Question

Part 1

M.A. 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?

Part 2

M.A. is a 72-year-old female who presents to the family practice with her 40-year-old daughter. The daughter states that her mother has been confused lately, complaining of a headache, shortness of breath, and coughing. The cough has been persistent for 6 days, and a fever developed 2 days ago. The patient states that she is bringing up yellow-green mucus and has a cough, which gets worse at night. Vital signs are T 100.5, P 88, R 16, and BP 110/55. Lungs are positive bilaterally for wheezing, positive egophony. A chest x-ray reveals consolidation indicative of bacterial pneumonia. Labs and culture are pending for specific antigen. The nurse proceeds with the physical assessment of the head, face, neck, and associated lymphatic system.

• 1. When performing a review of systems, the nurse obtains subjective data concerning the patient’s headache. What specific questions will assist the nurse in determining the cause of the headache?

The nurse proceeds to palpate the lymph nodes.

• 2. Which lymph nodes are located in the neck?
• 3. When performing the physical assessment, what objective data should the nurse inspect and palpate for the head and neck?
• 4. How might the physical assessment vary given the patient’s age?

Part 3

M.A. is a 4-year-old boy who presents to the pediatrician’s office with pain in his right ear.

Subjective Data

Mom states that her son woke up in the middle of the night, crying, 2 nights ago. She gave the child ibuprofen, and he went back to sleep. Last night he woke up in pain, and he was inconsolable. She felt the physician should see him.
Attends preschool program
Lives with mother
Father estranged

Objective Data

TM appears inflamed—it is red and may be bulging and immobile
T = 100.3
Last ibuprofen 3 hours ago

Questions

1. What other assessments should be included for this patient?
2. What questions are appropriate for a patient presenting with earache?
3. What risk factors are associated with earaches for this age group?
4. From the readings, what is the difference between otitis media and otitis externa?
5. From the readings, what is the most probable cause of the earache in this patient?
6. What are three nursing diagnoses?
7. What interventions should be included in the nursing care plan?

Answer 1

part 1

1)The patient may have diabetic related infection since the patient was a prediabetic patient.

*we nee to ask about the subjective informations like;

*Dry or moist cough for more than 2 days

*High fever with sweating or chills

*Any skin rashes

*Sore throat,scratchy throat

*Pain ,tenderness ,redness or swelling on any body part

*Wound or cut that wont hea

*Nasal congestion,headaches

* White patches in your mouth or on your tongue

*Nausea, vomiting, or diarrhea

*Flu-like symptoms (chills, aches, headache, or fatigue) or generally feeling "lousy"

*Vaginal itching

*Painful or frequent peeing or a constant urge to pee

*Bloody, cloudy, or foul-smelling pee.

2)The nurse noticed the tooth of patient are yeloow stained due to over use of tobacoo.

* Smokers are 30–40% more likely to develop type 2 diabetes than nonsmokers.

* The nicotine in cigarettes makes your blood vessels harden and narrow, curbing blood flow aroun your body.

*Here the patients BP is low 110/55 due to diabetes and the smoking will affect the BP more and it also affect the drug intake of INSULIN in a poor manner.

*Physical Features of oral cavity include:

* dry mouth (xerostomia), tooth decay (including root caries), periapical lesions, gingivitis, periodontal disease, oral candidiasis, burning mouth (especially glossodynia), altered taste, geographic tongue, coated and fissured tongue, oral lichen planus..

*HOW DIABETES LEADS TO ORAL PROBLEMS:

*When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow. These bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities.

3)HEALTH PROMOTION CONCEPTS SHOULD TEACHED BY THE NURSE:

1. Assessment of the patient's knowledge of diabetes
2. Basic information about the pathological process of diabetes
3. Nutritional issues
4. Exercise
5. Smoking cessation
6. Blood glucose monitoring
7. Safe and effective use of medications
8. Acute complications
9. Chronic complications

*The patient shoulb be educated about the disease,diet,exersise,meditation,medical and other   treatment,Complications of smoking and alcohol consuption,Complications of the disease...

3)From the history of patient,we know

*patient is a prediabetec patient ,may took the drugs,And the patient is also a smoker.

*Diabetes leads to respiratory problems and anticipates it and leads to aging of lungs.

*Diabetes along with smoking leads to cough and phlegm production.

*Some drugs for diabetes leads to DRY COUGH

*Type 2 Diabetes also leads to sorethroat and hoarseness of voice.

*Bacterial infections along with diabetes may produce cough.

PART 2

1)How nurse understood about the signs of bacterial pneumonial headache:

*The nurse should know the reason for headache ,so she should ask for:

• Cough, which may produce greenish, yellow or even bloody mucus
• Fever, sweating and shaking chills
• Shortness of breath
• Rapid, shallow breathing
• Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
• Loss of appetite, low energy, and fatigue
• Nausea and vomiting, especially in small children
• Confusion, especially in older people

*TO DIFFERENTIATE BETWEEN A VIRAL AND BACTERIAL PNEUMONIA SHE SHOULD ASK OF FOLLOWING:

A) BACTERIAL PNEUMONIA

• Acute onset
• Higher temperature
• has pleuritic pain
• has purulent sputum.

• B)VIRAL PNEUMONIA
• has severe muscle pain (myalgia)
• has a loss of sense of smell (anosmia)
• is breathless but has no pleuritic pain
• Insidious onset
• Lower temperature

2)*LYMPH NODES LOCATED AT NECK

*Cervical lymph nodes are lymph nodes found in the neck.

Of the 800 lymph nodes in the human body, 300 are in the neck.

Cervical lymph nodes are subject to a number of different pathological conditions including tumours, infection and inflammation.

*TYPES OF CERVICAL LYMPH NODES:

*There are two types: anterior and posterior.

*A)Anterior superficial and deep nodes include submental and submaxillary (tonsillar) nodes located under the chin and jawline, respectively.

(The anterior cervical lymph nodes are further down the front of the neck, divided into prelaryngeal, thyroid, pretracheal, and paratracheal, based on their position near structures of the throat)

*Posterior lymph nodes are located along the back of the neck.

THEY ARE POSTERIOR DEEP AND POSTERIOR INFERIOR NODES

3)OBJECTIVE DATA THAT SHOULD ANALYSE INCUDE

• Cough
• Phlegm
• Rhonchi or wheezes
• ↑ temperature
• ↓ temperature (not as common)
• Vomiting
• Mental status changes
• ↑ or ↓ RR
• Also check the swollen lymph node in neck region.

4)The patient is 72 year old

Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.

*See the doctor if have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher, or persistent cough, especially if coughing up pus.

PART3

1)PATIENT MAY HAVE OTTITIS MEDIA

*It is red,inflammed,with pain

A normal TM is a translucent pale gray. An opaque yellow or blue TM is consistent with MEE. Dark red indicates a recent trauma or blood behind the TM. A dark pink or lighter red TM is consistent with AOM or hyperemia of the TM caused by crying, coughing, or nose blowing.

The color of the eardrum is less important diagnostically than its position and mobility. Redness of the TM alone does not necessarily suggest AOM because crying, removal of cerumen with associated irritation of the auditory canal, coughing, nose blowing, and fever can all cause redness of the eardrum without a middle ear infection

2)Patient should be asked about type of earache(eg:thrombing pain)

patient also asked about:

• Ear pain, especially when lying down.
• Tugging or pulling at an ear.
• Trouble sleeping.
• Crying more than usual.
• Fussiness.
• Trouble hearing or responding to sounds.
• Loss of balance.
• Fever of 100 F (38 C)

3)Risk factor of earachge in child

Allergies or asthma seem to increase the risk of ear infections most often when pollen counts are high. Illnesses that lower immune system such as AIDS. Health issues present at birth that make it hard for the ear to drain well such as cleft palate, Down syndrome, or fetal alcohol syndrome.

4)OTTITIDS MEDIA

Otitis media can be associated with an infection or be sterile. In the first case, otitis media is usually caused by bacteria that migrate into the middle ear via the Eustachian tube. Occasionally otitis media may be caused by fungi (Aspergillus or Candida) or other pathogens, such as the herpes virus. In this situation, usually either there is a problem with immune function or (there is a hole (perforation) in the ear drum. Persons with diabetes are particularly susceptible to unusual pathogens such as pseudomonas. In underdeveloped parts of the world, tuberculosis should be considered (Mongkolrattanothai et al. 2003).

Sterile otitis media is usually called serous otitis media, or "SOM". The serous variety of otitis media is usually not painful.

*OTTIRIS EXTERNA

Otitis externa is an infection of the skin of the ear canal and is very common. The ear canal is a narrow, warm, blind-ended tunnel, which makes it a good protected environment for germs to grow in if they are given a chance. Most infections are caused by a germ (bacterium). Occasionally, they can be due to a fungal or yeast infection.

5)ACUTE OTTITIS MEDIA

6)IT IS DIAGNOSED BY NURSE BY ANALYSING :

*with acute onset, presence of middle ear effusion, physical evidence of middle ear inflammation, and symptoms such as pain, irritability, or fever.

7)The goal of nursing care to a child with otitis media include relief from pain, improved hearing and communication, avoidance of re-infection, and increased knowledge about the disease condition and its management.

Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for otitis media:

1. Acute Pain
2. Disturbed Sensory Perception: Auditory
3. Deficient Knowledge
4. Risk for Infection