Assignment 1: Case Study Assignment: Assessing the Head, Eyes, Ears, Nose, and Throat

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment.

Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes but would probably perform a simple strep test.

In this Case Study Assignment, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

To Prepare

· You will be assigned to a specific case study for this Case Study Assignment. (See below the case study)

· Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. (see exemplar as a guide and the template to use)

· Regarding the case study, you were assigned:

· Consider what history would be necessary to collect from the patient.

· Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?

· Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

CASE STUDY 2: Focused Throat Exam

Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus during the past 2 weeks, Lily figured she shouldn’t take her 3-day sore throat lightly. Your clinic has treated a few cases similar to Lily’s. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn’t sound congested.

The Assignment

1. Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study.

2. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case.

3. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

4. You are required to include at least five evidence-based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses.

5. Be sure to use correct APA 7th edition formatting.

Instructions

It will be carried out with two students working together. This is a “role play exercise,” in which one student is the student nurse, and the other will role play as a client. In this assignment, the nursing student will be demonstrating the therapeutic nurse-client relationship and analyzing the therapeutic and nontherapeutic techniques used. You will take turns in the roles.

This is not about always having therapeutic responses. It is about learning from practice and review. It is expected that you will think of other ways to respond or interact with the client that may be more therapeutic after the interaction is terminated. After the conversation is over, you will complete in IPR form.

The client roles are:

· Mr. Jones is a 69-year-old retired engineer. He was admitted to the in-patient psychiatric unit the previous day. His daughter had called the police when he locked himself in his bathroom and refused to come out. She thought he was suicidal. He was brought to the hospital by the police and was admitted on involuntary status. He has been reticent since admission but told his daughter he had no reason to live since his wife died.

· Diagnosis: Major Depressive Disorder

· Nursing Diagnosis: Risk for suicide.

· Mrs. Alvarez is a 34-year-old female who has lived in this country for the past 10 yrs. She is a stay at home mom with three small children. Her husband works two jobs to support the family. Lately, she has been extremely anxious and fears that her children will become ill or injured. This seems to be an unrealistic concern, but she has been unable to sleep well and has lost 15 lbs. in the past month. She is a voluntary admission and states she knows she needs help.

· Diagnosis: Generalized Anxiety Disorder

· Nursing Diagnosis: Ineffective coping

You will select the role you wish as a client and take turns switching roles. After the conversation, you will document the interactions using the form provided and following the guidelines instructions for each column.

IPR Form Explanation

The IPR is completed with the form to guide you, and the rubric to explain the grading process for content.

IPR Form

· The first column is for you, the nursing student’s, comments/ questions, and responses. You may want to include the introduction process. It is understandable if the initial conversation is more superficial to establish rapport. You may not want to include all of this but move on to the more focused interaction. Your nonverbal communication is included here.

· Then, the conversation will move to a focus on the client’s feelings, concerns, issues as he/she has identified them. After the introduction, it may be beneficial to establish with the client a short- term goal for the interaction.

· The second column is for the client’s comments, questions, responses. Also, the nonverbal reactions of the client are included in this column.

· The middle column is for you to write what you are thinking or feeling.

· The last two columns are for you to document the technique that you used in that portion of the conversation. If it is a non – therapeutic response, you are to write the response and think of how you could revise to more therapeutic response. You can change any response if you think of how you could have responded differently but, identify and change all non – therapeutic responses.

A research critique demonstrates your ability to critically read an investigative study. For this assignment, choose a research article related to nursing.

· Articles used for this assignment cannot be used for the other assignments (students should find new research articles for each new assignment).

· The selected articles should be original research articles. Review articles, concept analysis, meta-analysis, meta-synthesis, integrative review, and systemic review should not be used.

· Mixed-methods studies should not be used.

· Dissertations should not be used.

· Research articles shouldn’t be more then 5 years old

Your critique should include the following:

Research Problem/Purpose

· State the problem clearly as it is presented in the report.

· Have the investigators placed the study problem within the context of existing knowledge?

· Will the study solve a problem relevant to nursing?

· State the purpose of the research.

Review of the Literature

· Identify the concepts explored in the literature review.

· Were the references current? If not, what do you think the reasons are?

· Was there evidence of reflexivity in the design (qualitative)?

Theoretical Framework

· Are the theoretical concepts defined and related to the research?

· Does the research draw solely on nursing theory or does it draw on theory from other disciplines?

· Is a theoretical framework stated in this research piece?

· If not, suggest one that might be suitable for the study.

Variables/Hypotheses/Questions/Assumptions (Quantitative)

· What are the independent and dependent variables in this study?

· Are the operational definitions of the variables given? If so, are they concrete and measurable?

· Is the research question or the hypothesis stated? What is it?

Conceptual Underpinnings, Research Questions (Qualitative)

· Are key concepts defined conceptually?

· Is the philoosoophical basis, underlying tradition, conoceptual framework, or ideological orientation made explicit and is it appropriate for the problem?

· Are research questions explicitly stated? Are the questions consistent with the study’s philosophical basis, underlying tradition, conceptual framework, or ideological orientation?

Methodology

· What type of design (quantitative, qualitative, and type) was used in this study?

· Was inductive or deductive reasoning used in this study?

· State the sample size and study population, sampling method, and study setting.

· Did the investigator choose a probability or non-probability sample?

· State the type of reliability and the validity of the measurement tools (quantitative only)

Qualitative studies (answer the following questions in addition to those above except the last bulleted item)

· Were the methods of gathering data appropriate?

· Were data gathered through two or more methods to achieve triangulation?

· Did the researcher ask the right questions or make the right observations and were they recorded in an appropriate fashion?

· Was a sufficient amount of data gathered?

· Was the data of sufficient depth and richness?

Were ethical considerations addressed? Were appropriate procedures used to safeguard the rights of study participants?

Data Analysis

· What data analysis tool was used?

· Was saturation achieved? (qualitative)

· How were the results presented in the study?

· Were the data management (e.g., coding) and data analysis methods sufficiently described? (qualitative)

· Identify at least one (1) finding.

Summary/Conclusions, Implications, and Recommendations

· Do the themes adequately capture the meaning of the data?

· Did the analysis yield an insightful, provocative and meaningful picture of the phenomenon under investigation?

· Were methods used to enhance the trustworthiness of the data (and analysis) and was the description of those methods adequate?

· Are there clear explanation of the boundaries/limitations, thick description, audit trail?

· What are the strengths and limitations of the study?

· In terms of the findings, can the researcher generalize to other populations? Explain.

· Evaluate the findings and conclusions as to their significance for nursing (both qualitative and quantitative).

The body of your paper should be 4–6 double-spaced pages plus a cover page and a reference page. The critique must be attached to the article and follow APA guidelines.