Richard is a 50-year-old male presenting with nasal congestion, sneezing, rhinorrhea, and postnasal drainage for 5 days. On examination, he has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates obstructing airflow, but clear lungs and mildly erythematous throat. A focused SOAP note is written assessing Richard's case of presumed allergic rhinitis while considering other potential diagnoses.

1. 6512 Discussion wk 5
Discussion: Assessing the Ears, Nose, and ThroatMost 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 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 ExamRichard 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.Case 2: Focused Throat ExamLily 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

2. hoarseness in her voice but doesn’t sound congested.Case 3: Focused Ear ExamMartha
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.