Discussion: 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 disorders. 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 1–1.5-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 accommodation. 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.

1. Discussion: 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 disorders.
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 1–1.5-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

2. 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 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 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

3. 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 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.
To prepare:
·
Review this week’s media presentations and Parts 5–8 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

4. patient history and physical exam played in your diagnosis.
·
Reflect on potential treatment options based on your diagnosis.
Post
a 1 page paper APA format
1.
an explanation of the differential diagnosis for the patient in the
case study that you selected.
2.
Describe the role the patient history and physical exam played
in the diagnosis.
3.
Then, suggest potential treatment options based on your patient
diagnosis.
course reading
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-
Cook, J. (2013).
Primary care: A collaborative practice
(4th ed.). St. Louis, MO: Mosby.
·
Part 5, “Evaluation and Management of Skin Disorders” (pp.
227–312)
This part explores the pathophysiology, clinical presentation,
and management of various skin disorders, including dermatitis,
dry skin, fungal infections, and herpes. It also examines the
pathophysiology, clinical presentation, physical examination,
diagnostics, and management of wound healing.

5. ·
Part 6, “Evaluation and Management of Eye Disorders” (pp.
313–344)
This part covers eye examinations and explores the
pathophysiology, clinical presentation, physical examination,
diagnostics, and management of eye disorders, including
cataracts, conjunctivitis, and dry eye syndrome.
·
Part 7, “Evaluation and Management of Ear Disorders” (pp.
345–364)
This part reviews factors contributing to the diagnosis and
treatment of ear disorders, such as symptoms, patient history,
physical exams, and indications for referral or hospitalization.
It also covers lifespan considerations, complications, and
methods for educating patients and families about ear disorders.
Part 8, “Evaluation and Management of Nose Disorders” (pp.
365–384)
This part explores the development of differential diagnoses for
nose disorders. Nose disorders such as chronic nasal congestion
and discharge, nasal trauma, rhinitis, and sinusitis are
examined, as well as related complications, indications for
referral or hospitalization, and health promotion strategies.
·
Laureate Education, Inc. (Executive Producer). (2013a).
Case studies:
Ear disorder
. Baltimore, MD: Author.

6. Note:
The approximate length of this media piece is 11 minutes.
This media presentation features an evaluation of a patient
presenting with an ear disorder.
·
Laureate Education, Inc. (Executive Producer). (2013e).
Case study:
Throat disorder
. Baltimore, MD: Author.
Note:
The approximate length of this media piece is 11 minutes.
This media presentation features an evaluation of a patient
presenting with a throat disorder.