Assessing the Ears, Nose, and Throat

Discussion: Assessing the Ears, Nose, and Throat

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.

In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

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Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

Case 1: Nose Focused Exam – Discussion: Assessing the Ears, Nose, and Throat

Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he’s taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.

Case 2: Focused Throat Exam- Discussion: Assessing the Ears, Nose, and Throat

Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn’t take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily’s. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn’t sound congested.

Case 3: Focused Ear Exam- Discussion: Assessing the Ears, Nose, and Throat

Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past two days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he’s been spending his summer, James responds that he’s been spending a lot of time in the pool.

To prepare for Discussion: Assessing the Ears, Nose, and Throat:

With regard to the case study you were assigned:

  • Review this week’s Learning Resources and consider the insights they provide.
  • Consider what history would be necessary to collect from the patient.
  • Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
  • Identify at least 5 possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying the number of the case study you were assigned.

By Day 3 of Discussion: Assessing the Ears, Nose, and Throat

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Discussion: Assessing the Ears, Nose, and Throat

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition and justify your reasoning.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Content

Outstanding Performance Excellent Performance Competent Performance Proficient Performance Room for Improvement
Main Posting:
Response to the discussion question is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.
Points Range: 44 (44%) – 44 (44%)

Thoroughly responds to the discussion question(s)

is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module and current credible sources.

supported by at least 3 current, credible sources

Points Range: 40 (40%) – 43 (43%)

Responds to the discussion question(s)

is reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

75% of post has exceptional depth and breadth

supported by at least 3 credible references

Points Range: 35 (35%) – 39 (39%)

Responds to most of the discussion question(s)

is somewhat reflective with critical analysis and synthesis representative of knowledge gained from the course readings for the module.

50% of post has exceptional depth and breadth

supported by at least 3 credible references

Points Range: 31 (31%) – 34 (34%)

Responds to some of the discussion question(s)

one to two criteria are not addressed or are superficially addressed

is somewhat lacking reflection and critical analysis and synthesis

somewhat represents knowledge gained from the course readings for the module.

post is cited with fewer than 2 credible references

Points Range: 0 (0%) – 30 (30%)

Does not respond to the discussion question(s)

lacks depth or superficially addresses criteria

lacks reflection and critical analysis and synthesis

does not represent knowledge gained from the course readings for the module.

contains only 1 or no credible references

Main Posting:
Writing
Points Range: 6 (6%) – 6 (6%)

Written clearly and concisely

Contains no grammatical or spelling errors

Fully adheres to current APA manual writing rules and style

Points Range: 5.5 (5.5%) – 5.5 (5.5%)

Written clearly and concisely

May contain one or no grammatical or spelling error

Adheres to current APA manual writing rules and style

Points Range: 5 (5%) – 5 (5%)

Written concisely

May contain one to two grammatical or spelling error

Adheres to current APA manual writing rules and style

Points Range: 4.5 (4.5%) – 4.5 (4.5%)

Written somewhat concisely

May contain more than two spelling or grammatical errors

Contains some APA formatting errors

Points Range: 0 (0%) – 4 (4%)

Not written clearly or concisely

Contains more than two spelling or grammatical errors

Does not adhere to current APA manual writing rules and style

Main Posting:
Timely and full participation
Points Range: 10 (10%) – 10 (10%)

Meets requirements for timely and full participation

posts main discussion by due date

Points Range: 0 (0%) – 0 (0%)
NA
Points Range: 0 (0%) – 0 (0%)
NA
Points Range: 0 (0%) – 0 (0%)
NA
Points Range: 0 (0%) – 0 (0%)
Does not meet requirement for full participation
First Response: 

Post to colleague’s main post that is reflective and justified with credible sources.

Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings

responds to questions posed by faculty

the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives

Points Range: 8.5 (8.5%) – 8.5 (8.5%)
Response exhibits critical thinking and application to practice settings
Points Range: 7.5 (7.5%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting
Points Range: 6.5 (6.5%) – 7 (7%)
Response is on topic, may have some depth
Points Range: 0 (0%) – 6 (6%)
Response may not be on topic, lacks depth
First Response:
Writing
Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues

Response to faculty questions are fully answered if posed

Provides clear, concise opinions and ideas that are supported by two or more credible sources

Response is effectively written in Standard Edited English

Points Range: 5.5 (5.5%) – 5.5 (5.5%)

Communication is professional and respectful to colleagues

Response to faculty questions are answered if posed

Provides clear, concise opinions and ideas that are supported by two or more credible sources

Response is effectively written in Standard Edited English

Points Range: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues

Response to faculty questions are mostly answered if posed

Provides opinions and ideas that are supported by few credible sources

Response is written in Standard Edited English

Points Range: 4.5 (4.5%) – 4.5 (4.5%)

Responses posted in the discussion may lack effective professional communication

Response to faculty questions are somewhat answered if posed

Few or no credible sources are cited

Points Range: 0 (0%) – 4 (4%)

Responses posted in the discussion lack effective

Response to faculty questions are missing

No credible sources are cited

First Response:
Timely and full participation
Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely and full participation

posts by due date

Points Range: 0 (0%) – 0 (0%)
NA
Points Range: 0 (0%) – 0 (0%)
NA
Points Range: 0 (0%) – 0 (0%)
NA
Points Range: 0 (0%) – 0 (0%)
Does not meet requirement for full participation
Second Response:
Post to colleague’s main post that is reflective and justified with credible sources.
Points Range: 9 (9%) – 9 (9%)

Response exhibits critical thinking and application to practice settings * responds to questions posed by faculty

the use of scholarly sources to support ideas demonstrates synthesis and understanding of learning objectives

Points Range: 8.5 (8.5%) – 8.5 (8.5%)
Response exhibits critical thinking and application to practice settings
Points Range: 7.5 (7.5%) – 8 (8%)
Response has some depth and may exhibit critical thinking or application to practice setting
Points Range: 6.5 (6.5%) – 7 (7%)
Response is on topic, may have some depth
Points Range: 0 (0%) – 6 (6%)
Response may not be on topic, lacks depth
Second Response:
Writing
Points Range: 6 (6%) – 6 (6%)

Communication is professional and respectful to colleagues

Response to faculty questions are fully answered if posed

Provides clear, concise opinions and ideas that are supported by two or more credible sources

Response is effectively written in Standard Edited English

Points Range: 5.5 (5.5%) – 5.5 (5.5%)

Communication is professional and respectful to colleagues

Response to faculty questions are answered if posed

Provides clear, concise opinions and ideas that are supported by two or more credible sources

Response is effectively written in Standard Edited English

Points Range: 5 (5%) – 5 (5%)

Communication is mostly professional and respectful to colleagues

Response to faculty questions are mostly answered if posed

Provides opinions and ideas that are supported by few credible sources

Response is written in Standard Edited English

Points Range: 4.5 (4.5%) – 4.5 (4.5%)

Responses posted in the discussion may lack effective professional communication

Response to faculty questions are somewhat answered if posed

Few or no credible sources are cited

Points Range: 0 (0%) – 4 (4%)

Responses posted in the discussion lack effective

Response to faculty questions are missing

No credible sources are cited

Second Response:
Timely and full participation
Points Range: 5 (5%) – 5 (5%)

Meets requirements for timely and full participation

Posts by due date

Points Range: 0 (0%) – 0 (0%)
NA
Points Range: 0 (0%) – 0 (0%)
NA
Points Range: 0 (0%) – 0 (0%)
NA
Points Range: 0 (0%) – 0 (0%)
Does not meet requirement for full participation
Total Points: 100