NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

Walden University NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH– Step-By-Step Guide

This guide will demonstrate how to complete the Walden University NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

Whether one passes or fails an academic assignment such as the Walden University NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

The introduction for the Walden University NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

After the introduction, move into the main part of the NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

SUBJECTIVE DATA:  

Chief Complaint (CC): “I have been coughing a lot.” 

History of Present Illness (HPI):  

Danny Rivera is an 8-year-old Puerto Rican boy that presented to the Shadowville Elementary nurse’s office with complaints of cough. He provides subjective data about his health problem. He is responsive and answers appropriately the questions asked during the assessment. Danny reports that he has been coughing a lot for the last three days. The cough is wet, productive, leading to slimy clear phlegm. The cough worsens at night affecting his sleep, as he reports he did not get enough sleep the previous night. The cough lasts a few seconds.  

Danny resides in the same house with his grandfather who is a smoker, exposing him to cigar smoke. Danny reports that her mother gave her a table spoonsful of a purple-ish medicine, which soothed his cough. He has no history of using any home remedies for cough. He recently took syrup prescribed by his doctor for cough. He takes multivitamins daily. Danny is usually physically active. However, the cough has reduced his ability to engage in active physical activity, as he feels fatigued. The cough has also affected his ability to concentrate in class since he does not get enough sleep at night. Danny also reported worsening running nose ever since the cough started. The patient reports sore throat but denies sneezing.   

Medications: Danny reports that his mother gave him a purple-ish medicine to sooth his cough this morning. He is not on any other medication. 

Allergies: Danny does not have any history of food, drug, or environmental allergic reactions. 

Past Medical History (PMH): Danny has a history of pneumonia. He also has a frequent experience of cold, since his rose is runny most of the times. 

Past Surgical History (PSH):Danny has no history of surgeries 

Sexual/Reproductive History: Danny is an 8-year-old boy with unremarkable sexual or reproductive history.  

Personal/Social History: Danny resides with his mother and grandfather. He is a student. He likes engaging in active physical activity. His grandfather smokes cigarette, exposing him to harmful smoke at home. 

Immunization History: Danny’s immunization history is up-to date.  

Significant Family History (Include history of parents, Grandparents, siblings, and children): There is a history of asthma (his grandfather).  

Review of Systems:  

General: The patient is alert, responsive, and answers asked questions appropriately. He reports fatigue and denies fevers and chills.  

HEENT: Danny denies headache, vision changes, dizziness, watery eyes, eye redness, eye pain, and sinus pain. The patient reports sore throat, running nose, and itchy nose at times.  

Respiratory: The client denies difficulty in breathing. He reports wet productive cough. He also reports occasional sneezing 

OBJECTIVE DATA:  

Physical Exam: 

Vital signs: Not given  

General: The patient is alert and oriented to self, place time. He is well groomed for the occasion.  

HEENT: The sclera is white with most and pink conjunctiva with no discharge. The nasal cavities are pink with clear discharge. The turbinate is patent. The ears have no abnormal visible findings with cone of light being 7.00, no discharge, and tympanic membranes being pearly grey. The oral mucosa appears moist and pink with erythematous tonsils. The posterior oropharynx appears pink with cobble stoning in the posterior oropharynx texture. There is no postnasal drip. 

Respiratory: The breath sounds are present in all the areas with absent adventitious sounds. The lung sounds are clear with fremitus symmetrical bilaterally. Lung function tests: : FEV1: 1.549 L, FVC 1.78 L (FEV1/FVC: 87%) 

Cardiology: Auscultation of the bronchoscopy negative with no extra sounds. There is resonance on chest wall percussion with no dullness. 

Lymphatics: No lymphadenopathy 

Diagnostics/Labs: The additional laboratory and diagnostic investigations needed to develop diagnoses include nasal culture and chest x-ray should the patient demonstrate worsening symptoms. The chest x-ray may be needed to rule out other causes such as tuberculosis and pneumonia if the symptoms worsen. 

ASSESSMENT: 

Danny’s priority diagnosis is common cold. Common cold is a term used to refer to mild upper respiratory illness. The disease has viral origin. It is self-limiting disease that mainly affects the upper respiratory tract. In severe cases, patients may develop spread of the viral infection to other organs and complications such as those caused by the bacteria. Patients affected by common cold present the hospital with complaints that include sneezing, nasal discharge and stuffiness, sore throat, cough, and fatigue. The additional symptoms that patients may exhibit include hoarseness, headache, lethargy, and myalgia. The symptoms often last between 1 and 7 days with them peaking within 2-3 days of the infection (Ibrahim et al., 2021; Montesinos-Guevara et al., 2022; Wilson & Wilson, 2021). Danny has present with symptoms that align with those of common cold. For example, he complains of cough, sore throat, and running nose for the last three days, hence, common cold being his primary diagnosis.  

Danny’s secondary diagnosis is rhinosinusitis. Rhinosinusitis is a disorder characterized by the inflammation of the nasal cavities and passages. Patients develop this condition following their exposure to potential causes such as smoke, lowered immunity, and asthma. Patients often report symptoms such as nasal congestion, toothache, loss of smell, halitosis, postnasal drip, and runny nose (Chandy et al., 2019; Utkurovna et al., 2022). Danny is frequently exposed to tobacco smoke, which may have led to the development of rhinosinusitis. However, the absence of additional symptoms such as postnasal drip, toothache, loss of smell, and sinus pain or pressure, makes rhinosinusitis the least likely cause of his problem.  

The last differential diagnosis that should be considered for the patient is whooping cough or pertussis. Pertussis is a disorder of the upper respiratory system that is characterized by severe hacking cough accompanied by whooping breath sounds. The disease is highly contagious and requires immediate patient isolation to prevent its spread in the population. The symptoms associated with whooping cough include cough, fever, red, watery eyes, nasal congestion, and runny nose. The affected populations are increasingly predisposed to complications such as pneumonia, seizures, brain damage, and dehydration (Zhang et al., 2020). However, pertussis is Danny’s least likely diagnosis because of the lack of hacking, whooping cough and red, watery eyes. 

Also Read:

LAB ASSIGNMENT: ASSESSING THE ABDOMEN

DIGITAL CLINICAL EXPERIENCE: ASSESSING THE HEART, LUNGS, AND PERIPHERAL VASCULAR SYSTEM

ASSESSING MUSCULOSKELETAL PAIN

CASE STUDY ASSIGNMENT: ASSESSING NEUROLOGICAL SYMPTOMS

DIGITAL CLINICAL EXPERIENCE: COMPREHENSIVE (HEAD-TO-TOE) PHYSICAL ASSESSMENT

LAB ASSIGNMENT: ASSESSING THE GENITALIA AND RECTUM

References 

Chandy, Z., Ference, E., & Lee, J. T. (2019). Clinical Guidelines on Chronic Rhinosinusitis in Children. Current Allergy and Asthma Reports, 19(2), 14. https://doi.org/10.1007/s11882-019-0845-7 

Ibrahim, A. E., Elmaaty, A. A., & El-Sayed, H. M. (2021). Determination of six drugs used for treatment of common cold by micellar liquid chromatography. Analytical and Bioanalytical Chemistry, 413(20), 5051–5065. https://doi.org/10.1007/s00216-021-03469-3 

Montesinos-Guevara, C., Buitrago-Garcia, D., Felix, M. L., Guerra, C. V., Hidalgo, R., Martinez-Zapata, M. J., & Simancas-Racines, D. (2022). Vaccines for the common cold. Cochrane Database of Systematic Reviews, 12. https://doi.org/10.1002/14651858.CD002190.pub6 

Utkurovna, S. G., Farkhodovna, S. Z., &Furkatjonovna, B. P. (2022). OPTIMIZATION OF THE TREATMENT OF ACUTE RHINOSINUSITIS IN CHILDREN. Web of Scientist: International Scientific Research Journal, 3(3), Article 3. https://doi.org/10.17605/OSF.IO/GYBM7 

Wilson, M., & Wilson, P. J. K. (2021). The Common Cold. In M. Wilson & P. J. K. Wilson (Eds.), Close Encounters of the Microbial Kind: Everything You Need to Know About Common Infections (pp. 159–173). Springer International Publishing. https://doi.org/10.1007/978-3-030-56978-5_10 

Zhang, J.-S., Wang, H.-M., Yao, K.-H., Liu, Y., Lei, Y.-L., Deng, J.-K., & Yang, Y.-H. (2020). Clinical characteristics, molecular epidemiology and antimicrobial susceptibility of pertussis among children in southern China. World Journal of Pediatrics, 16(2), 185–192. https://doi.org/10.1007/s12519-019-00308-5 

Sample Answer 2 for NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

SUBJECTIVE DATA:

 Chief Complaint (CC): “I guess I’m kind of sick. . . I’ve been coughing a lot’

History of Present Illness (HPI): The affected person A young boy named Danny Riviera, who is only 8 years old, visits the medical center because he has been coughing for the past few days. According to what he says, the cough is very clear and has a watery quality to it. His cough is worse at night, which prevents him from getting adequate rest. As a consequence of this, he has trouble concentrating in class and often comes home exhausted. It’s painful in his right ear. The decision his mother made to use over-the-counter cough medicine, which only provided temporary relief, was made. Danny claims that he has a cold and that he suffers from a runny nose on a regular basis. Additionally, he inhales his father’s secondhand smoke on a regular basis. Within the past year, he has also been diagnosed with pneumonia. However, he does not have a fever, difficulty breathing, abdominal pain, chest tightness, or chills. He also does not have chest tightness.

Medications: The patient acknowledges that they do take their medications at home. In addition to that, he takes a vitamin every day. In addition to that, he takes a medication for coughing that is purple.

Allergies: NKDA

Past Medical History (PMH): Denies asthma diagnosis. Identifies immunizations as being up to date. Previous symptoms include chronic coughing and pneumonia.

Past Surgical History (PSH): None reported.

Sexual/Reproductive History:

Personal/Social History: Identifies himself as a member of a household that also includes his parents and grandparents. avers having a sense of well-being while at home. Describes a park with a playground in the neighborhood. It is reported that the father smokes in the house.

Immunization History: Immunizations are current.

Significant Family History: He is supported by his biological parents as well as both sets of grandparents.

Review of Systems:

General: During the course of the interview, the patient appears exhausted and coughs several times. Additionally, he seems to be steady.

HEENT: The mucus membrane is wet, and the discharge from the nose is clear. However, the back of his throat is red and clogged with mucus. His eyes are lifeless, and the conjunctiva around them is a pinkish hue. It seems as though the right tympanic membrane is inflamed and red. The lymph nodes in the patient’s right cervical region appear enlarged, and they have a certain degree of tenderness.

Respiratory: Lacks acute distress, has an increased respiratory rate at the age of 28, clear breath sounds on auscultation, and speaks in complete sentences; bronchoscopy is negative. When you percussed his chest wall, you could hear a resonant tone, and his fremitus was normal and bilaterally consistent.

                Cardiovascular/Peripheral Vascular:

                Psychiatric:

                Neurological:

                Lymphatics:

OBJECTIVE DATA:

                Physical Exam:

Vital signs:

General: During the course of the interview, the patient appears exhausted and coughs several times. Additionally, he seems to be steady.

HEENT: The head is atraumatic and has a normocephalic shape. The mucus membrane is wet, and the discharge from the nose is clear. However, the back of his throat is red and clogged with mucus. His eyes are lifeless, and the conjunctiva around them is a pinkish hue. It seems as though the right tympanic membrane is inflamed and red. The lymph nodes in the patient’s right cervical region appear enlarged, and they have a certain degree of tenderness.

Respiratory: Lacks acute distress, has an increased respiratory rate at the age of 28, clear breath sounds on auscultation, and speaks in complete sentences; bronchoscopy is negative. When you percussed his chest wall, you could hear a resonant tone, and his fremitus was normal and bilaterally consistent.

Cardiology: In S1 and S2, there were no murmurs, gallops, or rubs.

Lymphatics: When palpated, the lymph nodes in the right cervical region are tender.

Psychiatric: No mental issues noted.

Diagnostics/Labs (Include any labs, x-rays, or other diagnostics that are needed to develop the                 differential diagnoses.)

ASSESSMENT:

Based on the findings of the completed physical examination and the observations that were made, the following possible diagnoses can be made.

1. Common cold: The patient complains of having a stuffy nose and a sore throat, which are both symptoms of a common cold. This observation was also supported by the findings of a physical examination, which showed that the patient had swollen lymph nodes.
2. Streptococcus throat infection: The patient’s complaint of a sore throat suggests that they may have strep throat. On the other hand, symptoms like nausea, vomiting, headaches, and fever did not present themselves at any point.

iii. Rhinitis is another condition that could have been causing the patient’s symptoms, as they included stuffy nose, sore throat, and drainage from the nose. In addition to this, the patient has a history of recurrent ear infections throughout their lifetime.

1. Allergies and asthma: The patient does not have a history of allergic reactions. Nevertheless, it is possible that this condition will occur. This condition may have been the cause of the persistent cough. On the other hand, the patient does not exhibit any symptoms of wheezing, chest pain or tightness, or difficulty breathing.

Sample Answer 3 for NURS 6512 DIGITAL CLINICAL EXPERIENCE: FOCUSED EXAM: COUGH

Patient Information

Initials: Danny Riviera

Age: 38 years

Sex: Male

Race: African American

SUBJECTIVE DATA: Include what the patient tells you, but organize the information.

Chief Complaint (CC): “ I have had a cough for five days now.”

History of Present Illness (HPI): Danny is a 14-year-old African-American male who presents with the complaint of a cough for five days. The cough is wet with clear sputum. Reports coughing every couple of minutes. The cough is worse at night with no known triggering factors. The cough is not relieved by rest or upon taking water. However, it is temporarily relieved by over-the-counter cough medications. It is associated with a runny nose, ear pain, sore throat, and a little pain while swallowing. The nasal discharge is thin and clear while the right ear pain began the previous day with a severity of 3 on a scale of 0-10. There is no associated sneezing or ear discharge. Denies contact with an individual with a chronic cough.

Medications: Daily vitamin and over-the-counter cough medication that his mother gave him.

Allergies: Denies seasonal allergies and allergies to food, latex, medications, or animals.

Past Medical History (PMH): Reports frequent past pneumonia, ear infection, and cough. Denies asthma diagnosis as well as previous hospitalizations.

Past Surgical History (PSH): No previous surgeries.

Sexual/Reproductive History: No sexual debut yet.

Personal/Social History: He enjoys his studies and playing soccer. He neither smokes tobacco nor uses alcohol and other illicit drugs. However, he reports exposure to secondhand smoke as his father sometimes forgets to take cigars outside. Does not have a pet.

Immunization History: All immunizations are up to date.

Significant Family History: Both parents are alive. His father has had asthma since childhood that is well controlled with inhaler use. Mother has hypertension that is well controlled with diet and exercise. Paternal grandfather also has asthma. Paternal grandmother has type 2 diabetes and hyperlipidemia. His younger sister is alive without any known medical problems. No family history of allergies.

Review of Systems:

General: Reports frequent runny nose and fatigue. Denies fever, night sweats, weight loss, appetite loss, or chills.

            HEENT: Reports right ear pain and a history of frequent ear infections. Denies headache, ear surgeries, hearing problems, ear cracking, dizziness, watery eyes, vision problems, eye pain, eye redness, nose bleeds, sneezing, or sinus pain.

            Respiratory: Denies inhaler use, difficulty in breathing, chest pain, or chest tightness.

            Cardiovascular/Peripheral Vascular: No palpitations, orthopnea, chest pain, or peripheral edema.

Gastrointestinal: Denies anorexia, vomiting, diarrhea, abdominal pain, or constipation.

Genitourinary: No dysuria, frequency, nocturia, urgency, or hematuria.

            Psychiatric: Denies anxiety, depression, visual and auditory hallucinations, or delusions.

            Neurological: Denies headache, ataxia, syncope, convulsions, numbness, tingling, or alteration in bowel and bladder function.

Musculoskeletal: Denies muscle ache, back pain, joint pain, or joint stiffness.

Hematologic: Reports no bruising, bleeding, or anemia.

Dermatologic: Denies itching or rash.

Endocrinologic: Denies polyuria, polydipsia, heat, or cold intolerance.

            Lymphatics: No history of splenectomy. Enlarged right cervical nodes.

OBJECTIVE DATA:

            Physical Exam:

Vital signs: Blood pressure = 112/68 mmHg, temperature = 36.9 degrees Celsius, Pulse = 63 beats/minute, respiratory rate = 24 breaths/minute, saturation= 92% on room air. Height= 160cm, weight= 49 kg, BMI= 19.14

General: Fatigued appearing young boy seated on a nursing station bench.  Appropriate for her stated age and well-groomed. Appears stable. Well hydrated and of good nutritional status. No cyanosis, pallor, jaundice, or peripheral limb edema.

HEENT: Mucus membranes are moist, with clear nasal discharge. Redness, cobblestoning in the back of the throat. Eyes are dull in appearance, pink conjunctiva. The right Tympanic membrane is red and inflamed. The right cervical lymph nodes enlarged with reported tenderness.

Neck: Soft neck, normal range of motion. Right cervical lymphadenopathy.

Respiratory: Symmetrical chest that moves with respiration with no obvious chest wall deformities or scars. Tachypneic but no acute distress. Able to speak in full sentences. Breath sounds clear to auscultation. Negative bronchophony. Chest wall resonant to percussion. Expected fremitus, equal bilaterally. Spirometry: FEV1: 3.15 L, FVC 3.91L (FEV1/FVC: 80.5%).

Cardiology: Normoactive precordium. Point of maximal impulse in the fifth intercostal space in the mid-clavicular line. S1 and S2 are distinct. No murmurs, gallops, or rubs. No heaves or thrills. No peripheral limb edema.

Lymphatics: Tender right cervical lymphadenopathy. No splenomegaly.

Gastrointestinal: Symmetrical, non-distended abdomen that moves with respiration. Umbilicus everted. No surgical scars. No tenderness or organomegaly. Tympanic in all the quadrants. Bowel sounds are present.

Neurologic: GCS 15/15. Oriented to time, place, and person. Intact speech and memory. All cranial nerves were intact. Normal bulk and power of 5/5 across all muscle groups. Intact sensory function across all dermatomes. No ataxia and normal bladder and bowel function. No spinal tenderness.

Musculoskeletal: Normal muscle tone, normal bulk, power grade 5, and normal reflexes.

Psychiatric: Appropriate for his stated age, maintains eye contact, and is well groomed. Coherent speech and in a stable mood. No hallucinations or delusions. No suicidal thoughts. Good insight and judgment.

Diagnostics/Labs:  Spirometry: FEV1: 3.15 L, FVC 3.91L (FEV1/FVC: 80.5%). Spirometry is essential for the diagnosis of asthma and usually shows an obstructive pattern. Rapid antigen detection test (RADT) to exclude group A streptococcus. According to Arnold and Nizet (2018), RADT is specific to group A streptococci and treatment should be initiated following a positive test. A nasal smear is also essential to exclude allergic rhinitis. For instance, a nasal smear for patients with allergic rhinitis usually shows a large number of eosinophils. Other tests to exclude allergic rhinitis include a skin prick test and a radioallergosorbent test (RAST) (Small et al., 2018). A throat culture is also essential as it is the ideal standard for the diagnosis of bacterial pharyngitis. No diagnostic test is available for a common cold. Finally, there is no indication of an imaging study in his case.

ASSESSMENT:

Primary Diagnosis

Acute Pharyngitis. Acute pharyngitis refers to the inflammation of the mucus membranes of the oropharynx (Sykes et al., 2020). It is predominantly bacterial or viral. Less often, pharyngitis may be a result of cancer, reflux, trauma, allergies, and toxins. Danny Riviera manifests clinically with features of pharyngitis such as sore throat, cough, ear pain, discomfort in the throat, painful cervical adenopathy, and cobblestone appearance of the throat. Additionally, viral pharyngitis is frequently accompanied by rhinorrhea. Furthermore, Danny Riviera is 14 years old. According to Sykes et al. (2020), pharyngitis predominantly affects children less than 15 years of age. Uncomplicated pharyngitis is typically self-limiting and resolves within 5 to 7 days. Group A streptococcus is the most common cause of bacterial pharyngitis. Its isolation necessitates treatment due to an increased risk of life-threatening complications. A 10-day cause of oral penicillin is recommended for the eradication of streptococcus (Mustafa & Ghaffari, 2020).

Differential Diagnosis

Common Cold. Cold refers to a viral infection of the upper respiratory tract. Danny Riviera manifests clinically with features of a cold such as cough, runny nose, malaise, and sore throat (Pappas, 2018). Additional features of a cold include headache, joint pain, fever, chills, muscle aches, and stuffy nose. According to Pappas (2018), colds are usually harmless and self-limiting. Colds are frequent in children. No special tests have been developed for the diagnosis of a cold. Similarly, colds do not require treatment with medication, particularly antibiotics. However, it is elemental to note that bacterial infection may follow a viral upper respiratory tract infection.

 Acute Otitis Media

Acute otitis media refers to the inflammation of the middle ear (Wijayanti et al., 2021). According to Wijayanti et al. (2021), acute otitis media may be a complication of an upper respiratory tract infection. Danny Riviera presents with clinical features of otitis media such as ear pain and an inflamed and red tympanic membrane. Infection in acute otitis media is acquired principally via the eustachian tube (Hayashi et al., 2020). Consequently, acute otitis media is majorly seen in children. Other routes of infection include via external ear and blood-borne. Danny Riviera has a history of frequent ear and upper respiratory tract infections which predispose him to acute otitis media. Other risk factors for this condition include chronic rhinitis, sinusitis, nasal allergy, tumors of the nasopharynx, and cleft palate (Hayashi et al., 2020).

Allergic Rhinitis and Asthma

Allergic rhinitis refers to the IgE-mediated immunologic response of nasal mucosa to airborne allergens. Although Danny Riviera denies seasonal allergies or allergies to food, latex, and medication, he presents with features of allergic rhinitis including watery nasal discharge, congestion of the conjunctiva, and dull eyes. Additionally, he is genetically predisposed to allergies since his father has asthma. Perennial allergies may also manifest with frequent colds, stuffy nose, chronic cough, post-nasal drip, and hearing impairment. Finally, asthma must be ruled out in his case due to a family history of asthma.

References

Arnold, J. C., & Nizet, V. (2018). Pharyngitis. In Principles and Practice of Pediatric Infectious Diseases (pp. 202-208.e2). Elsevier. https://doi.org/10.1016/b978-0-323-40181-4.00027-x

Hayashi, T., Kitamura, K., Hashimoto, S., Hotomi, M., Kojima, H., Kudo, F., Maruyama, Y., Sawada, S., Taiji, H., Takahashi, G., Takahashi, H., Uno, Y., & Yano, H. (2020). Clinical practice guidelines for the diagnosis and management of acute otitis media in a children-2018 update. Auris, Nasus, Larynx, 47(4), 493–526. https://doi.org/10.1016/j.anl.2020.05.019

Mustafa, Z., & Ghaffari, M. (2020). Diagnostic methods, clinical guidelines, and antibiotic treatment for group A streptococcal pharyngitis: A narrative review. Frontiers in Cellular and Infection Microbiology, 10. https://doi.org/10.3389/fcimb.2020.563627

Pappas, D. E. (2018). The common cold. In Principles and Practice of Pediatric Infectious Diseases (pp. 199-202.e1). Elsevier. https://doi.org/10.1016/b978-0-323-40181-4.00026-8

Small, P., Keith, P. K., & Kim, H. (2018). Allergic rhinitis. Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2), 51. https://doi.org/10.1186/s13223-018-0280-7

Sykes, E. A., Wu, V., Beyea, M. M., Simpson, M. T. W., & Beyea, J. A. (2020). Pharyngitis: Approach to diagnosis and treatment. Canadian Family Physician Medecin de Famille Canadien, 66(4), 251–257. https://www.ncbi.nlm.nih.gov/pubmed/32273409

Wijayanti, S. P. M., Wahyono, D. J., Rejeki, D. S. S., Octaviana, D., Mumpuni, A., Darmawan, A. B., Kusdaryanto, W. D., Nawangtantri, G., & Safari, D. (2021). Risk factors for acute otitis media in primary school children: a case-control study in Central Java, Indonesia. Journal of Public Health Research, 10(1), 1909. https://doi.org/10.4081/jphr.2021.1909