Question

Part 1

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?

Part 2

P.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 exam 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 examination, what objective data should the nurse inspect and palpate for the head and neck?

4. How might the physical examination vary given the patient’s age?

Part 3

P.P. 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

What other assessments should be included for this patient?

What questions are appropriate for a patient presenting with earache?

What risk factors are associated with earaches for this age group?

From the readings, what is the difference between otitis media and otitis externa?

From the readings, what is the most probable cause of the earache in this patient?

What are three nursing diagnoses?

What interventions should be included in the nursing care plan?

Answer 1

Part 1:

1.First nurse should obtain all the information about the patient by interviewing him. It involves collection of personal data, symptoms,feeling , perception,desires.Here nurse should collect the temperature, blood pressure, along with this since the patient is prediabetes it's value should also be taken since he has more chance of developing type 2 DM.Symptoms like hoarseness,dry cough and sore throat together gives an idea that the patient is suffering from laryngitis.

2.While examining the oral structures,nurse will get to know patient suffers from sore throat ,dryness of throat and also yellow staining of teeth because of tobacco chewing.

3. Since the patient has a habit of chewing tobacco everyday, is has become an addict .So nurse should give some awareness about Health hazard of tobacco chewing and include anti tobacco awareness programs and compaigns on his teaching plan.

4.The patient is suffering from laryngitis. As a result he suffers from following symptoms:

Dry cough, sore throat, and hoarseness

Cause are : smoking,overuse of voice,GERD, inhalation of irritants, allergies.

Part 2:

1.Nurse will her to know the cause of headache is bacteial pneumonia ( symptom of bacterial pneumonia in older patients) by asking about other features like shortness of breath, yellow green mucus ,cough ,fever ,chill and correlating these features with headache. This she could conclude that it is the symptom of bacterial pneumonia caused by Streptococcus pneumoniae.

2.mainly about 300 lymph nodes are present on neck .These are divides into superioS and inferior deep cervical lymph node.

3. The nurse should check for the headchae and altered mental status.She should palpate for swollen lymph node - Mediastinal lymph node in case of pneumonia

4. In case children similar features are seen along with there will be flarring of nostrils,bluish nails ,lips

In case older inviduals ,there will be more headache, dizziness and confusion.

Part 3:

1. Other assessment are whether patient has drainage of fluid from ear ,ear pain , hearing loss, nasal congestion ,nausea

2.whether patient has earache along with fluid discharge, or due damage to ear like trauma , due to ear wax, dental abscess, throat infections.

3. Risk factors are age , family history,cold , allergies,chronic illeness ,ethinicity.

4. Otitis media means inflammation of tympanic membrane or ear drum ,that is infection goes into the middle ear but in case of otitis externa the infection does not go to middle ear instead it is the infection of external part of ear canal.

5. The probable cause of earache in this patient is because of inflamed and bulged tympanic membrane.

6. The three nursing diagnosis are acute pain due to inflammation of middle ear, there will be anxiety related to health and impaired verbal communication because of hearing loss.

7. These are the interventions that should be included under nursing care plan- Positioning like sit ups, hygiene, good diet, heat application, monitoring of hearing loss.