PLEASE READ CAREFULLY must be done by tonight

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USW1.575.202130 - NURS-6512C-1/NURS-6512D-1/NURS-6512N-1-Advanced Health Assessment2020 Winter Qtr 11/30-02/21-PT27

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Monica Castelao on Wed, Jan 06 2021, 3:32 AM 68% highest match Submission ID: bb56b440-40e4-4e90-8c80-18bff0b840f6

Week5Castelao.M.extention.docx
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Running head: FOCUSED EAR EXAMINATION 1 FOCUSED EAR EXAMINATION 5 Focused Ear Examination Monica Castelao Walden University 1 Focused Ear Examination

Suspected Entry: 63% match Uploaded - Week5Castelao.M.extention.docx Focused Ear Examination Source - Another student's paper Focused Ear Exam Patient Information: 2 JK is an 11 year old male African American

Suspected Entry: 65% match Uploaded - Week5Castelao.M.extention.docx JK is an 11 year old male African American Source - Another student's paper The patient is an 11-year-old African American male brought into the clinic by his grandmother S 3 Chief Complaint (CC):

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx Chief Complaint (CC) Source - Another student's paper CC (chief complaint) 4 I have had a mild earache for the past 2 days

Suspected Entry: 68% match Uploaded - Week5Castelao.M.extention.docx I have had a mild earache for the past 2 days Source - Another student's paper “Mild earache for the past two days” HPI: Location: Right ear Onset: 3 2 days ago

Suspected Entry: 99% match Uploaded - Week5Castelao.M.extention.docx 2 days ago Source - Another student's paper 2 days ago Character: Aching 3 Associated signs and symptoms:

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx Associated signs and symptoms Source - Another student's paper Associated signs and symptoms 5 Pain when falling asleep and hearing difficulty.

Suspected Entry: 89% match Uploaded - Week5Castelao.M.extention.docx Pain when falling asleep and hearing difficulty Source - Another student's paper difficulty hearing, pain worsen when falling asleep Timing: 5 Troubling all the time

Suspected Entry: 64% match Uploaded - Week5Castelao.M.extention.docx Troubling all the time Source - Another student's paper all the time 6 Exacerbating/ relieving factors:

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx Exacerbating/ relieving factors Source - Another student's paper Exacerbating/ relieving factors Going to sleep worsens the situation. Paracetamol relieves the pain. Severity: 1 5/10 pain scale

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx 5/10 pain scale Source - Another student's paper 5/10 pain scale Current Medication: 7 Over the counter paracetamol 200 mg, 1 tablet after every 8 hours for pain relief.

Suspected Entry: 67% match Uploaded - Week5Castelao.M.extention.docx Over the counter paracetamol 200 mg, 1 tablet after every 8 hours for pain relief Source - Another student's paper Ibuprofen 200 mg, 1 tablet every 8 hours Allergies: None PMHx: All immunizations up-to-date, including recent tetanus and influenza shots received in November 2020. 5 No previous hospitalizations except at birth, which was uneventful.

Suspected Entry: 63% match Uploaded - Week5Castelao.M.extention.docx No previous hospitalizations except at birth, which was uneventful Source - Another student's paper no previous hospitalizations except for birth (no complications) No surgeries. Soc Hx: Lives with grandmother alongside his brother after the loss of his parents in 2017 due to car accident. The grandmother is a retired k-12 teacher. He enjoys swimming and outdoor games. He is not exposed to secondhand cigarette smoke. The grandmother quit drinking alcohol in 2016 after a long history of alcoholism. James usually wears seat belt and does not need booster seat when travelling. He only uses the back seat of a car when travelling in their family car. The grandmother does not use text or mobile phone while driving. 8 The family has working smoke and carbon dioxide detectors.

Suspected Entry: 62% match Uploaded - Week5Castelao.M.extention.docx The family has working smoke and carbon dioxide detectors Source - Another student's paper Working smoke and carbon monoxide detectors in house They live in a quiet middle class neighborhood and take part in local activities such as cleaning their church compound. Fam Hx: Older brother died in 2015 at age of 9 years due to malignant neoplasm. Grandfather died in 2010 aged 60 years due to type 2 diabetes. ROS General: 9 No fatigue, weakness, fever, and weight loss

Suspected Entry: 84% match Uploaded - Week5Castelao.M.extention.docx No fatigue, weakness, fever, and weight loss Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ No weight loss, fever, chills, weakness or fatigue HEENT: Eyes: 3 no blurred vision, yellow sclera, loss of sight or double vision.

Suspected Entry: 87% match Uploaded - Week5Castelao.M.extention.docx no blurred vision, yellow sclera, loss of sight or double vision Source - Another student's paper No visual loss, blurred vision, double vision or yellow sclera 9 Ears, Nose, Throat:

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx Ears, Nose, Throat Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ Ears, Nose, Throat 8 Hearing difficulty in the right ear for the past 2 days.

Suspected Entry: 70% match Uploaded - Week5Castelao.M.extention.docx Hearing difficulty in the right ear for the past 2 days Source - Another student's paper Difficulty hearing to right ear x2 days 1 No sneezing, sore throat, runny nose, and/or congestion.

Suspected Entry: 98% match Uploaded - Week5Castelao.M.extention.docx No sneezing, sore throat, runny nose, and/or congestion Source - Another student's paper no sneezing, congestion, runny nose or sore throat SKIN: 9 No itching or rashes

Suspected Entry: 64% match Uploaded - Week5Castelao.M.extention.docx No itching or rashes Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ No rash or itching CARDIOVASCULAR: 9 No chest discomfort, chest pain, and chest pressure.

Suspected Entry: 94% match Uploaded - Week5Castelao.M.extention.docx No chest discomfort, chest pain, and chest pressure Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ No chest pain, chest pressure or chest discomfort 4 No edema and palpitation.

Suspected Entry: 86% match Uploaded - Week5Castelao.M.extention.docx No edema and palpitation Source - Another student's paper No palpitation or edema RESPIRATORY: 4 No cough or shortness of breath

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx No cough or shortness of breath Source - Another student's paper No shortness of breath or cough GASTROINTESTINAL: 9 No nausea, diarrhea, vomiting, and anorexia.

Suspected Entry: 92% match Uploaded - Week5Castelao.M.extention.docx No nausea, diarrhea, vomiting, and anorexia Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ No anorexia, nausea, vomiting or diarrhea 10 No abdominal pain GENITOURINARY:

Suspected Entry: 80% match Uploaded - Week5Castelao.M.extention.docx No abdominal pain GENITOURINARY Source - Another student's paper No abdominal pain 9 No burning urination

Suspected Entry: 89% match Uploaded - Week5Castelao.M.extention.docx No burning urination Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ No burning on urination MUSCULOSKELETAL: 3 No muscle, back pain, joint pain, and stiffness.

Suspected Entry: 93% match Uploaded - Week5Castelao.M.extention.docx No muscle, back pain, joint pain, and stiffness Source - Another student's paper No muscle, back pain, joint pain or stiffness HEMATOLOGIC: No bleeding. Minor bruising to right elbow LYMPHATICS: 11 No enlarged nodes and history of splenectomy

Suspected Entry: 82% match Uploaded - Week5Castelao.M.extention.docx No enlarged nodes and history of splenectomy Source - Another student's paper No history of splenectomy or enlarged nodes · ENDOCRINOLOGIC PSYCHIATRIC: 9 No history of depression and anxiety

Suspected Entry: 88% match Uploaded - Week5Castelao.M.extention.docx No history of depression and anxiety Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ No history of depression or anxiety ENDOCRINOLOGIC: 9 No reports of cold, heat intolerance, and sweating.

Suspected Entry: 93% match Uploaded - Week5Castelao.M.extention.docx No reports of cold, heat intolerance, and sweating Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ No reports of sweating, cold or heat intolerance No reports of polyuria or polydipsia.

Suspected Entry: 84% match Uploaded - Week5Castelao.M.extention.docx No reports of polyuria or polydipsia Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ No polyuria or polydipsia ALLERGIES: 9 No history of rhinitis, eczema, and asthma as well as hives.

Suspected Entry: 82% match Uploaded - Week5Castelao.M.extention.docx No history of rhinitis, eczema, and asthma as well as hives Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ No history of asthma, hives, eczema or rhinitis O Physical Examination: EENT: 1 Non reddened eyes and normal sclera.

Suspected Entry: 97% match Uploaded - Week5Castelao.M.extention.docx Non reddened eyes and normal sclera Source - Another student's paper Eyes non reddened, normal sclera 5 Visualize external auditory canal and the middle ear using otoscope, with results showing mild redness with serous fluid and no pearly white lesions.

Suspected Entry: 84% match Uploaded - Week5Castelao.M.extention.docx Visualize external auditory canal and the middle ear using otoscope, with results showing mild redness with serous fluid and no pearly white lesions Source - Another student's paper use otoscope visualized external auditory canal and middle ear showing mild redness and bulging, with serous fluid, no pearly white lesions 12 No facial grimace and drainage from ears.

Suspected Entry: 69% match Uploaded - Week5Castelao.M.extention.docx No facial grimace and drainage from ears Source - Another student's paper Upon further investigation, no signs of facial grimace and no drainage from his ears 3 The patient is not tugging on his ears or demonstrating signs of distress.

Suspected Entry: 66% match Uploaded - Week5Castelao.M.extention.docx The patient is not tugging on his ears or demonstrating signs of distress Source - Another student's paper Patient is not pulling or tugging on ear, or showing signs of distress Nose: 5 No congestion, drainage, soreness, or redness.

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx No congestion, drainage, soreness, or redness Source - Another student's paper No redness, congestion, drainage or soreness 3 No enlarged nodes or sore throat with swallowing.

Suspected Entry: 88% match Uploaded - Week5Castelao.M.extention.docx No enlarged nodes or sore throat with swallowing Source - Another student's paper No sore throat with swallowing, or enlarged nodes, no redness Diagnostic results: The patient is not feverish at 37.20 c. Though not breastfed, he takes pacifiers 13 Otoscope used to visualize external auditory canal and the middle ear.

Suspected Entry: 95% match Uploaded - Week5Castelao.M.extention.docx Otoscope used to visualize external auditory canal and the middle ear Source - Another student's paper Otoscope to visualize external auditory canal, and middle ear 14 The patient has intact hearing after checking cranial nerve V111.

Suspected Entry: 66% match Uploaded - Week5Castelao.M.extention.docx The patient has intact hearing after checking cranial nerve V111 Source - Another student's paper Hearing evaluated to check cranial nerve V111:intact 15 Results from Weber and Rinne tests showed that the patient could hear whispered sound.

Suspected Entry: 63% match Uploaded - Week5Castelao.M.extention.docx Results from Weber and Rinne tests showed that the patient could hear whispered sound Source - Another student's paper Patient was able to hear whispered voice according Weber and Rinne tests Left Weber had better hearing. 12 Rinne tests demonstrated air heard longer with slight variation to the right side.

Suspected Entry: 64% match Uploaded - Week5Castelao.M.extention.docx Rinne tests demonstrated air heard longer with slight variation to the right side Source - Another student's paper Rinne test (positive) showed air heard longer, a slight difference to the right side Weber and Rinne tests help in detecting hearing problems (Ball et al., 2015). 7 Pneumatic otoscopy Tympanogram tests carried out to detect otitis media with effusion

Suspected Entry: 71% match Uploaded - Week5Castelao.M.extention.docx Pneumatic otoscopy Tympanogram tests carried out to detect otitis media with effusion Source - Another student's paper Pneumatic otoscopy Tympanogram used to check for otitis media with effusion 3 Answers to Key Questions:

Suspected Entry: 91% match Uploaded - Week5Castelao.M.extention.docx Answers to Key Questions Source - Another student's paper Key questions and answers Patient reported swimming at least three times a day, hitting the water hard a few times, and landing on his right side quite often. He denied cleaning and swabbing his ears, without the help of his grandmother. 1 No history of excessive earwax and putting objects in the ear.

Suspected Entry: 66% match Uploaded - Week5Castelao.M.extention.docx No history of excessive earwax and putting objects in the ear Source - Another student's paper No history of placing objects in ears, or excessive earwax 16 He reports muffed sounds on right ear but can hear well and denies dizziness.

Suspected Entry: 68% match Uploaded - Week5Castelao.M.extention.docx He reports muffed sounds on right ear but can hear well and denies dizziness Source - Another student's paper He reports that ear sounds are slightly more muffled on the right side, but he can hear good, denies ringing, dizziness He can repeat simple sentences without any hesitation and does not appear to have hearing difficulties.

Suspected Entry: 64% match Uploaded - Week5Castelao.M.extention.docx He can repeat simple sentences without any hesitation and does not appear to have hearing difficulties Source - Another student's paper Does not turn head when listening or appear to have difficulty hearing and can repeat back simple sentences without hesitation (Dains et al., 2016) A Differential Diagnosis Primary Diagnosis: 3 Acute otitis media.

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx Acute otitis media Source - Another student's paper Acute Otitis Media Although he is not feverish, Marchisio et al. (2019) associate acute otitis media with symptoms such as reddening of ears and ear pains. Differential Diagnosis: Ear trauma: While there is no perforation, this may have occurred during swimming. Dains, Baumann, and Scheibel (2016) indicate that blunt trauma and no vertigo can lead to ear trauma 3 Middle ear effusion:

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx Middle ear effusion Source - Another student's paper Middle ear effusion Common symptoms of middle ear effusion include serous fluid and rightward lateralization, which can occur due to occluded ear (Ball et al., 2015). Cholesteatoma: This infection is associated with hearing difficulties but no loss of hearing and perforations (Gulati et al., 2019). References Ball, J. 14 W., Dains, J.

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx W., Dains, J Source - Another student's paper W., Dains, J E., Flynn, J.

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx E., Flynn, J Source - Another student's paper E., Flynn, J A., Solomon, B.

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx A., Solomon, B Source - Another student's paper A., Solomon, B S., & Stewart, R.

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx S., & Stewart, R Source - Another student's paper S., Stewart, R W. (2015). 14 Siedel’s guide to physical examinations (8th ed.).

Suspected Entry: 64% match Uploaded - Week5Castelao.M.extention.docx Siedel’s guide to physical examinations (8th ed.) Source - Another student's paper Seidel's guide to physical examination (8th ed.) St. Louis, MO: Elsevier Mosby. Dains, J. 17 E., Baumann, L.C., & Scheibel, P.

Suspected Entry: 66% match Uploaded - Week5Castelao.M.extention.docx E., Baumann, L.C., & Scheibel, P Source - Another student's paper Dains, J., Baumann, L., & Scheibel, P (2016). 9 Advanced health assessment and clinical diagnosis in primary care (5th ed.).

Suspected Entry: 100% match Uploaded - Week5Castelao.M.extention.docx Advanced health assessment and clinical diagnosis in primary care (5th ed.) Source - https://besthomeworkhelp.org/assessing-neurological-symptoms/ Advanced health assessment and clinical diagnosis in primary care (5th ed.) St. Louis, MO: Elsevier Mosby Gulati, M., Gupta, S., Prakash, A., Garg, A., & Dixit, R. (2019). HRCT imaging of acquired cholesteatoma: A pictorial review. Insights into Imaging, 10(1), 1-8. Marchisio, P., Bortone, B., Ciarcià, M., Motisi, M. A., Torretta, S., Gattinara, G. C.,. & Varricchio, A. (2019). 18 Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics:

Suspected Entry: 95% match Uploaded - Week5Castelao.M.extention.docx Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics Source - Another student's paper Updated guidelines for the management of acute otitis media in children by the Italian society of pediatrics diagnosis Prevention. 19 The Pediatric Infectious Disease Journal, 38(12), 22-36.

Suspected Entry: 64% match Uploaded - Week5Castelao.M.extention.docx The Pediatric Infectious Disease Journal, 38(12), 22-36 Source - Another student's paper Pediatric Infectious Disease Journal, 38, S3-S9