PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note

Walden University PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note  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 PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note                                                      

Whether one passes or fails an academic assignment such as the Walden University PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note   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 PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note                                                    

The introduction for the Walden University PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note   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 PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note                                                    

After the introduction, move into the main part of the PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note   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 PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note                                                    

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 PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note                                                      

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 PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note

Episodic/FocusNote Template

Patient Information:

Initials: L.W

Age: 6 years

Sex: Female

Race: African American

S.

CC (chief complaint): “Ear pulling.”

HPI: L.W. is a 6-year-old AA girl whose parents brought her for assessment and treatment. They presented with a chief complaint of their child pulling her right ear and being irritable. The symptoms began three days ago and have been worsening. They also reported that she had rhinorrhea, low-grade fever, changes in appetite, and was crying.

Current Medications: Daily Omega-3 supplements.

Allergies: No food or drug allergies.

PMHx: Immunization is not up to date. The last flu vaccine was two years ago. No current chronic illnesses or frequent infections. No history of surgery.

Soc Hx: L.W. is the second-born in a family of two. She lives with both her parents and her elder brother, who is ten years old. She is in first grade and enjoys school, including playing with her classmates. She has friends both at school and at home. She enjoys painting and swimming. Her parents report limiting screen time to five hours per day.

Fam Hx: The maternal great-grandfather died from COPD and HTN at 80 years old. The paternal grandfather has HTN and a history of stroke. The parents and siblings have no chronic illnesses.

ROS:

GENERAL: Positive for irritability, low-grade fever, and reduced appetite.

HEENT: Eyes: Denies visual changes or eye pain. Ears, Nose, Throat: Positive for right ear pulling and rhinorrhea. Denies nasal congestion or sore throat.

SKIN: Denies rash or itching.

CARDIOVASCULAR: Denies chest pain, SOB, or palpitations.

RESPIRATORY: Denies cough, sputum, or wheezing.

GASTROINTESTINAL: Reports loss of appetite. Denies nausea, vomiting, abdominal pain, or diarrhea.

GENITOURINARY: Denies dysuria.

NEUROLOGICAL: Denies headache, dizziness, or muscle weakness.

MUSCULOSKELETAL: Denies muscle or back pain.

HEMATOLOGIC: Denies bleeding or easy bruising.

LYMPHATICS: No swollen nodes.

PSYCHIATRIC: No history of depression or anxiety.

ENDOCRINOLOGIC: Denies excessive sweating, cold or heat intolerance, polyuria, or polydipsia.

ALLERGIES: No history of allergies.

O.

Physical exam:

Vitals: Wt-48 pounds, Temp-100.22F, HR- 98; SPO2 98% room air.

General: The child is pleasant, well-developed, active, and shows no distress.

HEENT: Head: Symmetrical and normocephalic. Eyes:  Ears: The right tympanic membrane is red and erythematous with a loss of light reflex. Nose: Presence of clear nasal drainage. Throat: Tonsillar glands are non-inflamed.

Diagnostic results: No tests were ordered.

A.

Differential Diagnoses

Primary diagnosis Acute Otitis Media, right ear (H66. 91): Acute Otitis Media (AOM) occurs when a microbe in the middle ear causes inflammation of the mucosa, causing swelling and irritation of ossicles in the middle ear and purulent inflammatory exudates (Jamal et al., 2022). This infection of the middle ear cavity is associated with ear pain and fever, which are the most distressing symptoms in children. Jamal et al. (2022) explain that AOM leads to irritability, sleeplessness, reduced appetite, imbalance, and dizziness in young children. AOM is the primary diagnosis based on the patient’s ear pulling, fever, irritability, appetite changes, and rhinorrhea. Positive exam findings include erythematous right tympanic membrane with loss of light reflex.

Otitis media with effusion (OME), right ear (H65. 91): OME is diagnosed in children with a hearing disorder, delayed acquisition of language, difficulties at school, and behavioral and sleep disorders (Vanneste & Page, 2019). The patient’s right ear pulling could be due to problems with hearing, making OME a differential diagnosis.

Acute otitis externa (AOE), right ear (H60. 531): AOE is an acute inflammatory reaction caused by a bacterial infection that affects the sub-dermis of the external auditory canal. Clinical features include severe ear pain aggravated by pressure on the tragus or tension on the pinna (Wiegand et al., 2019). Other symptoms are fever, otorrhea, itch, swelling, and erythema of the ear canal that can cause conductive hearing loss. AOE is a differential based on the patient’s ear pulling, often caused by ear pain, fever, and erythematous right tympanic membrane.

Rhinitis (J30. 9): This is characterized by inflammation of the nasal membranes. Clinical symptoms include sneezing, nasal congestion, nasal itching, and rhinorrhea (Liva et al., 2021). The patient has rhinorrhea, making this a differential diagnosis.

P.

Diagnostic studies: Pneumatic otoscopy to distinguish acute otitis media from otitis media with effusion (Chiappini et al., 2019).

Therapeutic Interventions: Cefdinir 250mg/5mL to treat otitis media (Chiappini et al., 2019).

Zyrtec 5 ml at night for rhinorrhea.

Patient Education: The parents were educated about the importance of the influenza vaccine. They were advised to bring the child back should the symptoms fail to improve. The parents were advised to encourage the child to have bed rest to restrict head movements that increase ear pain (Gaddey et al., 2019).

Referrals: Referral to an otolaryngologist if symptoms do not improve with treatment or if the child has recurrent infections.

Follow-up visits. Follow up after one week to assess treatment progress.

Reflection. I agree with the preceptor’s treatment of AOM with Cefdinir and Zyrtec. Cefdinir is an empiric antibiotic that is comprehensive and covers all likely pathogens causing AOM (Chiappini et al., 2019). I learned from the case that AOM diagnosis in children can be problematic because symptoms and indicators are not always conclusive, and physical examination can be challenging in this age group (Gaddey et al., 2019).In a different case, I would prescribe an analgesic and antipyretic for symptomatic management of ear pain and fever. Health promotion and disease prevention for this patient should focus on adhering to immunization. Pneumococcal vaccines have been found effective in decreasing the incidence of AOM in children. Thus, the parents should be educated on the importance of having the child undergo all vaccinations to reduce the incidence of future AOMs.

 References

Chiappini, E., Ciarcià, M., Bortone, B., Doria, M., Becherucci, P., Marseglia, G. L., Motisi, M. A., de Martino, M., Galli, L., Licari, A., De Masi, S., Lubrano, R., Bettinelli, M., Vicini, C., Felisati, G., Villani, A., Marchisio, P., & Italian Panel for the Management of Acute Otitis Media in Children (2019). Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Diagnosis. The Pediatric Infectious Disease Journal, 38(12S Suppl), S3–S9. https://doi.org/10.1097/INF.0000000000002429

Gaddey, H. L., Wright, M. T., & Nelson, T. N. (2019). Otitis media: rapid evidence review. American Family Physician, 100(6), 350–356.

Jamal, A., Alsabea, A., Tarakmeh, M., & Safar, A. (2022). Etiology, Diagnosis, Complications, and Management of Acute Otitis Media in Children. Cureus, 14(8). doi: 10.7759/cureus.28019

Liva, G. A., Karatzanis, A. D., & Prokopakis, E. P. (2021). Review of Rhinitis: Classification, Types, Pathophysiology. Journal of Clinical Medicine, 10(14), 3183. https://doi.org/10.3390/jcm10143183

Vanneste, P., & Page, C. (2019). Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review. Journal of Otology, 14(2), 33–39. https://doi.org/10.1016/j.joto.2019.01.005

Wiegand, S., Berner, R., Schneider, A., Lundershausen, E., & Dietz, A. (2019). Otitis Externa. Deutsches Arzteblatt international, 116(13), 224–234. https://doi.org/10.3238/arztebl.2019.0224

Sample Answer 2 for PRAC 6531 WEEK 3 Episodic Visit: HEENT Focused Note

Patient Information:

Initials: E.F.               Age: 8 years old                   Sex: Female             Race: Caucasian

S.

CC (chief complaint): “Symptoms of the upper respiratory tract.”

HPI: E.F., an 8-year-old girl of Caucasian/White ethnicity, is accompanied by her mother to assess symptoms related to the upper respiratory tract. The patient exhibits signs of nasal congestion, pharyngitis, unproductive cough, and pyrexia. The fever manifested yesterday evening, reaching a maximum recorded temperature of 102. The patient had throat pain 24 hours ago, characterized by moderate irritation. The cough was first noticed 48 hours ago. The patient has a cephalalgia. There have been no recorded occurrences of sickness, diarrhea, or rash. The patient’s mother has not disclosed any mitigating circumstances. The patient’s medical history revealed a detrimental outcome from a self-administered Covid test performed three days ago.

Location: The head and neck

Onset: two days beforehand

Character: irritable cough with a moderate intensity

Associated signs and symptoms: fever, sore throat, nonproductive cough, and nasal congestion

Timing: worse throughout the evening

Exacerbating/relieving factors: None

Severity: 5/10 pain scale

Current Medications: The patient administers Amoxicillin 400mg/5ml oral suspension orally, taking 5 ml thrice daily.

Allergies: None

PMHx: The patient has recently been immunized. Prior diagnoses or surgical operations are not included in the patient’s medical history.

Soc & Substance Hx: The patient lives with her 12-year-old sister and parents. Her father, a 45-year-old architect, works in the family business. The patient’s mother is a nurse practitioner who is 39 years old. The mother claims to have delivered her child vaginally at 38 weeks gestation, taken prenatal vitamins regularly and had no complications throughout her pregnancy. The patient’s mother said that no drugs were used in the family. She sometimes confesses to drinking alcohol, which she safely hides and conceals. The person lives with a cat and a dog.

Fam Hx: The paternal grandpa died of cervical cancer at the age of 68. The maternal grandma, who is 77 years old, suffers from hypercholesterolemia. The client’s maternal grandpa died of a heart attack at the age of 69. Diabetes has been diagnosed in the maternal grandma, who is 63 years old. The father is 45 years old and in excellent health. The mother, 39 years old, has no known medical problems. There have been no known health difficulties with your brother.

Surgical Hx: None.

Mental Hx: The patient denies experiencing anxiety or depression. Denies ever engaging in self-harming acts or contemplating suicide or murder.

Violence Hx: None

Reproductive Hx: The patient was delivered vaginally as predicted. There were no reports of HIV/STIs.

ROS:

GENERAL: There have been complaints of mild throat pain that started a day ago and felt itchy. There have been reports of fever and headache. Denies being overweight, fatigued, or worn out.

HEENT: Eyes: denies the presence of double eyesight, yellow eye, or visual loss. Ears, Nose, and Throat: The patient has a painful throat and nasal congestion.

SKIN: denies the existence of any rash or itching.

CARDIOVASCULAR: denies experiencing chest pressure, pain, or discomfort. There is no swelling or palpitations.

RESPIRATORY: denies having breathing problems. An ineffectual cough has been reported.

GASTROINTESTINAL: claims no vomiting, constipation, or anorexia. Denies experiencing stomach pain or blood.

GENITOURINARY: denies Urinary Urgency or Burning.

NEUROLOGICAL: There has been a complaint of a headache. Denies feeling lightheaded, suffering syncope, paralysis, vertigo, or tingling in the digits. Denies any change in bladder or bowel control.

MUSCULOSKELETAL: The patient denies having stiffness, joint pain, back pain, or muscle pain.

HEMATOLOGIC: Refuses to admit bruises, bleeding, or anemia.

LYMPHATICS: Denies having a large number of nodes. There is no past splenectomy history.

PSYCHIATRIC: rejects a concern or sadness-filled history.

ENDOCRINOLOGIC: disputes heat, cold, or sweat intolerance claims. There was no polydipsia or polyuria.

REPRODUCTIVE: prevents vaginal leaking. I’m not a sexual being.

ALLERGIES: denies ever suffering from hay fever, hives, acne, or asthma.

O.

Physical exam:

Vitals: BP: 97/65,  R 19, P 113, T 98: Weight: 41 lbs 0 oz. Height: 3′ 8.8″ BMI: 14.36 (75^th Percentile), BSA 0.77

General: The patient is not currently at risk. Demonstrates appropriate engagement and participation during examinations.

HEENT: The individual has a typical cranial morphology and no history of physical injury—absence of discharge. The conjunctiva appears clear in both eyes. A bullous lesion is present in the right ear at approximately 11 o’clock without accompanying redness. The auditory system is generally resilient to damage. The nose does not exhibit any visible lesions, mucosal inflammation, or abnormalities in the septum and turbinates. The throat exhibits minor edema and exudates. The tonsils have become enlarged. The nostrils exhibit signs of swelling and redness. The oral cavity’s mucous membranes are moist and devoid of any lesions.

Cardiac: Consistent rhythm and rate. S1 and S2 were heard without any audible sounds of movement or friction.

Respiratory: Bilateral breath sounds are symmetrical, precise, and balanced, without rhonchi, rales, or wheezes. There is no necessity to exert additional effort to inhale and exhale.

Neck: The neck exhibits the full range of motion, is free from lymphadenopathy, and demonstrates flexibility.

Skin: Skin appears normal with no signs of rash or excessive dryness. Capillary refill time is less than 2 seconds.

Neuro: Neurological examination reveals regular and symmetrical tone and strength. Provide appropriate responses to inquiries. The speech exhibits audibility and clarity, albeit with slight slurring.

Musculoskeletal: Upper limb tension without contractile limitations. The individual maintains a stable stance, with a slight inward rotation of the left foot.

Diagnostic results: The diagnostic results indicate a positive result for the strep test swab. The recommended code for rapid streptococcal testing is 87880.

A.

Differential Diagnoses

• J02.0 Streptococcal Pharyngitis: Common signs and symptoms of streptococcal pharyngitis include throat pain, fever, tonsillar exudates, and cervical adenopathy (Sauve et al., 2021). The patient exhibits symptoms such as nasal congestion, sore throat, non-productive cough, and fever, consistent with this specific diagnosis. A positive Strep test swab confirms the diagnosis.
• J11. 1 Influenza: Influenza is a respiratory illness due to viral respiratory tract infection caused by seasonal influenza A and B viruses, widespread worldwide (Javanian et al., 2021). Rapid antigen-detection assays at the point-of-care (PoC) in upper respiratory tract specimens can identify influenza viral proteins.
• J20. 9 Acute bronchitis: Acute bronchitis is distinguished by temporary inflammation of the bronchi the lower airways within the lungs (Di Mauro et al., 2019). The patient documented various symptoms frequently correlated with acute bronchitis, such as hoarse throat, chest pain, congested nose, fatigue, body pains, headache, shivers, and mild fever.
• B08.5 Herpangina: A common condition observed during infancy frequently ascribed to group A coxsackie viruses. Herpangina is classified as a viral infection that predominantly impacts children and adolescents aged three to ten (Yu et al., 2019). Due to the unique attributes exhibited by herpanginal lesions, a diagnosis can frequently be established solely through physical inspection.
• J05. 10 Acute Epiglottitis: This is a life-threatening condition characterized by tissue inflammation surrounding the trachea. Epiglottitis is commonly associated with an infectious cause (Allen et al., 2021). Flexible fiberoptic laryngoscopy is utilized in the diagnostic process to establish a definitive diagnosis.

Primary Diagnosis: J02.0 Streptococcal Pharyngitis

Medication: The patient initiated treatment with Amoxicillin, taking 5 ml of the 400mg/5ml oral suspension orally thrice daily. Penicillin or amoxicillin is the recommended antibiotic for treating group A streptococcal pharyngitis. Ibuprofen liquid, specifically at a concentration of 100 mg/5 ml, is utilized for treating fever as needed, as stated by Di Muzio et al. (2020).

Non-pharmacological interventions: Sore throats may be relieved by eating cold items like ice pops and drinking warm liquids like broth, tea without caffeine, or warm water with honey.

Education: To promote a favorable therapeutic outcome, provide the patient’s mother with guidance on the appropriate administration of antibiotics.

Health Promotion: Provide recommendations to the patient’s mother regarding optimal activities and dietary choices for her child. Luo et al. (2019) argue that Bright Futures for Children promotes the holistic well-being of children, with a focus on nutrition, health, safety, security, and early education from birth.

Referral: Refer the patient to an otolaryngologist for additional evaluation (Di Muzio et al., 2020).

Follow-up: After four weeks, the patient should make another visit to the clinic to assess the effectiveness of the treatment.

Reflection: Nurses are instructed to comply with the nursing code of ethics when providing care, considering various patient demographics, such as race and ethnicity, along with other factors. Regarding a minor patient, the mother is bestowed with the power to make medical decisions on behalf of her kid. Tanz et al. (2020) recommend educating the mother about appropriate antibiotic use to mitigate antibiotic resistance and improve treatment efficacy. The mother should be instructed about health promotion techniques, including the significance of maintaining a well-balanced diet, ensuring enough sleep for the kid, and engaging in regular physical exercise.

References

Allen, M., Meraj, T. S., Oska, S., Spillinger, A., Folbe, A. J., & Cramer, J. D. (2021). Acute epiglottitis: Analysis of U.S. mortality trends from 1979 to 2017. American Journal of Otolaryngology, 42(2), 102882. https://doi.org/10.1016/j.amjoto.2020.102882

Di Mauro, Ammirabile, Quercia, Panza, Capozza, Manzionna, & Laforgia. (2019). Acute Bronchiolitis: Is There a Role for Lung Ultrasound? Diagnostics, 9(4), 172. https://doi.org/10.3390/diagnostics9040172

Di Muzio, I., d’Angelo, D. M., Di Battista, C., Lapergola, G., Zenobi, I., Marzetti, V., Breda, L., & Altobelli, E. (2020). Pediatrician’s approach to diagnosis and management of group A streptococcal pharyngitis. European Journal of Clinical Microbiology & Infectious Diseases, 39(6), 1103–1107. https://doi.org/10.1007/s10096-020-03821-y

Javanian, M., Barary, M., Ghebrehewet, S., Koppolu, V., Vasigala, V., & Ebrahimpour, S. (2021). A brief review of influenza virus infection. Journal of Medical Virology, 93(8), 4638–4646. https://doi.org/10.1002/jmv.26990

Luo, R., Sickler, J., Vahidnia, F., Lee, Y.-C., Frogner, B., & Thompson, M. (2019). Diagnosis and Management of Group a Streptococcal Pharyngitis in the United States, 2011–2015. BMC Infectious Diseases, 19(1). https://doi.org/10.1186/s12879-019-3835-4‌

Sauve, L., Forrester, A. M., & Top, K. A. (2021). Group A streptococcal pharyngitis: A practical guide to diagnosis and treatment. Paediatrics & Child Health, 26(5), 319–319. https://doi.org/10.1093/pch/pxab025

Tanz, R. R., Gewitz, M. H., Kaplan, E. L., & Shulman, S. T. (2020). Stay the Course: Targeted Evaluation, Accurate Diagnosis, and Treatment of Streptococcal Pharyngitis Prevent Acute Rheumatic Fever. The Journal of Pediatrics, 216, 208–212. https://doi.org/10.1016/j.jpeds.2019.08.042

Yu, H., Li, X.-W., Liu, Q.-B., Deng, H.-L., Liu, G., Jiang, R.-M., Deng, J.-K., Ye, Y.-Z., Hao, J.-H., Chen, Y.-H., Nong, G.-M., Shen, Z.-B., Liu, C.-S., Zou, Y.-X., Wu, J.-Z., Wu, X.-D., Chen, B.-Q., Luo, R.-P., Lin, A.-W., & Chen, Y. (2019). Diagnosis and treatment of herpangina: Chinese expert consensus. World Journal of Pediatrics, 16(2), 129–134. https://doi.org/10.1007/s12519-019-00277-9