NU-664B Week 1 Discussion 1: Telehealth/Transgender

NU-664B Week 1 Discussion 1: Telehealth/Transgender

NU-664B Week 1 Discussion 1: Telehealth/Transgender

35-year-old transgender women on hormone suppressant therapy presents with complaints of sinus congestion and runny nose that starts 2 days ago. Patient shares she has postnasal drip, and the color of the sputum is clear. She had a sinus infection about 2 months ago and was treated with a z-pack. Patient has a history of allergies. Patient is otherwise healthy. Here four differential diagnosis:

Differential Diagnosis

1. Allergic rhinitis: Patient is experiencing many symptoms that is consistent with the diagnosis of allergic rhinitis. Some of the symptoms includes sinus congestion, nasal obstruction, postnasal drip, clear discharge, and itchiness of the inner ear (deShazo et al., 2022). Allergic rhinitis occurs in the setting of an exposure to an allergen (deShazo et al., 2021). After exposure to the allergen, the body starts to produce allergen-specific immunoglobulin E (IgE), which bind to the cells in the respiratory mucosa and blood (deShazo et al., 2021). Every time the person becomes exposed to the allergen, the body will activate the IgE antibodies and release chemical mediators that cause the symptoms of allergic rhinitis to initiate (deShazo et al., 2021). Patient shares that she starts to develop symptoms after exposure to smoke, dust, hot and spicy food, seasonal changes, and weather changes. Allergic rhinitis develops symptoms in both the nose and sinuses (deShazo et al., 2022). It is common to see that untreated rhinitis will lead to the development of sinusitis (deShazo et al., 2022). Allergic rhinitis is a possible diagnosis given the patient symptoms, history of allergens, and frequency in recurrence of illness. To confirm diagnosis, patient will need to undergo a detailed health history and physical examination (deShazo et al., 2022). During physical examination, provider will look for exam the eyes, ears, nose, and throat to look for any signs of inflammation or swelling (deShazo et al., 2022). Allergy skin testing can help confirm the allergens (deShazo et al., 2022).

2. Hormonal Related Rhinitis: Hormonal related rhinitis occurs when there is a change in the hormonal level in the body that leads to activation of the inflammatory process (Lieberman et al., 2022). When there is a change to the hormone levels in the body, it can lead to increased production of clear and thin nasal secretion, develop nasal congestion and postnasal drip (Lieberman et al., 2022). Patient is undergoing female hormonal therapy. Patient states that recently the dose of the hormones was increased. Hormonal related rhinitis if more common in females during pregnancy and menopause. However, since patient is a transgender female receiving female hormones, the development of nonallergic rhinitis can be a possibility as a consequence of the hormone treatment. There are no indicated tests to confirm hormonal related rhinitis, diagnosis is made by health history and physical examination. Based on patients health history of being highly allergic to many pollutants, it is less likely symptoms developed as a result of the hormone therapy.

3. Common cold: Common cold is a highly contagious acute viral illness that primarily affects the upper respiratory system (Sexton et al., 2022). Some of the symptoms that are consistent with the diagnosis is nasal congestion, nasal discharge, sneezing, sore throat, cough, fever, headache, and body aches (Sexton et al., 2022). The patient is experiencing nasal congestion, clear nasal discharge, and postnasal drip. Patient does not report other symptoms commonly seen with the common cold. There are no tests available to confirm the diagnosis. The common cold symptoms will usually last between 3-10 days (Sexton et al., 2021). The virus is short lived and will resolve on its own without medications. Medications are usually taken for symptom management such as nasal congestion, cough, fever, and headache.

4. Acute viral rhinosinusitis: Acute viral rhinosinusitis is an infection that occurs in the nasal cavity and sinuses as a result to exposure to the contagious virus (Patel et al., 2022). The most common viruses are the rhinovirus, influenza virus, and parainfluenza virus (Patel et al., 2022). Symptoms start to develop as soon as 1 day after exposure to virus (Patel et al., 2022). Some common symptoms with acute viral rhinosinusitis include fevers lasting for 1 to 2 days, purulent nasal discharge, cough, body aches, and headaches (Patel et al., 2022). Patient is complaining of nasal congestion, clear nasal discharge, and postnasal drip. Patient does not have any fevers, which makes the diagnosis less likely to occur. Diagnosis can be made by doing nasal swabs such as influenza PCR, and sending to laboratory to confirm presence of virus. There is no treatment indicated for acute viral rhinosinusitis, symptoms should resolve after 10 days (Patel et al., 2022).

Confirmed diagnosis: Allergic Rhinitis

Plan

Diagnostics: No diagnostics exam is indicated to diagnose allergic rhinitis (deShazo et al., 2022).

Laboratory: No laboratory exam is indicated to confirm the diagnoses of allergic rhinitis (deShazo et al., 2022).

Pharmacological intervention:
• Claritin 10 mg by mouth daily for allergic rhinitis (deShazo et al., 2022).
• Flonase Allergy Relief 50 mcg/spray one spray in each nostril two times per day for nasal congestion (deShazo et al., 2022).
• Ocean Nasal Spray 0.65% 2 to 3 spays in each nostril as needed for nasal congestion (deShazo et al., 2022).

Non-pharmacological interventions.
• Use saline nasal spray to irrigate and wash out allergens and diminish nasal congestion (deShazo et al., 2022).
• Maintain the house clean and well ventilated to avoid dust or molds.
• When going outside during high pollen season, always take a shower and wash clothes to get rid of pollutants.
• Increase fluid intake. Warm caffeine-free fluids can help loosen nasal congestion.
• Humidify the air to help loosen secretions.
• Take warm showers to help loosen nasal stuffiness.

Referrals: See an allergist to perform skin testing to confirm allergens (deShazo et al., 2022).

• Avoid exposure to allergens such as smoke, dust, and outdoor pollutants (deShazo et al., 2022).
• Claritin is an antihistamine which will help reduce itching, sneezing, and runny nose (deShazo et al., 2022).
• Flonase Allergy Relief spay is a glucocorticoid spray and will assist with nasal congestion and postnasal drip (deShazo et al., 2022). It is important not to exceed the indicated amount to optimize the effects of the medication (deShazo et al., 2022). Once congestion improves, you can transition to use the nasal spray once per day, or as needed for recurring nasal congestion (deShazo et al., 2022).
• If nasal congestion persists after Flonase Allergy Spray, alternate with nasal saline sprays.
• The correct method to administer a nasal spray is by inserting the tip of the spray halfway inside the nares, tilting head slightly downward, pressing the spray, and gently inhale the medication (deShazo et al., 2022). Do not advance the tip of the spray too far to prevent touching the septum (deShazo et al., 2022).

Follow-Up: In 2 weeks if symptoms of sinus congestion, runny nose, and postnasal drip has not improved, return to health center for a follow-up appointment with provider.

NU-664B Week 1 Discussion 1: Telehealth/Transgender References

deShazo, R., D., Kemp, S., Corren, J., Feldweg, A. M. (2021). Pathogenesis of allergic rhinitis (rhinosinusitis). UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/pathogenesis-of-allergic-rhinitis-rhinosinusitis?search=allergic%20rhinitis&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

deShazo, R. D., Kemp, S. F., Corren, J., & Feldweg, A. M. (2022). Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/allergic-rhinitis-clinical-manifestations-epidemiology-and-diagnosis?search=allergic%20rhinitis&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H7950204

deShazo, R. D., Kemp, S. F., Corren, J., & Feldweg, A. M. (2022). Pharmacotherapy of allergic rhinitis. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/pharmacotherapy-of-allergic-rhinitis?search=allergic%20rhinitis&topicRef=7525&source=see_link

Lieberman, P. L., Corren, J., Feldweg, A. M. (2022). Chronic nonallergic rhinitis. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/chronic-nonallergic-rhinitis?search=nonallergic%20rhinitis%20treatment&topicRef=7533&source=see_link

Sexton, D. J., McClain, M. T., Aronson, M. D., Hirsch, M. S., & Givens, J. (2021). The common cold in adults: Diagnosis and clinical features. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/the-common-cold-in-adults-diagnosis-and-clinical-features?sectionName=Incubation%20period%20and%20symptom%20duration&search=common%20cold&topicRef=6868&anchor=H11414490&source=see_link#H11414490

Sexton, D. J., McClain, M. T., Aronson, M. D., Hirsch, M. S., & Givens, J. (2022). The common cold in adults: Treatment and prevention. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/the-common-cold-in-adults-treatment-and-prevention?search=common%20cold&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

Patel, Z. M., Hwang, P. H., Deschler, D. G., File, T. M., Givens, J., & Bond, S. (2022). Acute sinusitis and rhinosinusitis in adults: Clinical manifestations and diagnosis. UpToDate. https://www-uptodate-com.regiscollege.idm.oclc.org/contents/acute-sinusitis-and-rhinosinusitis-in-adults-clinical-manifestations-and-diagnosis?search=acute%20bacterial%20rhinosinusitis&source=search_result&selectedTitle=6~63&usage_type=default&display_rank=5

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If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.

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Communication is so very important. There are multiple ways to communicate with me:

Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.

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Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

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Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

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Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource