NURS 6531 Week 2 discussion: Diagnosing Skin, Eye, Ear, and Throat Disorders

NURS 6531 Week 2 discussion Diagnosing Skin, Eye, Ear, and Throat Disorders

Week 2 discussion

Diagnosing Skin, Eye, Ear, and Throat Disorders

When entering examination rooms, advanced practice nurses
often immediately begin assessing patients by looking for external
abnormalities such as skin irritations or cloudy eyes. By making these simple
observations, they can determine how to proceed with their patient evaluations.
During the patient evaluation, advanced practice nurses will use initial
observations to guide them in acquiring the necessary medical history,
performing additional assessments, and ordering the appropriate diagnostics.

The information obtained during this evaluation process will help in the
development of a differential diagnosis. Once a diagnosis is made, the advanced
practice nurse can consider potential treatment options and work with the
patient to develop a plan of care. For this Discussion, consider the following
four case studies of patients presenting with skin, eye, ear, and throat
disorders

Case Study 1:

A 46-year-old male presents to the office complaining of a
pruritic skin rash that has been present for a few weeks. He initially noted
the rash on his chest, but it then spread to his back and arms. He notes that
it does not seem to be on his legs. He recently came home from a trip to
Florida, but denies fever, chills, new soaps or detergents, other travel, or
known insect bites. He takes occasional ibuprofen for knee pain, but denies
taking other medications or having other health problems. He has no known drug
allergies. The physical examination reveals a male with a deep tan and notable
scattered 1–1.5-centimeter, flat, circular, light-colored patches on his chest,
back, and upper extremities.

Case Study 2:

An 86-year-old widowed female is brought to the office by
her daughter-in-law. The patient complains of constant tearing and an itchy,
burning sensation in both eyes. The patient states this is not a new problem,
but it has worsened in the past week and is affecting her vision. The patient complains that her eyes are dry.
She thinks the problem must be caused by one of her medications. Her patient medical history is positive for
hypertension, atrial fibrillation, and heart failure. She has an allergy to
erythromycin that causes rash and elevated liver enzymes. Medications currently
prescribed include Furosemide 40 milligrams po twice a day, diltiazem 240
milligrams po daily, lisinopril 20 milligrams po daily, and warfarin 3
milligrams po daily. The physical examination reveals a frail older female with
some facial dryness and slight scaling.
Her visual acuity is 20/60 OU, 20/40 OD, 20/60 OS. The eyelids are
erythematous and edematous with yellow crusting around the lashes. Sclera are
injected, conjunctiva are pale, and pupils are equal and reactive to light and
accommodation.

Case Study 3:

A middle-aged male presents to the office complaining of a
two-day history of a left earache. The onset was gradual, but has steadily been
increasing. It has been constantly aching since last night, and his hearing
seems diminished to him. Today he thinks the left side of his face may even be
swollen. He denies upper respiratory infection, known fever, or chills. His
patient medical history is positive for Type 2 diabetes mellitus, hypertension,
and hyperlipidemia. The patient has a known allergy to Amoxicillin that results
in pruritus. Medications currently prescribed include Metformin 1,000
milligrams po twice a day, lisinopril 20 milligrams po daily, Aspirin 81
milligrams po daily, and simvastatin 40 milligrams po daily. The physical exam
reveals a middle aged male at a weight of 160 pounds, height of 5’8”,
temperature of 98.8 degrees Fahrenheit, heart rate of 88, respiratory rate of
18, and blood pressure of 138/76. Further examination reveals the following:

Face: Faint asymmetry with left periauricular area slightly
edematous

Eyes: sclera clear, conj wnl

L ear: + tenderness L pinna, + edema, erythema, exudates
left external auditory canal, TM not visible

R ear: no tenderness, R external auditory canal clear
without edema, erythema, exudates

+ tenderness L preauricular node, otherwise no
lymphadenopathy

Cardiac: S1 S2 regular. No S3 S4 or murmur.

Lungs: CTA w/o rales, wheezes, or rhonchi.

Case Study 4:

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 this week’s media presentations and Parts 5–8 of the
Buttaro et al. text.

Select one of the four 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 on or before Day 3 an explanation of the differential
diagnosis for the patient in the case study that you selected. Describe the
role the patient history and physical exam played in the diagnosis. Then,
suggest potential treatment options based on your patient diagnosis.

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DISCUSSION RUBRIC

NURS 6531 Week 2 discussion Diagnosing Skin, Eye, Ear, and Throat Disorders Grading Rubric Guidelines

Performance Category	10	9	8	4	0
Scholarliness Demonstrates achievement of scholarly inquiry for professional and academic decisions.	Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions Evaluates literature resources to develop a comprehensive analysis or synthesis. Uses valid, relevant, and reliable outside sources to contribute to the threaded discussion	Provides relevant evidence of scholarly inquiry but does not clearly state how the evidence informed or changed professional or academic decisions. Evaluates information from source(s) to develop a coherent analysis or synthesis. Uses some valid, relevant, reliable outside sources to contribute to the threaded discussion.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) with some interpretation/evaluation, but not enough to develop a coherent analysis or synthesis. Little valid, relevant, or reliable outside sources are used to contribute to the threaded discussion. Demonstrates little or no understanding of the topic.	Discusses using scholarly inquiry but does not state how scholarly inquiry informed or changed professional or academic decisions. Information is taken from source(s) without any interpretation/evaluation. The posting uses information that is not valid, relevant, or reliable	No evidence of the use of scholarly inquiry to inform or change professional or academic decisions. Information is not valid, relevant, or reliable
Performance Category	10	9	8	4	0
Application of Course Knowledge – Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources; Applies concepts to personal experience in the professional setting and or relevant application to real life.	Posts make direct reference to concepts discussed in the lesson or drawn from relevant outside sources. Applies concepts to personal experience in their professional setting and or relevant application to real life Interactions with classmates are relevant to the discussion topic but do not make direct reference to lesson content	Posts are generally on topic but do not build knowledge by incorporating concepts and principles from the lesson. Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life Does not demonstrate a solid understanding of the principles and concepts presented in the lesson	Posts do not adequately address the question posed either by the discussion prompt or the instructor’s launch post. Posts are superficial and do not reflect an understanding of the lesson content Does not attempt to apply lesson concepts to personal experience in their professional setting and or relevant application to real life	Posts are not related to the topics provided by the discussion prompt or by the instructor; attempts by the instructor to redirect the student are ignored No discussion of lesson concepts to personal experience in the professional setting and or relevant application to real life
Performance Category	5	4	3	2	0
Interactive Dialogue Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. *(5 points possible per graded thread)*	Exceeds minimum post requirements Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts three or more times in each graded thread, over three separate days. Replies to a post posed by faculty and to a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days Replies to a question posed by a peer Summarizes what was learned from the lesson, readings, and other student posts for the week.	Meets expectations of 2 posts on 2 different days. The main post is not made by the Wednesday deadline Does not reply to a question posed by a peer or faculty	Has only one post for the week Discussion posts contain few, if any, new ideas or applications; often are a rehashing or summary of other students’ comments	Does not post to the thread No connections are made to the topic
	Minus 1 Point	Minus 2 Point	Minus 3 Point	Minus 4 Point	Minus 5 Point
Grammar, Syntax, APA Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition	2-3 errors in APA format. Written responses have 2-3 grammatical, spelling, and punctuation errors. Writing style is generally clear, focused, and facilitates communication.	4-5 errors in APA format. Writing responses have 4-5 grammatical, spelling and punctuation errors. Writing style is somewhat focused.	6-7 errors in APA format. Writing responses have 6-7 grammatical, spelling and punctuation errors. Writing style is slightly focused making discussion difficult to understand.	8-10 errors in APA format. Writing responses have 8-10 grammatical, spelling and punctuation errors. Writing style is not focused, making discussion difficult to understand.	Post contains greater than 10 errors in APA format. Written responses have more than 10 grammatical, spelling and punctuation errors. Writing style does not facilitate communication. The student continues to make repeated mistakes in any of the above areas after written correction by the instructor
	0 points lost				-5 points lost
Total Participation Requirements *per discussion thread*	The student answers the threaded discussion question or topic on one day and posts a second response on another day.				The student does not meet the minimum requirement of two postings on two different days
Early Participation Requirement *per discussion thread*	The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week.				The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT.