider the following three case
studies of patients presenting with head, eyes, ears, nose, and throat
disorders.

Case Study 1

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 accommodation.

Case Study 2

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 5’8”,
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
edematous

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
lymphadenopathy

Cardiac: S1 S2 regular. No S3 S4 or murmur.

Lungs: CTA w/o rales, wheezes, or rhonchi.

Case Study 3

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.