Post an explanation of the differential diagnosis for the patient in the case study that you selected.

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 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.

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.

By Day 3

Post 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.

ANSWER

Diagnosing Skin, Ear, Eye and Throat Disorders

Otitis externa is the most probable diagnoses for this middle-aged male. The condition develops when the patient’s immune system is compromised (Schaefer & Baugh, 2012). Other differential diagnoses include cholesteatoma, foreign body, cerumen impaction, otitis media, otitis media with effusion, fungal infection, dermatoses, and referred dental pain. Although all these are probable conditions, the patient’s history, physical examination and reported symptoms points to acute otitis externa.

Approximately 90 percent of otitis externa cases are caused by bacteria, particularly Staphylococcus aureus and Pseudomonas aeruginosa (Rosenfeld et al., 2014). Although the incubation duration is variable, this condition usually presents within 48 hours following upper respiratory tract infection. The notable symptoms and signs include itching, canal inflammation, otalgia, erythema, edema, otorrhea, and pain upon moving the pinna. A diagnosis is normally based on the reported symptoms, but the caregiver may examine the tympanic membrane and ear canal to confirm the diagnosis. On the same note, a microscopic examination of drainage with the help of potassium hydroxide may detect a fungal cause (Buttaro, Trybulski, Polgar-Bailey & Sandberg-Cook, 2017).

Treatment Most occurrences of otitis externa are treated using topical eardrops and analgesics. The treatment plan entails pain management, removing debris from the external auditory canal, use of antibiotics, and avoidance of contributing factors (Sander, 2001). The patient should be put on antibiotic for 14 days. If the condition does not improve, canal drainage with antibiotic sensitivities may be recommended. The choice of the appropriate medication must put into consideration the pre-existing conditions of the patient including Type2 diabetes mellitus, hypertension, hyperlipidemia and being allergic to Amoxicillin. It is also paramount…