Discussion Posts NUR 504 Advanced Health Assessment

Module 2 Discussion Skin, Eye, & Ear Disorders

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

Case 1 Case 2 Case 3

Chief Complaint (CC)

A 57-year-old man presents to the office with a complaint of left ear drainage since this morning.

A 45-year-old female presents with a complaint of an itchy red rash on her arms and legs for about two weeks.

A 11-year-old female patient complains of red left eye and edematous eyelids. Her mother states the child complains of “sand in my left eye.”

Subjective

Patient stated he was having pulsating pain on left ear for about 3 days. After the ear drainage the pain has gotten a little better.

She has been going on a daily basis to the local YMCA with children for Summer camp.

Patient noticed redness three days ago. Denies having any allergies. Symptoms have gotten worse since she noticed having the problem.

Objective Data

VS

(T) 99.8°F; (RR) 14; (HR) 72; (BP) 138/90

(T) 98.3°F; (RR) 18; (HR) 70, regular; (BP) 118/74

(T) 98.2°F; (RR) 18; (HR) 78; BP 128/82; SpO2 96% room air; weight 110 lb.

General well-developed, healthy male healthy-appearing female in no
acute distress well-developed, healthy, 11 years old

HEENT

EAR: (R) external ear normal, canal without erythema or exudate, little bit of cerumen noted, TM- pearly grey, intact with light reflex and bony landmarks present; (L) external ear normal, canal with white exudate and crusting, no visualization of tympanic membrane or bony landmarks, no light reflex EYE: bilateral anicteric conjunctiva, (PERRLA), EOM intact. NOSE: nares are patent with no tissue edema.
THROAT: no lesions noted, oropharynx moderately erythematous with no postnasal drip.

EYES: no injection, no increase in lacrimation or purulent drainage;
EARS: normal
TM: Normal

EYES: very red sclera with dried, crusty exudates; unable to open eyes in the morning with the left being worse than the right

Skin No rashes CTA AP&L CTA AP&L

Neck/Throat

no neck swelling or tenderness with palpation; neck is supple; no JVD; thyroid is not enlarged; trachea midline

mild edema with inflammation located on forearms, upper arms, and chest wall, thighs and knees; primary lesions are a macular papular rash with secondary linear excoriations on forearms and legs

Once you received your case number, answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.

Submission Instructions:
Your instructor will assign you your case number and you will post on the case number you
have been assigned.
You will reply to the other two case studies (One of each).
Your initial post should be at least 500 words, formatted and cited in current APA style with
support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Module 3 Discussion Throat, Respiratory & Cardiovascular Disorders

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

Case 1 Case 2 Case 3

Chief Complaint (CC)

A 65-year-old male with chronic obstructive pulmonary disease (COPD) presents to the clinic with a cough he has had for the past 2 weeks.

A 25-year-old Hispanic female, computer programmer presents to your clinic complaining of a 12-day history of a runny nose

A 75-year-old female reports experiencing pain in her chest while walking up steps today.

Subjective

denies chest pain, denies night sweats, admits to having a fever but does not know the temp.

States that her symptoms began about 12 days ago. She suffers from allergies; she gets

a runny nose during the spring- time, pollen season. However,

in the winter, her allergies are not a problem.

Could not sleep previous night. Feels like an ache or a burning sensation at the center of sternum. Denies any arm pain, pain was at a scale of 8 in the AM now it is at a

Suffers from History of hypertension, denies heart disease, denies leg swelling up, denies pain feeling worse when taking deep breath.

Objective Data

VS

(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air.

(BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air

BP 129/70, (HR) 72 and regular, (RR) 16 unlabored, temperature 98.8°F, oral pulse oximetry is 99%

General patient appears tired; skin color pale, patient is diaphoretic and sweaty, height 5′3′′; weight 175 lbs

No signs of acute distress. Patient appears mildly fatigued. She is breathing through her
mouth. Breathing easily. Voice has a nasal quality to it.

obese female, alert, in no acute distress.

HEENT

EYES: no injection, no increase in lacrimation or purulent drainage; EARS: normal
TM: Normal
NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Obstructed air passages

Ear canals: normal;
EYES: normal;
NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Nares: Obstructed air passages

Atraumatic, normocephalic,
PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition – multiple carries.

Respiratory lung crackles in LLL, no wheezes or rhonchi noted; does not clear with coughing; dullness to percussion over the LLL; shallow respirations and is 30, accessory muscles use not present

CTA AP&L CTA AP&L

Neck/Throat

no neck swelling or tenderness with palpation; neck is supple; no JVD; thyroid is not enlarged; trachea midline

Posterior pharynx: mildly injected, scant postnasal drainage (PND), no exudate, tonsils 1+, no cobblestoning

carotids are 2+ without bruits; thyroid is not palpable; no lymphadenopathy

Heart

Regular rate and rhythm, no murmur, S3, or S4

Regular rate and rhythm, no murmur, S3, or S4

S1 and S2 normal without murmur, gallop, or rub

Once you received your case number, answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.

Submission Instructions:
Your instructor will assign you your case number and you will post on the case number you
have been assigned.
You will reply to the other two case studies (One of each).
Your initial post should be at least 500 words, formatted and cited in current APA style with
support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Module 4 Discussion Gastrointestinal & Endocrine

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

Case 1 Case 2 Case 3

Chief Complaint (CC)

“I am here today due to frequent and watery bowel movements”

“I have pain in my belly” “neck swelling”

History of Present Illness (HPI)

A 37-year-old European American female presents to your practice with “loose stools” for about three days. One event about every three hours

A 25-year-old female presents to the emergency room (ER) with complaints of severe abdominal pain for 2 weeks . The pain is sharp and crampy It hurts if I run, sit down hard, or if I have sex

A 42-year-old African American female who refers that she has been noticing slow and progressive swelling on her neck for about a year. Also she stated she has lost weight without any food restriction

PMH No contributory Patient denies Patient denies
PSH Appendectomy at the age of 14

Surgical removal of benign left breast nodule 2 years ago
Drug Hx No meds Birth control No medication at the time Allergies Penicillin NKA NKA

Subjective

Fever and chills, Lost appetite Flatulence No mucus or blood on stools

Nausea and vomiting, Last menstrual period 5 days ago, New sexual partner about 2 months ago, No condoms, he hates them
No pain, blood or difficulty with urination

Mild difficult to shallow, Neck feels tight, Pt states she feels Palpitations

Objective Data

PE

B/P 188/96; Pulse 89; RR 16; Temp 99.0; Ht 5,6; wt 110; BMI 17.8

B/P 138/90; temperature 99°F; (RR) 20; (HR) 110, regular; oxygen saturation (PO2) 96%;
pain 5/10

B/P 158/90; Pulse 102; RR 20; Temp 99.2; Ht 5,4; wt 114; BMI 19.6

General

well-developed female in no acute distress, appears slightly fatigued

acute distress and severe pain

42-year-old female appears thin. She is anxious – pacing in the room and fidgeting, but in no acute distress.

HEENT

Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.

Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition.
Piercing in her right nostril and lower lip.

Bulging eyes

Neck Supple

Diffuse enlargement of the thyroid gland
Lungs CTA AP&L CTA AP&L CTA AP&L
Card S1S2 without rub or gallop S1S2 without rub or gallop S1S2 without rub, Tachycardia

Abd

positive bowel sounds (BS) in all four quadrants; no masses; no organomegaly noted; diffuse, mild, bilateral lower quadrant pain noted Mild diffuse tenderness.

• INSPECTION: no masses or thrills noted; no discoloration and skin is warm to; no tattoos or piercings; abdomen is nondistended and round
• AUSCULTATION: bowel sounds (BS) are normal in all four quadrants, no bruits noted
• PALPATION: on palpation, abdomen is tender to touch in four quadrants; tenderness noted on light palpation, deep palpation reveals no masses, spleen and liver unremarkable
• PERCUSSION: tympany heard in all quadrants, no dullness noted in abdominal area
• benign, normoactive bowel sounds x 4

GU Non contributory

• EXTERNAL: mature hair distribution; no external lesions on labia
• INTROITUS: slight green-gray discharge, no lesions
• VAGINAL: normal rugae; moderate amount of green discharge on vaginal walls
• CERVIX: nulliparous os with small amount of purulent discharge from os with positive cervical motion tenderness (CMT)
• UTERUS: ante-flexed, normal size, shape, and position
• ADNEXA: bilateral tenderness with fullness; both ovaries without masses
• RECTAL: deferred
• VAGINAL DISCHARGE: green in color

Non contributory

Ext no cyanosis, clubbing or edema no cyanosis, clubbing or edema

no cyanosis, clubbing or edema

Integument

good skin turgor noted, moist mucous membranes

intact without lesions masses or rashes

Thin skin, Increase moisture

Neuro

No obvious deformities, CN grossly intact II-XII

No obvious deficits and CN grossly intact II-XII

No obvious deficits and CN grossly intact II-XII

Once you received your case number, answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
   
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.

Submission Instructions:
Your instructor will assign you your case number and you will post on the case number you
have been assigned.
You will reply to the other two case studies (One of each).
Your initial post should be at least 500 words, formatted and cited in current APA style with
support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Module 5 Discussion Neurological & Male Genitourinary Disorders

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

Case 1 Case 2 Case 3

Chief Complaint (CC)

“It burns when I urinate”

“I had a severe headache yesterday with difficulty to speak”

“I have been having frequents headaches lately”

History of Present Illness (HPI)

A 68-year-old Caucasian male who reports to have increase on the frequency of urination with urgency for the last 5 days. He also present dysuria and nocturia.

A 64-year-old African American female who reports having a severe pulsatile diffuse headache yesterday with sudden difficulty to talk with last for about two hours.
She did not seek medical attention. This morning she woke up with no problems but is here
today due her husband advise.

A 25-year-old Hispanic female presents to your clinic with a headache located on right temporal area, pulsatile.

PMH

Benning prostatic hyperplasia diagnosed 3 years ago, UTI 6 months ago, Lithotripsy left kidney 10 years ago. No issues after treatment

Atrial Fibrillation, Hypertension. Is

allergic to Non-steroidal Anti- inflammatory drugs Aspirin

Frequent headaches since I was 15, with menses.

Drug Hx

Rosuvastatin 20 mg
Olmesartan 20 mg

Losartan 50 mg
Xarelto 15 mg BID

Ibuprofen for Headaches

Subjective

Fever and chills, no changes in vision or hearing, no difficulty chewing or swallowing. No sexually active, nocturia, dysuria. Yellowish urethral secretion.

Feels Palpitations, joint pain with
yesterday’s episode

Light makes headache worst Nausea associated with headaches. No vomiting,
Headaches improve usually with rest, ibuprofen, and sleep, but it is annoying to have to sleep all-day

VS

B/P 150/96; Pulse 89; RR 16; Temp 99.4; Ht 6,1; wt 180;

B/P 131/80; temperature 98.2°F; (RR) 18; (HR) 84, irregular; oxygen saturation (PO2) 96%;

B/P 108/64; Pulse 86; RR 16; Temp 98.6;

General

well-developed male, no acute distress

well-developed female, no acute distress

25-year-old female appears

well developed and well- nourished, healthy appearing,

wearing dark glasses in a dim room

HEENT

Atraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.

Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition.

no injection, anicteric, PERRLA, EOMs intact, without pain to movement; normal vision

Lungs CTA AP&L CTA AP&L CTA AP&L
Card

S1S2 without rub or gallop S4 present

Irregular heart beat with normal rate

S1S2 without rub or gallop

Abd

No tenderness normoactive bowel sounds x 4;

No tenderness normoactive bowel sounds x 4;

benign, normoactive bowel sounds x 4;

Rectal exam Warm, swollen and painful

prostate gland

Non contributory Non contributory

Integument

good skin turgor noted, moist mucous membranes

intact without lesions masses or rashes.

intact without lesions masses or rashes.

Neuro

No obvious deformities, CN grossly intact II-XII

No obvious deficits and CN grossly intact II-XII

Cranial nerves II to XII intact; sensation intact, DTRs 2+
throughout. Functional neurological exam is
WNL

Once you received your case number, answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.
6. What teachings will you provide?

Submission Instructions:
Your instructor will assign you your case number and you will post on the case number you
have been assigned.
You will reply to the other two case studies (One of each).
Your initial post should be at least 500 words, formatted and cited in current APA style with
support from at least 2 academic sources. Your initial post is worth 8 points.

You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.

Module 6 Discussion Female Genitourinary, & Musculoskeletal

For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.

Case 1 Case 2 Case 3

Chief Complaint (CC)

“I have a tumor on my left breast”

“I have pain during intercourse and urination”

“My back hurts so bad I can barely walk”

History of Present Illness (HPI)

A 55-year-old African American social worker presents to your clinic with a finding of a lump in her left breast while in the shower this past week.

A 19-year-old female reports to you that she has “sores” on and in her vagina for the last three months.

A 35-year-old male painter presents to your clinic with the complaint of low back pain. He recalls lifting a 5-gallon paint can and felt an immediate pull in the lower right side of his back. This happened 2 days ago and he had the weekend to rest, but after taking Motrin and using heat, he has not seen an improvement. His pain is sharp, stabbing, and he scored it as a 9 on a scale of 0 to 10.

Drug Hx

I took birth control pills for 10 years, starting when I was 20 I am not on hormone replacement

She tries to practice safe sex but has a steady boyfriend and figures she doesn’t need to be so careful since she is on the birth control pill

Motrin for pain.

Family Hx

My grandmother had breast cancer when she was 76 years old

Father hypertension
Mother DM

Subjective

Denies any fever or chills. No changes in vision or hearing, no difficulty chewing or swallowing.
Supple neck, states that she does self-breast-exams on occasion.
Menopause at 52
No skin changes or nipple discharge from the left breast

states “I have sores and bumps on the inner creases of my thighs and pelvic area”. “There is yellowish discharge from the sores that comes and goes”

He is having some right leg pain but no bowel or bladder changes. No numbness or tingling

Objective Data

VS temperature 98.6°F; respiratory rate (RR) 16; heart rate (HR) 80, regular; blood pressure (BP)

temperature: 100.2°F; pulse 92; respirations 18; BP 122/78;

temperature: 98.2°F, respiratory rate 16, heart rate 90, blood

130/84; height: 5′8′′; weight 160 lbs; body mass index (BMI) 24

weight 156 lbs, 25 lbs overweight; height 5′3′′

pressure 120/60 O2 saturation 98%

General

well developed, nourished, healthy-appearing female

patient appears to have good hygiene; minimal makeup, pierced ears, no tattoos; well nourished (slightly overweight);
no obvious distress noted

well-developed healthy 35-year- old male; no gross deformities

HEENT

Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.

Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.

Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition – multiple carries.

Lungs clear to auscultation

within normal limits, appropriate lung sounds auscultated, clear and equal bilaterally

CTA AP&L

Card regular rate and rhythm (RRR) S1S2 without rub or gallop S1S2 without rub or gallop

Breast

Examined in sitting and supine positions. In sitting position, no evidence of skin changes, right breast is slightly larger than the left, symmetrical movement with the arms above the head and at the side and with flexion of the pectoral muscles; 5-mm nonmobile, non-tender, firm mass felt at 10 o’clock position, 5 cm from the areola. Right breast without dominant masses or tenderness. Nipples without inversion or evidence of nipple discharge. Breast mass is palpated in the supine position in the same manner as in the sitting position

• INSPECTION: no dimpling or abnormalities noted upon inspection
• PALPATION: Left breast no abnormalities noted. Right breast: denies tenderness, pain, no abnormalities noted.
• INSPECTION: no dimpling or abnormalities noted upon inspection
• PALPATION: Left breast – no abnormalities noted. Right breast – denies tenderness, pain, no abnormalities noted.

Lymph

negative axillary, infraclavicular, and supraclavicular lymphadenopathy

Inguinal Lymph nodes: tenderness bilaterally, numerous, 1 cm in size

no bruising, fever, or swelling noted, no acute bleeding or trauma to skin.

Abd normoactive bowel sounds x 4;

tender during palpation; the left lower quadrant was very tender during palpation; patient denies nausea or vomiting

benign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.

GU Bladder is non-distended.

labia major and minor: numerous ulcerations, too many to count; some ulcerations enter
the vaginal introitus; no ulcerations in the vagina mucosa; cervix is clear, some greenish discharge; bimanual exam reveals tenderness in left lower quadrant; able to palpate the left ovary; unable to palpate the right ovary; no tenderness; uterus is normal in size, slight tenderness with cervical mobility

Bladder is non-distended.

Integument

good skin turgor noted, moist mucous membranes

intact without lesions masses or rashes.

MS Muscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.

Muscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.

No obvious deformities, masses, or discoloration. Palpable pain noted at the right lower lumbar region. No palpable spasms. ROM limited

to forward bending 10 inches from floor; able to bend side to side but had difficulty twisting and going into extension.

Neuro

No obvious deformities, CN grossly intact II-XII

No obvious deficits and CN grossly intact II-XII

DTRs 2+ lower sensory neurology intact to light touch and patient able to toe and heel walk. Gait was stable and no limping noted.
Once you received your case number, answer the following questions:

1. What other subjective data would you obtain?
2. What other objective findings would you look for?
3. What diagnostic exams do you want to order?
4. Name 3 differential diagnoses based on this patient presenting symptoms?
5. Give rationales for your each differential diagnosis.
6. What teachings will you provide?

Submission Instructions:
Your instructor will assign you your case number and you will post on the case number you
have been assigned.
You will reply to the other two case studies (One of each).
Your initial post should be at least 500 words, formatted, and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Attention: Please post your initial response by 11:59 PM ET Thursday, and comment on the
posts of two classmates by 11:59 PM ET Friday.
You can expect feedback from the instructor within 48 to 72 hours from the Friday due date.