Tympanic Membrane by Lisa Mike FILE T IME SUBMIT T ED 17 - DEC- 2016 12:02PM SUBMISSION ID 7 54 4 537 7 9 WORD COUNT 14 00 CHARACT ER COUNT 7 57 8 ORDER_4 4 897 _109194 .DOC (39.5K) %35 SIMILARIT Y INDEX %7 INT ERNET SOURCES %4 PUBLICAT IONS %34 ST UDENT PAPERS 1 %30 2 %2 3 %1 4 %1 5 %1 EXCLUDE QUOT ES OFF EXCLUDE BIBLIOGRAPHY OFF EXCLUDE MAT CHES OFF Tympanic Membrane ORIGINALITY REPORT PRIMARY SOURCES Submitted to EDMC St udent Paper Submitted to AUT University St udent Paper journals.lww.com Int ernet Source etheses.bham.ac.uk Int ernet Source ukplatinumessays.com Int ernet Source Tympanic Membraneby Lisa MikeTympanic MembraneORIGINALITY REPORTPRIMARY SOURCES 1 Running head: WEEK TWO ASSIGNMENT TWO 8 WEEK TWO ASSIGNMENT TWO Week Two Assignment Two: Tympanic Membrane and Thyroid Gland Sample Student Paper South University NSG 3012 Week Two Assignment Two: Tympanic Membrane and Thyroid Gland Conducting a thorough examination of the tympanic membrane and thyroid gland can identify the cause of presenting symptoms. When a patient reports ear pain, blockage, loss of hearing, and/or ear ringing the nurse will need to perform a thorough assessment to identify the cause. Tympanic ear perforation is one issue that may be identified. Additionally, when a patient reports recent weight loss, weight gain, hair loss, fatigue, irritability, and sensitivity to heat or cold, the nurse may suspect thyroid problems and will examine the thyroid. Dysfunction of the thyroid can lead to many problems, hypothyroidism is one such issue, caused by the thyroid not producing the thyroid hormone (Jarvis, 2016). An overview of the tympanic membrane and thyroid gland will be discussed to further detail the associated assessments. Health History One A 19-year-old Hispanic male presents to the primary care office with a constant earache lasting three days. He describes the dulling pain as deep in his left ear. He rates the pain as a 10 out of 10. He has a temperature of 101.1. It is suspected the patient may have an ear infection. The patient reports a history of ear infections. Patient denies hearing loss, discharge, ringing or buzzing, and/or ear injury. Findings for Tympanic Membrane Examination of the ear are mainly performed using inspection and palpation (Jarvis, 2016). The client was seated on the exam table, with the examiner’s head at the same level as the client’s. The examiner begins by inspecting both auricles for abnormalities. No abnormalities were noted, but the left ear is red in color. The auricles and mastoid areas were palpated to check for swelling, tenderness, or nodules. The left ear was tender to touch. When using an otoscope, the provider is examining the external auditory canal and tympanic membrane. When inspecting the pinna, it is important to look for lesions (Kalyanakrishnan, Sparks, & Berryhill, 2007). Inspecting the canal, the examiner is looking f ...

1. Tympanic Membrane
by Lisa Mike
FILE
T IME SUBMIT T ED 17 - DEC- 2016 12:02PM
SUBMISSION ID 7 54 4 537 7 9
WORD COUNT 14 00
CHARACT ER COUNT 7 57 8
ORDER_4 4 897 _109194 .DOC (39.5K)

2. %35
SIMILARIT Y INDEX
%7
INT ERNET SOURCES
%4
PUBLICAT IONS
%34
ST UDENT PAPERS
1 %30
2 %2
3 %1
4 %1
5 %1
EXCLUDE QUOT ES OFF
EXCLUDE
BIBLIOGRAPHY
OFF
EXCLUDE MAT CHES OFF
Tympanic Membrane
ORIGINALITY REPORT
PRIMARY SOURCES
Submitted to EDMC

3. St udent Paper
Submitted to AUT University
St udent Paper
journals.lww.com
Int ernet Source
etheses.bham.ac.uk
Int ernet Source
ukplatinumessays.com
Int ernet Source
Tympanic Membraneby Lisa MikeTympanic
MembraneORIGINALITY REPORTPRIMARY SOURCES
1
Running head: WEEK TWO ASSIGNMENT TWO
8
WEEK TWO ASSIGNMENT TWO
Week Two Assignment Two: Tympanic Membrane and Thyroid
Gland
Sample Student Paper
South University
NSG 3012

4. Week Two Assignment Two: Tympanic Membrane and Thyroid
Gland
Conducting a thorough examination of the tympanic
membrane and thyroid gland can identify the cause of
presenting symptoms. When a patient reports ear pain,
blockage, loss of hearing, and/or ear ringing the nurse will need
to perform a thorough assessment to identify the cause.
Tympanic ear perforation is one issue that may be identified.
Additionally, when a patient reports recent weight loss, weight
gain, hair loss, fatigue, irritability, and sensitivity to heat or
cold, the nurse may suspect thyroid problems and will examine
the thyroid. Dysfunction of the thyroid can lead to many
problems, hypothyroidism is one such issue, caused by the
thyroid not producing the thyroid hormone (Jarvis, 2016). An
overview of the tympanic membrane and thyroid gland will be
discussed to further detail the associated assessments.
Health History One
A 19-year-old Hispanic male presents to the primary care
office with a constant earache lasting three days. He describes
the dulling pain as deep in his left ear. He rates the pain as a 10
out of 10. He has a temperature of 101.1. It is suspected the
patient may have an ear infection. The patient reports a history
of ear infections. Patient denies hearing loss, discharge, ringing
or buzzing, and/or ear injury.
Findings for Tympanic Membrane
Examination of the ear are mainly performed using

5. inspection and palpation (Jarvis, 2016). The client was seated
on the exam table, with the examiner’s head at the same level as
the client’s. The examiner begins by inspecting both auricles
for abnormalities. No abnormalities were noted, but the left ear
is red in color. The auricles and mastoid areas were palpated to
check for swelling, tenderness, or nodules. The left ear was
tender to touch. When using an otoscope, the provider is
examining the external auditory canal and tympanic membrane.
When inspecting the pinna, it is important to look for lesions
(Kalyanakrishnan, Sparks, & Berryhill, 2007). Inspecting the
canal, the examiner is looking for discharge, swelling, wax,
redness, and foreign bodies. This patient has redness.
Inspecting the tympanic membrane, the examiner is observing
for landmarks, light reflex, color, bulging or retraction,
perforation, scarring, fluids, and bubbles. The whisper test is
performed next. This is a simple hearing test where the
examiner sits arms-length behind the patient and whispers
several numbers and letters, asking the patient to repeat them
(Vazquez, Gigirey, del Oro, & Seoane, 2014). The patient
repeated them correctly, suggesting he does not have hearing
loss. The findings of a tender and red left ear, with reported
pain and a fever suggest the patient has otitis media. Normal
findings of the tympanic membrane would show translucent
pearl gray in color, no tenderness, no redness, no perforations,
wax, and no odor or discharge (Jarvis, 2016).
SOAP Note
Subjective
A 19-year-old Hispanic male presents to the primary care office
with a constant earache lasting three days. He describes the
dulling pain as deep in his left ear. He rates the pain as a 10
out of 10. Patient denies hearing loss, discharge, ringing or
buzzing, and/or ear injury. The patient reports a history of ear
infections, otherwise no history of medical issues. Patient is
not currently taking any medications. Patient is single,
employed as a salesman, and no reported drug history. Patient
denies tobacco use. Patient reports exercising four times per

6. week at the gym. Patient family history is negative. All other
systems are negative. No known medication allergies.
Objective
Vital Signs: BP 120/80, P77 regular, R16, T 101.1F, Wt.
190lbs., Ht. 6’2”, BMI 24.9
HEENT: normocephalic, no masses, visual acuity intact, follows
examiners finger with eyes, no drainage noted, hearing intact,
no drainage, redness and tenderness in ear, redness in throat.
Neck: Full range of motion, flexible, no swelling or tenderness.
Axillary: No lesions, rash, swelling, tenderness, masses on skin
or lymph nodes.
Heart: Regular rhythm and rate, no murmurs, no extra sounds.
Lungs: Rise and fall symmetrically, clear to auscultation.
Breast: Patient declined.
Abdomen: Bowel sounds gurgling every 10 seconds, no
tenderness.
Assessment
Patient has otitis media of the left ear.
Plan
Prescribe Amoxicillin 875 mg PO BID for seven days and
follow-up in one week. No laboratory testing needed at this
time.
Health History Two
A 40-year-old Caucasian female presents to the primary
care clinic complaining of symptoms of weight gain, hair loss,
fatigue, dry skin, sensitivity to cold, and irritability. The
symptoms have been ongoing for several months. The patient
reports no other symptoms and has no other health issues. She is
not currently taking medications, and family history is negative.
The nurse conducted a head-to-assessment with no
abnormalities, and will focus on the thyroid gland.
Findings for Thyroid Gland
Aside from the reported symptoms, the nurse identified

7. brittle hair and nails, and dry skin. There was not an
enlargement in the thyroid area, and no redness. The laboratory
testing came back and was 10.0 for TSH, and T4 is 3 indicating
hypothyroidism.
Thyroid Gland Exam
Using the anterior position, the nurse will face the patient
and have the patient tip her head forward and right (Jarvis,
2016). The nurses right thumb will move the trachea to the
right and the other thumb will hook around the sternomastoid
muscle. The purpose of this is to feel for enlargement when
patient swallows. Using the posterior method both hands will
encircle the neck, with the thumbs will sit on the nape of neck,
while the index and middle fingers palpate for thyroid isthmus
and anterior of lateral lobes. The nurse also had the patient
swallow water to better observe the thyroid and look for
enlargement. Normal findings include no enlargement found, no
redness noted, hair, skin, nails have not changed in texture, no
visual complaints, no tachycardia or palpitations. Normal lab
results for TSH is 0.4 to 2.4, and for T4 is 5 to 13.5 (Berber &
Sargis, 2016).
SOAP Note
Subjective
A 40-year-old Caucasian female presents to the primary care
clinic complaining of symptoms of weight gain, hair loss,
fatigue, dry skin, sensitivity to cold, and irritability. The
symptoms have been ongoing for several months. The patient
reports no other symptoms and has no other health issues. She is
not currently taking medications, and family history is negative.
The amount of weight gain in three months is 22 pounds. The
amount of sleep patient is getting is 10-12 hours per day.
Patient is married, unemployed, and no reported drug history.
Patient denies tobacco use. Patient reports no exercise. All other
systems are negative. No known medication allergies.
Objective
Vital Signs: BP 95/68, P68 regular, R18, T 98.2F, Wt. 144lbs.,
Ht. 5’2”, BMI 26.3,

8. overweight.
HEENT: normocephalic, no masses, visual acuity intact, follows
examiners finger with eyes, no drainage noted, hearing intact,
no drainage. No tenderness or redness.
Neck: Full range of motion, flexible, no swelling or tenderness.
Axillary: No lesions, rash, swelling, tenderness, masses on skin
or lymph nodes.
Heart: Regular rhythm and rate, no murmurs, no extra sounds.
Lungs: Rise and fall symmetrically, clear to auscultation.
Breast: Patient declined.
Abdomen: Bowel sounds active, WNL, no tenderness.
Skin: Cool, turgor is WNL, dry, pale.
Assessment
With reported symptoms of weight gain, hair loss, fatigue,
dry skin, sensitivity to cold, and irritability, observed brittle
hair and nails, dry skin, and 10.0 for TSH, and T4 is 3, the
patient has hypothyroidism.
Plan
Further testing will be performed to rule out hashimotos
thyroiditis and anemia. Levothyroxine will be prescribed. The
nurse will provide education on the need to take iron and
calcium while taking this medication. A follow-up will be
scheduled in one month.
Laboratory Tests
The laboratory test results can be found above.
Conclusion
Nurses must commit to always conducting a thorough
assessment. This improves the outcomes of the patient in
regards to identifying any problems that may be present. Once
the patient has been diagnosed, the nurse can educate the patient
on the illness and identify any needs the patient may have.
Additionally, it will be important to encourage follow-up and
identify any barriers that may exist limiting patient follow-up.

9. References
Berber, E., & Sargis, R.M. (2016). Hypothyroidism diagnosis.
Retrieved from
http://www.endocrineweb.com/conditions/hypothyroidism/hypot
hyroidism-diagnosis
Jarvis, C. (2012). Physical examination and health assessment
(6th ed.). St. Louis, MO: Saunders
Kalyanakrishnan, R., Sparks, R.A., & Berryhill, W.E. (2007).
Diagnosis and treatment of otitis
media. American Family Physician, 76(1), 1650-1658.
Vázquez, C., Gigirey, L., del Oro, C., & Seoane, S. (2014).
P233: Using whisper voice test for
early detection of hearing loss in Galician government
nursing homes. European
Geriatric Medicine, 5(1, Number 1 Supplement 1), S157.