Discussion: HEENT Orders for Family Nurse Practitioner
Discussion HEENT Orders for Family Nurse Practitioner
A middle-aged woman comes to the office saying she has throat infection. According to her, the infection began with a sudden sore throat yesterday afternoon, which has since become worse. At night, she experienced a feverish and chilly feeling. She reports that she has not had any contact with anyone else with strep throat recently. However, she says that she has previously had strep sore and that this is what it has always felt. The patient does not take any medications, but she is hypersensitive to penicillin. Physical examination shows that the patient is slender. She has a heart rate of 112, body temperature of 101°F, blood pressure of 96/64, and a respiratory rate of 22. The HEENT evaluation is positive for bilateral tonsilla swelling with no exudations. Examination shows that the neck is lithe with bilateral, inflamed, and tender frontal cervical nodes.
Differential Diagnoses
- Infectious mononucleosis: This might lead to sore throat, but it is often experienced by young adults aged between 15 and 24 years. According to Ruppert (2015), the Epstein Barr virus causes this condition, but it normally presents tonsilla inflammation with exudations and may be accompanied by abdominal pain. The diagnosis of this condition is possible through conducting a Monospot test. Nevertheless, it can take several weeks to produce a positive result using this method according to Lyden (2017). This might be the diagnosis, but the typical symptoms of mononucleosis are malaise and extreme fatigue among individuals younger than our patient.
- Acute pharyngitis: According to Ruppert (2015), this is among the top 20 reasons why patients visit healthcare providers. The condition results in an inflammation of the pharynx, either by infection or irritation. According to Lyden (2017), both adults and children can suffer from this condition.
- Bacterial: Bacterial pharyngitis is commonly caused by Group A streptococcus. Lyden (2017) explains that the commonest symptoms of bacterial pharyngitis are erythema of the tonsils or throat; discrete, patchy, yellowish, or white exudation; tender anterior cervical adenopathy, and pharyngeal petechiae. There is a high likelihood that our patient is having acute bacterial pharyngitis (most likely primary diagnosis) because of the presence of anterior cervical node tenderness.
- Viral: Rhinovirus is the most common cause of viral pharyngitis. As in the case of many other viral infections, the condition is normally self-limiting (Lyden, 2017). The condition presents several symptoms such as a cough fever, mild erythema, and nasal symptoms. While it could still be present, tender lymphadenopathy is not common (Lyden, 2017).
- Peritonsillar abscess: This is brought by pus getting within the quinsy tissue. It mostly starts with quinsy cellulitis resulting from tonsillitis that has not been treated effectively. The physician can rule this out in our patient because drooling is often accompanied by a hoarse voice. Similarly, the patient does not present complaints of pain in either side of their ears (Lyden, 2017).
- Epiglottitis: This affects the supraglottic structures, primarily the epiglottis. It is normally caused by bacterial cellulitis and can occur in case of a direct invasion or spread because of bacteremia. According to Berkow and Sakles (2015), epiglottitis is regarded as an airway emergency since the swelling can result in the inability to control secretions, as well as difficulty in breathing.
Role of H&P in the Diagnosis
Since the patient is convinced that she has strep throat, the practitioner needs to consider other conditions and rule them out. It is imperative to obtain a thorough medical history, particularly on physical examination, which helps in ruling out other diagnoses. This can be achieved by simply asking a question regarding the current illness. The physician needs to consider other questions such as whether the patient experiences any pain when swallowing: whether she has been exposed to dry heat, smoke, or heat recently; whether she has a cough; whether she has taken any medicine for her illness and whether it has made her better; whether she has had experience with any postnasal drip; whether she uses any tobacco products; as well as whether she has seen a dentist in the past (Ball, Dains, Flynn, Solomon, & Stewart, 2015). If she has seen a dentist in the past, the physician should find out how recent the visit was.
Potential Treatment Options
The type of organism that causes infection determines what treatment of acute pharyngitis to choose. It will be preferable to treat the condition using amoxicillin or penicillin because there is a high likelihood that the patient has bacterial pharyngitis and the infection is most likely caused by streptococci bacteria. Nevertheless, the patient is hypersensitive to penicillin. Thus, the next most preferred treatment medication is clarithromycin, 250mg BID taken for 10 days.
Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Discussion: HEENT Orders for Family Nurse Practitioner
Additional Health Promotion Strategies
As is always the case with antibiotics, it is crucial to educate the patient regarding the need to adhere to the full course of antibiotics as
prescribed, as well as the risk of not complying with the full dosage. It is crucial to talk about the inauspicious effects of the antibiotics and the ones that the physician needs to report. Treatment should aim to eliminate more complications from this bacteria strain, which can result in glomerulonephritis or rheumatic fever (Lyden, 2017). The physician might also administer alternative treatment options including local anesthetics for the treatment of headaches, fever, and sore throat (Donowitz, 2018). Treatment could also be done with analgesics. Providers also need to educate patients regarding hand-washing, proper oral hygiene, as well as the various ways in which the spread of infection can be avoided.
Socio-cultural Barriers
These might include the lack of insurance, time to visit the physician, and means of transportation. There could also be influences from family and friends regarding the illness, which could affect the patient’s decision to make appropriate treatment decisions.
Discussion: Diagnosing HEENT Disorders
In clinical settings, advanced practice nurses may initiate a physical examination of a patient by examining the components of the HEENT system. Assessing primary diagnoses and differential diagnoses as they concern the HEENT system are important in informing your practice in providing optimal care.
For this Discussion, consider the following three case studies of patients presenting with head, eyes, ears, nose, and throat disorders.
Case Study 3
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 the case studies provided in this week’s Resources.
You will either select or be assigned one of the three case studies provided.
Reflect on the provided patient information including history and physical exams.
Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
Reflect on potential treatment options based on your diagnosis.
Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study you selected. Describe the role of the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.