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. Assessing the Ears, Nose, and Throat

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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. Assessing the Ears, Nose, and Throat

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.  Assessing the Ears, Nose, and Throat

Question 1 A nurse is working in a women’s hospital where she is caring for a new mother who is experiencing postpartum urinary retention. Bethanechol (Urecholine) has been ordered. The nurse will observe for which of the following?

A) Bradycardia

B) Hypertension experiencing postpartum urinary retention

C) Hypotension

D) Decreased salivation

Question 2 A woman is receiving magnesium sulfate for intrapartum eclampsia. The patient is perspiring and her blood pressure is 88/50. The serum magnesium level is 10 mg/dL. The nurse will interpret these manifestations as

A) common adverse effects of magnesium sulfate

B) magnesium sulfate toxicity

C) a hypersensitivity reaction to magnesium sulfate

D) an idiosyncratic reaction from the magnesium sulfate

Question 3 A male patient is taking finasteride for BPH.Which of the following will the nurse evaluate at each clinic visit?

A) Serum cholesterol levels

B) Bone growth

C) Hemoglobin levels

D) Urinary elimination patterns

Question 4 A 71-year-old man has just been prescribed finasteride (Proscar). Which of the following complaints by this patient most likely indicated a need for this drug?

A) “My urine is extremely concentrated lately and it smells strong.”

B) “To be honest, I find that I can’t get an erection for the past few months.”

C) “My urine’s been cloudy for the last little while and it burns when I go to the bathroom.” experiencing postpartum urinary retention

D) “Lately, I have to get up three or four times a night to go to the bathroom.”

Question 5 After 6 months of unsuccessfully trying to conceive, a 31-year-old woman and her husband have sought a referral to a fertility specialist in order to explore their options. A nurse at the clinic should recognize that the woman may benefit from

A) clomiphene

B) conjugated estrogen

C) progesterone

D) mifepristone

Question 6 A 59-year-old man with a recent history of erectile dysfunction has been assessed and prescribed sildenafil (Viagra). When providing patient education to this man, the nurse should tell him which of the following?

A) “You might find that your face becomes flushed or you get a headache after you take Viagra.”

B) “You should take your Viagra at the same time each morning, ideally on an empty stomach.”

C) “Make sure that you don’t take any other prescription medications while you’re using Viagra.”

D) “If you get some heart palpitations or dizziness after you take Viagra, know that this is normal and will pass with time.”

Question 7 A 66-year-old man has made an appointment with his primary care provider to discuss his recent erectile dysfunction (ED) and has requested a prescription for tadalafil (Cialis) based on television commercials he has seen. What characteristic of this patient would most likely contraindicate the use of tadalafil for his ED?

A) The patient takes allopurinol for the treatment of gout

B) The patient has a family history of osteoporosis and has undergone bone density testing

C) The patient has unstable angina and uses a nitroglycerin patch experiencing postpartum urinary retention

D) The patient often takes ginseng when he gets a common cold

Question 8 A pregnant patient who has diabetes has been admitted to the hospital to begin labor.Since the patient has diabetes, the physician has decided to use oxytocin (Pitocin) to initiate labor contractions. When talking to the patient about the adverse effects of the drug, the nurse should understand that the most common adverse effects of the drug include

A) metabolic alkalosis

B) uterine tachysystole

C) electrolyte imbalances

D) water intoxication

Question 9 A 73-year-old woman has osteoporosis and is prescribed alendronate. She takes calcium and vitamin D supplements, drinks lots of water, and has just quit smoking. The nurse should advise the patient to also

A) include adequate amounts of vitamin C in the diet

B) drink at least 6 to 8 oz of milk daily

C) stop using artificial sweeteners while taking alendronate

D) perform light-weight exercises and go for walks

Question 10 A 29-year-old pregnant patient is extremely upset about having to take medication for a pre-existing medical condition. She is consumed with fear that her baby will be born with a physical deformity or a congenital anomaly but knows that she has to take the medication. She talks constantly about this and is unable to sleep most nights. Which of the following is the most appropriate nursing diagnosis for this patient is?

A) Injury, Risk to the fetus related to adverse effects of maternal drug therapy

B) Injury, Risk to the patient related to failure to receive needed drug therapy

C) Anxiety related to perceived danger of drug therapy to fetus or infant

D) Noncompliance with Drug Therapy

Question 11 The nurse practitioner has recommended that a breast-feeding woman take her prescribed medications just before her infant takes his longest nap of the day. The woman does not understand and asks the nurse to explain. The nurse will tell the woman that the recommendation was made to

A) increase the blood concentrations of the drug in the breast-feeding infant experiencing postpartum urinary retention

B) reduce neonatal drug exposure

C) reduce the half-life of the drug

D) evaluate the drug’s potential adverse effects on the neonate

Question 12 A nurse is instructing a 19-year-old female patient on the use of fluconazole for candida vaginitis. A teaching priority will be to

A) take an antiemetic or antidiarrheal for adverse GI effects

B) use an alternative form of birth control, if taking an oral contraceptive

C) use an aspirin for relief of minor discomforts

D) take the drug with food

Question 13 A pregnant patient asks the nurse what over-the-counter medication she can take for recurring headaches. The nurse should recommend

A) aspirin

B) advil

C) tylenol

D) motrin

Question 14 A 38-year-old pregnant patient admits to the nurse that she is an alcoholic and has been consuming alcohol during her pregnancy. The nurse knows that using alcohol during pregnancy may result in a child who presents with

A) a high-pitched cry

B) microcephaly.

C) an electrolyte imbalance

D) thrombocytopenia

Question 15 A 68-year-old man is being treated for benign prostatic hypertrophy (BPH) and began treatment with finasteride (Proscar) 3 months ago. When planning the care of this patient, what desired outcome should the nurse prioritize?

A) The patient will remain free of sexual side effects related to drug therapy

B) The patient will experience complete bladder emptying

C) The patient will remain free of urethral pain

D) The patient will not experience hematuria

Question 16 A male patient with a medical background tells the nurse that he is not satisfied with the oral synthetic testosterone that has been prescribed for him and he would like to try a natural form of oral testosterone. Which of the following would be an appropriate response by the nurse?

A) “Natural testosterone undergoes a high first-pass effect and is not used orally.”

B) “Natural testosterone poses a higher risk of gynecomastia.”

C) “Natural testosterone undergoes a short first-past effect and is less extensively metabolized than what has been prescribed for you.”

D) “Natural testosterone would be more effective for you.”

Question 17 A nurse is caring for a patient who is at 28 weeks’ gestation and is receiving terbutaline (Brethine) to control preterm labor. Which of the following assessment parameters should the nurse prioritize?

A) Maternal body temperature

B) Fetal heart rate (FHR)

C) Correct fetal position

D) Fetal blood pressure

Question 18 A nurse is working with a patient in the clinic who has erectile dysfunction. The patient has been prescribed sildenafil (Viagra). The patient wants to do everything he can to promote effectiveness of the drug. The nurse will instruct him to

A) avoid taking the drug with a high-protein meal

B) avoid taking the drug with a high-fat meal

C) drink plenty of fluids

D) take a double dose of the drug

Question 19 A patient is being discharged from the hospital and will be taking oxybutynin (Ditropan) for overactive bladder. The nurse will instruct the patient that she will be taking a medication

A) that will be provided in pill form and which may cause lightheadedness

B) that will be administered as a weekly IM injection in an outpatient setting

C) that may be prescribed as a patch and which may cause dry mouth

D) that can be inhaled and that may cause occasional heart palpitations

Question 20 A nurse is discussing with a 58-year-old male patient the causes of erectile dysfunction in men over 50 years of age. Which of the following will the nurse inform the patient is the primary physical cause of erectile dysfunction of men in this age group? experiencing postpartum urinary retention

A) Emotional stress

B) Atherosclerosis of the penile artery

C) Diabetes mellitus

D) Decrease in testosterone levels

Question 21 A nurse is working with a 16-year-old pregnant teen and assessing for behavior that may put the baby at risk. The most important assessment the nurse can make is

A) whether the pregnant woman uses illegal substances

B) whether the pregnant woman has health insurance

C) the pregnant woman’s exercise habits

D) the pregnant woman’s dietary habits

Question 22 A man has a demonstrated history of androgen deficiency and the consequences of this health problem include an inability to maintain an erection. Which of the following medications would best address this patient’s erectile dysfunction (ED)?

A) Sildenafil (Viagra)

B) Tamsulosin (Flomax)

C) Exogenous testosterone

D) Tadalafil (Cialis)

Question 23 Which of the following would the nurse include in a teaching plan about the signs and symptoms of thrombophlebitis and thromboembolism that should be reported by a patient taking estrogen?

A) Cholestatic jaundice

B) Amenorrhea

C) Headaches and chest pain

D) Breast tenderness

Question 24 A 36-year-old patient comes to the clinic and tells the nurse that she suspects that she is pregnant. During the initial assessment, the nurse learns that the patient is currently taking medications for diabetes, hypertension, and a seizure disorder. The nurse would be most concerned about which of the following medications?

A) Insulin

B) Ibuprofen (Advil)

C) Phenytoin (Dilantin)

D) Furosemide (Lasix)

Question 25 A woman is receiving prolonged drug therapy during her complicated pregnancy, and it may pose a risk to both the mother and the fetus. The primary care physician has made dosage adjustments to minimize adverse effects and prevent toxicity. The nurse should make sure

A) that serum levels of the drug are being monitored

B) that the FDA is informed that the woman is receiving drug therapy

C) to check the drug’s FDA pregnancy category to determine safety

D) that only nonpharmacologic alternatives are being used

Question 26 A 56-year-old woman will soon begin treatment of her overactive bladder with tolterodine (Detrol). What patient teaching should the nurse provide to this woman?

A) “It’s good to measure your heart rate before you take your Detrol each day, and withhold it if your heart rate is below 60 beats/minute.”

B) “You’ll probably need to stop taking your hormone replacement therapy when you’re taking Detrol.”

C) “You’ll likely find that you have scant amounts of blood in your urine for the first few days, but this is not unusual or problematic.”

D) “You might find that you get a dry mouth or a headache from this drug, but this does not mean it has to be discontinued.”

Question 27 The nurse has established peripheral IV access and begun an infusion of magnesium sulfate on a 29-year-old antepartum patient who is 35 weeks pregnant. Which of the following assessment findings most likely prompted the patient’s physician to order magnesium sulfate for this patient?

A) Decreased level of consciousness with a sudden onset

B) The presence of rales and rhonchi and oxygen saturation less than or equal to 80% on room air

C) Maternal bradycardia accompanied by a prolonged QT interval

D) Systolic blood pressure readings in excess of 190 mmHg

Question 28 The nurse recognizes that the potential for teratogenic drug effects is not static throughout the prenatal and postnatal periods. The potential for teratogenic effects is highest during

A) breast-feeding of the neonate

B) the first 2 months of pregnancy.

C) the two to 3 weeks prior to delivery experiencing postpartum urinary retention

D) the second trimester

Question 29 Alendronate (Fosamax) is prescribed for a 67-year-old postmenopausal woman. In order to help prevent gastrointestinal distress, the nurse will advise the patient to

A) stand or sit upright for at least 30 minutes after taking alendronate..

B) avoid drinking water with the drug

C) lift weights in the gym at least five times a week

D) take calcium and vitamin D supplements

Question 30 A female patient is taking oral cyclophosphamide therapy for breast cancer. Because of possible adverse effects of the drug, the nurse will instruct the patient to do which of the following?

A) Drink a lot of water

B) Limit fluid intake

C) Take the medication at bedtime

D) Increase the protein in her diet

Question 31 A patient is taking flavoxate hydrochloride (Urispas) to help control an overactive bladder. On a follow-up visit to the clinic, the nurse will question the patient about which of the following?

A) Chronic diarrhea

B) Dental hygiene practices

C) Headaches

D) Diet

Question 32 Alprostadil (Caverject), a drug used to treat erectile dysfunction, has been prescribed to a 42-year-old patient. When providing education to the patient and his wife, the nurse should inform the wife about which of the following adverse effects?

A) Low blood pressure

B) Vaginal burning

C) Increased heart rate

D) Reduced desire for sexual activity

Question 33 A male patient is trying to decide if he should use finasteride (Proscar) to treat benign prostatic hypertrophy (BPH). When providing information about the drug, the nurse will include which of the following as a risk associated with finasteride therapy?

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A) Excess fluid volume related to potential effects of drug therapy

B) Hypercalcemia related to drug therapy, immobility, and breast cancer

C) Sexual dysfunction related to erectile dysfunction

D) Prostatic neoplasia

Question 34 A 20-year-old woman has been prescribed estrogen. As with all women taking estrogen, the nurse will carefully monitor the patient for which of the following?

A) Lack of secondary sexual characteristics

B) Cardiovascular complications

C) Early epiphyseal closure

D) Decreased libido

Question 35 A nurse is providing patient education to a 50-year-old woman who is taking methotrexate (MTX) for breast cancer. The nurse will instruct the patient to avoid which of the following drugs?

A) Acetaminophen

B) Salicylates

C) Furosemide

D) Digoxin

Question 36 A patient is taking etoposide for a testicular tumor refractory to treatment. The nursing assessment reveals that he is also taking warfarin. The nurse must carefully monitor for which of the following?

A) Decreased heart rate

B) Increased serum drug levels of etoposide

C) Elevated prothrombin time

D) Lower liver enzymes

Question 37 A nurse is caring for a 46-year-old female patient who is taking paclitaxel for ovarian cancer. Two or three days after the infusion of the drug, the nurse must closely monitor for which of the following?

A) Cardiotoxicity

B) Constipation

C) Neurotoxicity

D) Asthma

Question 38 A nurse is performing patient education for a woman who has just been prescribed a bisphosphonate. Which of the following diagnostic and history findings would have prompted the woman’s care provider to prescribe a bisphosphonate? experiencing postpartum urinary retention

A) Height in the lowest quartile of the population and a history of joint pain

B) Low bone density and a family history of osteoporosis

C) Complaints of cold intolerance, recurrent constipation, and evidence of diverticular disease

D) Labile moods and short-term memory deficits

Question 39 A nurse is explaining to a pregnant 21-year-old college student why she cannot continue to take ibuprofen (Advil) for her headaches. The nurse draws a picture depicting drug molecules crossing the placental membrane and entering into the fetal circulation. The nurse tells the patient that the main reason this happens is because

A) there is a 40% increase in blood volume during pregnancy

B) the mother’s heart rate is 10 to 15 beats per minute faster during pregnancy

C) drugs compete with the hormones of pregnancy for albumin-binding sites

D) hemodilution of plasma albumin occurs

Question 40 A 36-year-old woman with a history of dysmenorrhea has begun treatment with progesterone, which she will be receiving by the intramuscular route. The nurse participating in the woman’s care should prioritize which of the following potential nursing diagnoses?

A) Incontinence, Functional, related to neurosensory and musculoskeletal changes

B) Fluid Volume Deficit related to metabolic changes secondary to drug therapy

C) Confusion, Chronic, related to CNS changes resulting from adverse drug effects

D) Risk for Injury related to loss of vision or thrombotic events experiencing postpartum urinary retention

   5 

For this assignment, you will interview a person from a cultural background that is different from your own. Using the twelve domains of culture from the Purnell Model, discuss the health practices of that culture and compose a scholarly paper in a Microsoft Word document of 5–6 pages formatted in APA style.

In your paper, you should include the following:

Select a person from a cultural group different from your own. You may choose a patient, friend, or work colleague. For the sake of confidentiality, do not reveal the name of the person you interview; use only initials. Culturally Competent Nursing

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For the person you select, complete the cultural assessment using questions 1 through 12 from the Purnell Model for Cultural Competence in your textbook, Transcultural Health Care: A Culturally Competent Approach.

On a separate page, cite all sources using APA format.

• Use this APA Citation Helper as a convenient reference for properly citing resources.
• This handout will provide you the details of formatting your essay using APA style.
• You may create your essay in this APA-formatted template.

Submission Details:

• Name the document SU_NSG4074_W2_A2_LastName_FirstInitial.doc.
• Submit it to the Submissions Area by the due date assigned. Culturally Competent Nursing

Case Study

Read the following case study:

A small community hospital in the Midwest has used a homegrown information system for years. The system began in the early 1970s with a financial module. Over time, additional modules were added. A limited number of departments selected a commercial system and interfaces were used to integrate these into the overall functionality of the hospital information system. Except for physicians, most in-house clinical or care-related documentation is online. However, about 15% to 20% of this documentation is done by free text and is not effectively searchable. In addition, the screens, including the drop-down and default values, were built using terms selected by the in-house development team in consultation with clinical staff; thus there is no data dictionary or specific standard language. In the last few years, the hospital has purchased two outpatient clinics (obstetrics and mental health) and a number of local doctor practices. The clinics and doctors’ offices are now being converted to the hospital administrative systems. A few of the clinical applications that are tied directly to the administrative systems such as order entry and results reporting are also being installed. Healthcare Data Standardization

A major change is being planned. A new chief information officer (CIO) was hired last year and she has appointed a chief medical information officer (CMIO) and a chief nursing information officer (CNIO). No other significant staff changes were made. With her team in place, one of the CIO’s first activities was to complete an inventory of all applications. Rather than continue to build, a decision was made to switch to a commercial vendor and the hospital selected a commercial system.

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As a member of the clinical staff with informatics education, the CIO has requested that you develop a training and information presentation for the clinical staff that will:

1· Identify two or more issues with the existing system

2· Provide staff with appropriate “work-around” for using the existing system

3· Provide an overview of two of the standard languages used within the new system including discipline or specialty, updating frequency, and available cross-maps

– One standard language should pertain only to nursing Healthcare Data Standardization

– One standard language should be multidisciplinary. 

4· Obtain clinical staff input, using a five-question survey, of specific methods to support transition to the new system; questions should be open-ended.

PowerPoint Presentation

Directions:

1. Review the case study.

2. Download the provided PowerPoint template to create a presentation that includes:

· Your name on the title slide of the presentation

· Identification of two or more issues with existing system

· Identification of “work-a-round” solutions when using existing system

· Overview of standard language used only in nursing

· Overview of multidisciplinary standard language

· Set of five (5) open-ended survey questions for staff input on transitioning to the new system

Presentation is free of spelling and grammar errors. Healthcare Data Standardization