Question

B.W. is a 44-year-old man who presents to the family practice with complaints of sore throat, hoarseness, and a dry cough that worsens at night. He states that the cough started 6 days ago, and the sore throat and hoarseness began 3 days ago and appear to be getting worse The patient has a history of prediabetes, which is controlled through diet and exercise. Vital signs are T 99.5, P 58, R 16, and BP 110/55.

1. What subjective information should the nurse obtain?

2. The nurse is assessing the structures of the oral cavity. What are the physical features?

The nurse notes that the patient’s teeth are stained yellow and asks the patient about tobacco use. The patient states that he chews one bag of tobacco every other day.

3. What health promotion concepts should the nurse include in the teaching plan?

4.What is the most likely cause of this patient’s cough, sore throat, and hoarseness?

Answer 1

Answer to 1st Question:

Collecting subjective information from patient is the integral part and primary duty of nursing health assessment. Usually,the subjective date contains the information about patient's - symptoms, sensations, severity of pain and timing.

Nurse should ask patient present health status to get information and further useful in effective  treatment. They are like -- What makes the symptoms better or worse?

---- Describe the symptoms?

--- is there any extension of the symptoms to another area of the throat?

--- to get to know severity, on a scale of 1-10 ,how bad is the symptoms of cough, hoarseness,and sore throat?

-- are these symptoms get severe with any other things like talking, eating .?

Answer to 2nd Question:  

The nurse is assessing the structures of the oral cavity. The physical features of oral cavity  are palatine tonsil, soft palate, gingiva (gums), hard palate, palpilae of tongue, tongue, molars, premolar, canine, incisor, uvula, lips.

When assessing throat , the nurse should assess patient's throat of  tonsils, Cranial nerve XII by sticking out tongue.

Answer to 3rd Question: health promotion concepts should the nurse include in the teaching plan :

in Health promotion, nurse provides the information that the patients need to manage and use it to improve their health.

-Dont smoke untill he get better otherwise it leads to throat cancer.

-Increase the amount of fluids he take, keep his body warm and sleep early .

- nurse advise to patient that if his sore throat symptoms get severe or chronic then he must seek for the doctor or nurse .

-Rest his voice and dont get stress to speak loudly. take medication regularly to help treatment effective.

- patient with sore throat should not use any outdated or antibiotic drugs which they used in the patient.

Answer to 4th Question: the most likely cause of this patient’s cough, sore throat, and hoarseness is Laryngitis

Hoarseness: it means abnormal voice changes and may sound like harsh, raspy, straines , breathy voice . it most often caused by tobacco smoking, stoamch acid reflux, screaming, prolonged singing or overuse of vocal cords.

Laryngitis is an infection of vocal cords and it can be acute means for short term, or chronic lasts for long term. here irritaion due to tobacco smoking can cause laryngitis.