CASE STUDY 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 during the past 2 weeks, Lily figured she shouldn't take her 3-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. Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat Photo Credit: Getty Images/Blend Images 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. 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 Use the Episodic/Focused SOAP Template and create an episodic/focused note about the pat.

1. CASE STUDY 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 during the
past 2 weeks, Lily figured she shouldn't take her 3-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.
Assignment 1: Case Study Assignment: Assessing the Head,
Eyes, Ears, Nose, and Throat
Photo Credit: Getty Images/Blend Images
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.

2. 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

3. 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
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.
Learning Resources
Required Readings
(click to expand/reduce)
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.

4. 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.
Credit Line: Advanced Health Assessment and Clinical
Diagnosis in Primary Care, 6th Edition by Dains, J.E.,
Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby.
Reprinted by permission of Mosby via the Copyright Clearance
Center.
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”

5. 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.

6. 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.
Credit Line: Seidel's Guide to Physical Examination, 9th
Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B.
S., & Stewart, R. W. Copyright 2019 by Elsevier Health
Sciences. Reprinted by permission of Elsevier Health Sciences
via the Copyright Clearance Center.
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.
Credit Line: Seidel's Guide to Physical Examination, 9th
Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B.
S., & Stewart, R. W. Copyright 2019 by Elsevier Health
Sciences. Reprinted by permission of Elsevier Health Sciences
via the Copyright Clearance Center.
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.

7. Credit Line: Seidel's Guide to Physical Examination, 9th
Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B.
S., & Stewart, R. W. Copyright 2019 by Elsevier Health
Sciences. Reprinted by permission of Elsevier Health Sciences
via the Copyright Clearance Center.
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.
Credit Line: Seidel's Guide to Physical Examination, 9th
Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B.
S., & Stewart, R. W. Copyright 2019 by Elsevier Health
Sciences. Reprinted by permission of Elsevier Health Sciences
via the Copyright Clearance Center.
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.
Credit Line: Seidel's Guide to Physical Examination, 9th
Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B.
S., & Stewart, R. W. Copyright 2019 by Elsevier Health
Sciences. Reprinted by permission of Elsevier Health Sciences
via the Copyright Clearance Center.
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

8. (9th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Seidel's Guide to Physical Examination, 9th
Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B.
S., & Stewart, R. W. Copyright 2019 by Elsevier Health
Sciences. Reprinted by permission of Elsevier Health Sciences
via the Copyright Clearance Center.
Colyar, M. R. (2015).
Advanced practice nursing procedures.
Philadelphia, PA: F. A. Davis.
Credit Line: Advanced practice nursing procedures, 1st Edition
by Colyar, M. R. Copyright 2015 by F. A. Davis Company.
Reprinted by permission of F. A. Davis Company via the
Copyright Clearance Center.
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

9. 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/S0042698913
000217
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/S00426989130
00436
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).
Document
: Episodic/Focused SOAP Note Exemplar (Word document)
Document
: Episodic/Focused SOAP Note Template (Word document)

10. Document:
Midterm Exam Review (Word document)
Shadow Health Support and Orientation Resources
Frey, C. [Chris Frey]. (2015, September 4). Student orientation
[Video file]. Retrieved from
https://www.youtube.com/watch?v=Rfd_8pTJBkY
Shadow Health. (n.d.). Shadow Health help desk. Retrieved
from https://support.shadowhealth.com/hc/en-us
Document
: Shadow Health. (2014). Useful tips and tricks (Version 2)
(PDF)
Document
: Student Acknowledgement Form (Word document)
Note
: You will sign and date this form each time you complete your
DCE Assignment in Shadow Health to acknowledge your
commitment to Walden University’s Code of Conduct.
Document
: DCE (Shadow Health) Documentation Template for Focused
Exam: Cough (Word document)
Use this template to complete your Assignment 2 for this week.
USE 6 RESOURCES FROM THE SCHOOL