NRNP 6540 Week 4 Assignment Week 4: Case Study 1: A 76-year-old woman presents today with complaints of nasal drainage

NRNP 6540 Week 4 Assignment Week 4: Case Study 1: A 76-year-old woman presents today with complaints of nasal drainage Head, Neck, and Face Disorders in the Older Population NRNP 6540F Advanced Practice Care of Older Adults Head, Neck, and Face Disorders in the Older Population Older adults face many age-related disorders that involve the head, neck, ad face. Advanced practice nurses should assess older patients appropriately, as many of these conditions significantly affect their quality of life. The goal of this paper is to discuss a focused subjective, objective, assessment, and plan (SOAP) for a geriatric patient with complaints of upper respiratory tract symptoms. The paper also aims to present diagnostic tests, differential diagnoses, treatment plans, and reflect learnings from analyzing the medical condition affecting the older patient. Focused SOAP Note Subjective Patient Information: Mrs. A, 76, White, Female Chief Complaint: Mrs. A came to the clinic complaining of persistent “runny nose” for 3 weeks now, associated clearing of throat, and nasal congestion on awakening in the morning. History of Present Illness: Mrs. A is a 76-year-old white female who comes to the clinic with complaints of nasal drainage, clearing of throat, and occasional nasal congestion that usually occurs when walking in the morning. The said symptoms usually occur to her during spring, in which she associated the nasal discharge with pollination. Being now in the winter season, the patient could not associate the trigger of her symptoms. Patient also reported she recently moved into an independent living center after residing in her home for 40 years. Current Medications: Medication unknown Allergies: Seasonal allergies Past Medical History: Allergic Rhinitis (AR) Immunization status unknown Unknown last visit to primary doctor Social and Substance History: Recently moved to an independent living center after living in her home for 40 years. Unknown tobacco, alcohol, and drug use. Family History: Family history unknown Surgical History: No surgical history was reported Reproductive Hx: Postmenopausal Review of Systems: The focused review of systems for a patient with upper respiratory symptoms should include general; head, eyes, ears, nose and throat; respiratory; integumentary; and allergy. • General: No fever, chills, weakness, fatigue, and weight loss. • Head: No headache. No trauma reported. • Eyes: No blurred vision, double vision or visual loss. Denies eye pain. • Ears: No loss or changes in hearing, ringing, and discharges. • Nose: Reports persistent “runny nose” for the past three weeks. Reports occasional nasal congestion. • Throat: Reports occasional clearing of throat. No chewing or swallowing difficulties. No changes to voice and taste. • Respiratory: No shortness of breath, cough, hemoptysis. • Integumentary: No changes to skin, hair, and nails. Denies rashes or changes to moles. • Allergic: No history of asthma, hives, eczema. Has history of seasonal AR. Objective Physical exam: General: Awake, alert and oriented to person, place and time. Speech is clear and coherent. Good eye contact. Appears well groomed and well nourished. Vital Signs: BP: 1300/84 mm/Hg, Heart Rate: 78, Respiratory Rate: 20 and unlabored, Temperature: 98.6 degrees Fahrenheit. HEENT: Head: Normocephalic and atraumatic. Intact facial sensation. Eyes: Pupils equal, round, and reactive to light and accommodation. No AV nicking or exudates in fundoscopic exam. No abnormal discharge noted. No periorbital swelling noted. Eye brows symmetrical. Ears: Symmetrical. Patent external auditory canal with no swelling noted. No abnormal ear discharges noted. Tympanic membranes intact with no erythema or effusion. Nose: Symmetrical. Clear nasal discharges noted with mild swelling of the nasal mucosa. No nasal deviation, flaring, or nasal polyps noted. Throat: Patient noted attempts to clear throat occasionally. No erythema or exudates noted. Gag reflex intact. Neck: Supple with full range of motion. Carotid arteries wit no bruits or jugular vein distention. No masses palpated. No tracheal deviation noted. Respiratory: Clear lung sounds in all lung fields to auscultation with inspiration and expiration. Equal chest with rise and fall bilaterally, upon inspiration and expiration. Integumentary: No significant rash or lesions noted. Skin color appropriate for age. Skin warm to touch with skin turgor appropriate for age. No clubbing or cyanosis noted to nails. Lymphatics: No enlarged lymph nodes palpated. Diagnostic tests: 1. Skin testing – The test determines sensitivity to allergens that cause AR. According to Health Quality Ontario (2016), since skin prick testing is easy to implement and less invasive, it is recommended to diagnose AR, then followed by intradermal testing to confirm the skin prick test results. Skin testing is reliable tool to diagnose AR. In a metaanalysis performed by researchers, its sensitivity was 85% and specificity was 77% (Health Quality Ontario (2016). 2. Total serum IgE testing If skin testing cannot be performed due to medications or skin conditions, total serum IgE testing is an alternative. Small et al. (2015) explained that allergen-specific IgE tests