Most 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 Case Study Assignment, 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.

To Prepare

By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.

· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style 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.

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 five possible conditions that may be considered in a differential diagnosis for the patient.

The Assignment: 

CASE STUDY 4: Focused Thyroid Exam Chantal, a 32-year-old female, comes into your office with complaints of “feeling tired” and “hair falling out”. She has gained 30 pounds in the last year but notes markedly decreased appetite. On ROS, she reports not sleeping well and feels cold all the time. She is still able to enjoy her hobbies and does not believe that she is depressed.

Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the 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.

REQUIRED RESOURCES: 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

· Chapter 11, “Head and Neck”
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.

· Chapter 12, “Eyes”
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.

· Chapter 13, “Ears, Nose, and Throat”
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. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

.
Chapter 15, “Earache”
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.

Chapter 21, “Hoarseness”
This chapter focuses on the most common causes of hoarseness. It provides strategies for evaluating the patient, both through questions and through physical exams.

Chapter 25, “Nasal Symptoms and Sinus Congestion”

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.

Chapter 30, “Red Eye”

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.

Chapter 32, “Sore Throat”

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.

Chapter 38, “Vision Loss”
This chapter highlights the causes of vision loss and how the causes of the condition can be diagnosed.

Note: Download the six documents (Student Checklists and Key Points) below, and use them as you practice conducting assessments of the head, neck, eyes, ears, nose, and throat.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Ball, J. W., Dains, J. E., Flynn, J. A., & Solomon, B. S., & Stewart, R. W. (2019). Head and neck: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Eyes: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby. 

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Ears, nose, and throat: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Colyar, M. R. (2015). Advanced practice nursing procedures. Philadelphia, PA: F. A. Davis. 

· Chapter 71, “Visual Function Evaluation: Snellen, Illiterate E, Pictorial
 

This section explains the procedural knowledge needed to perform eyes, ears, nose, and mouth procedures.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

· Chapter 2, “The Comprehensive History and Physical Exam” (Previously read in Weeks 1, 3, 4, and 5)

Bedell, H. E., & Stevenson, S. B. (2013). Eye movement testing in clinical examination. Vision Research 90, 32–37. doi:10.1016/j.visres.2013.02.001. Retrieved from https://www.sciencedirect.com/science/article/pii/S0042698913000217 

Rubin, G. S. (2013). Measuring reading performance. Vision Research, 90, 43–51. doi:10.1016/j.visres.2013.02.015. Retrieved from http://www.sciencedirect.com/science/article/pii/S0042698913000436  

Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Harrison, R. V., & Passamani, P. P. (2013). Otitis media: Diagnosis and treatment. American Family Physicians, 88(7), 435–440.

Otolaryngology Houston. (2014). Imaging of maxillary sinusitis (X-ray, CT, and MRI). Retrieved from http://www.ghorayeb.com/ImagingMaxillarySinusitis.html

This website provides medical images of sinusitis, including X-rays, CT scans, and MRIs (magnetic resonance imaging).

Assignment: Lab Assignment: Assessing the Genitalia and Rectum

Patients are frequently uncomfortable discussing with healthcare professional’s issues that involve the genitalia and rectum; however, gathering an adequate history and properly conducting a physical exam are vital. Examining case studies of genital and rectal abnormalities can help prepare advanced practice nurses to accurately assess patients with problems in these areas.In this Lab Assignment, you will analyze an Episodic note case study that describes abnormal findings in patients seen in a clinical setting. You will consider what history should be collected from the patients, as well as which physical exams and diagnostic tests should be conducted. You will also formulate a differential diagnosis with several possible conditions.

To Prepare

Review the Episodic note case study your instructor provides you for this week’s Assignment. Please see the “Course Announcements” section of the classroom for your Episodic note case study.Based on the Episodic note case study:

Review this week’s Learning Resources, and consider the insights they provide about the case study. Refer to Chapter 3 of the Sullivan resource to guide you as you complete your Lab Assignment.

Search the Walden library or the Internet for evidence-based resources to support your answers to the questions provided.

Consider what history would be necessary to collect from the patient in the case study.

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 five possible conditions that may be considered in a differential diagnosis for the patient.

The Lab Assignment

Using evidence-based resources from your search, answer the following questions and support your answers using current evidence from the literature.

Analyze the subjective portion of the note.

List additional information that should be included in the documentation.Analyze the objective portion of the note.

List additional information that should be included in the documentation.

Is the assessment supported by the subjective and objective information? Why or why not?

Would diagnostics be appropriate for this case, and how would the results be used to make a diagnosis?

Would you reject/accept the current diagnosis? Why or why not?

Identify three possible conditions that may be considered as a differential diagnosis for this patient.

Explain your reasoning using at least three different references from current evidence-based literature.

Case Study

Subjective:

•CC: “I have bumps on my bottom that I want to have checked out.”

•HPI: AB, a 21-year-old WF college student reports to your clinic with external bumps on her genital area. She states the bumps are painless and feel rough. She states she is sexually active and has had more than one partner during the past year. Her initial sexual contact occurred at age 18. She reports no abnormal vaginal discharge. She is unsure how long the bumps have been there but noticed them about a week ago. Her last Pap smear exam was 3 years ago, and no dysplasia was found; the exam results were normal. She reports one sexually transmitted infection (chlamydia) about 2 years ago. She completed the treatment for chlamydia as prescribed.

•PMH: Asthma•Medications: Symbicort 160/4.5mcg

•Allergies: NKDA

•FH: No hx of breast or cervical cancer, Father hx HTN, Mother hx HTN, GERD

•Social: Denies tobacco use; occasional etoh, married, 3 children (1 girl, 2 boys)

Objective:

•VS: Temp 98.6; BP 120/86; RR 16; P 92; HT 5’10”; WT 169lbs•Heart: RRR, no murmurs

•Lungs: CTA, chest wall symmetrical

•Genital: Normal female hair pattern distribution; no masses or swelling. Urethral meatus intact without erythema or discharge. Perineum intact. Vaginal mucosa pink and moist with rugae present, pos for firm, round, small, painless ulcer noted on external labia

•Abd: soft, normoactive bowel sounds, neg rebound, neg murphy’s, neg McBurney

•Diagnostics: HSV specimen obtained

Assessment:•Chancre

Plan: This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

NOTE: THIS IS THE LINK TO DOWNLOAD THE BOOK:

https://www.sendspace.com/file/3dx3zx

CHECK THE ASSIGNMENT FOR PLAGIARISM

Week 2: Leadership Styles and Personality Types: Impact on Communication – Collaborative Group 3
From NR534-61667No unread replies.11 reply.

Part 1: Individual

Identity your leadership style and personality typology using the following instruments:
Blake and Mouton Managerial Grid: Leadership Self-Assessement Questionnaire: https://www.bumc.bu.edu/facdev-medicine/files/2010/10/Leadership-Matrix-Self-Assessment-Questionnaire.pdf (Links to an external site.)
Personality Typology Profile: http://www.humanmetrics.com/personality/type (Links to an external site.)
Discuss the dominant leadership style and personality type of each group member and compare the similarities and differences related to the steps of the communication cycle/feedback loop.
Part 2: With Your Group

Suppose your group is an ad hoc task force charged with finding a solution for reducing call-outs by staff. Based on what you’ve learned about the communication attributes of each other, create a scenario that depicts how you envision communication and collaboration on this project among this group. Discuss what considerations might be taken based on how the different members give and receive information.

Question 1 

Suppose that you are following a group of children for the development of asthma over a one- year period. You identify 100 children on January 1st, screen them for asthma, and set up a monitoring program to check on their status on a monthly basis. Five children are considered prevalent cases because they were diagnosed with asthma before January 1st. Ten children develop asthma on March 1st and another ten children develop asthma on July 1st. Another 10 children who remain healthy were followed for six months and then were lost to follow-up. All of the remaining children did not develop asthma and were not lost to follow-up. Follow-up ended on December 31st.

· What was the prevalence of asthma on June 1st?

· What was the prevalence of asthma on September 1st?

· How many person-months of observation were accrued by this population?

· What was the incidence rate of asthma in this population for the one-year period?

Question 2 

A population of 1,000 people is monitored for a year for the development of measles. No one has measles at the start of the investigation. Thirty people develop measles on June 30 and twenty people develop measles on September 30. Eight people are lost to follow-up on March 31 and twenty-four people are lost to follow-up on November 30. None of those lost to follow-up had developed measles prior to becoming lost. Assume that you can only get measles once.

· What is the cumulative incidence of measles in this population?

· What is the incidence rate of measles?

· What is the prevalence of measles on July 1?

Question 3 

· Which type of measure of disease frequency best describes each of the following scenarios?

· Percentage of students enrolled in a college who developed influenza during the spring semester of 2012.

· Percentage of students enrolled in an epidemiology class who had sore throats on the first day of class.

· Percent of breast cancer patients who underwent mastectomy during 2012.

· Percent of men found to have high blood pressure at their yearly physical.

· Number of newly-diagnosed cases of AIDS in a year per 100,000 persons.

· Percent of infants born with spina bifida out of 1,000 live-born infants.

· Percent of drivers found to be legally drunk at the time of their car accident.

Short Paper.
Arrange a 1- to 1.5-hour session with your volunteer. During your session, please collect a health history from your volunteer to serve as the evidence source for your short paper this week. You should also practice the focus exam skills learned thus far including cardiovascular, respiratory systems, and exam of the skin, hair, and nails. The short paper reflects the compilation and analysis of data collected during the patient volunteer health history interview. The paper is private between the student and instructor. Within the paper, you will have the opportunity to discuss interview techniques and strategies that were utilized in the patient interview to facilitate therapeutic communication with a patient. You will also provide a brief synopsis of the health history information that was collected, describe health risks and health behaviors that were identified in the volunteer interview, and prioritize a health promotion need. Be sure to address all of the required elements outlined in the prompt. Prompt This week you completed a health history interview with your patient volunteer. Address the following prompts based on your experience:

Discuss the interviewing skills that were utilized when collecting the volunteer’s health history information. What strategies were used to develop therapeutic rapport with the patient?
Provide a brief synopsis of the pertinent health history information that was collected.
Analyze the collected health history. Describe potential health risks and health behaviors that were identified in the volunteer interview.
Prioritize one health promotion need that was identified in the volunteer interview. Include rationale as to why this need was identified as a priority. Rubric
Guidelines for Submission: Use APA formatting for any references and in-text citations. Your paper should be 2 to 3 pages in length with 12-point Times New Roman font. Submit the assignment as a Word document. For additional details, please refer to the Module Three Short Paper Guidelines and Rubric document.