NR 603 APEA Predictor Case Study Discussion Part 1
University:
Chamberlain University
NR 603 APEA Predictor Case Study Discussion Part 1
Paper Instructions
Preparing the Assignment
Follow these guidelines when completing each component of the assignment. Contact your course faculty if you have questions.
Include the Following Sections;
Application of Course Knowledge
Review the results of your APEA predictor exam. Identify the knowledge area in which your score was the lowest.
Create an original case study based on a common chief complaint seen in clients in primary care settings in the body system related to the lowest-scoring knowledge area. Select a chief complaint not already covered in this term’s i-Human case studies.
Case study requirements
Include the chief complaint, demographics, previous medical history (PMHx), previous surgical history (PSHx), allergies, lifestyle, history of present illness (HPI).
- Analyze associated risk factors/demographics that contribute to the chief complaint and differential diagnoses
- List three common differential diagnoses for the chief complaint, including pathophysiology and rationale, from the topic area identified on the APEA exam.
- Discuss how the three differential diagnoses differ from each other in occurrence, pathophysiology, and presentation. Your discussion should compare and contrast these diagnoses rather than listing them.
- Describe relevant testing required to diagnose/evaluate the severity of the three differential diagnoses.
- Present applicable national guidelines related to diagnosis and diagnostic testing for the differential diagnoses.
Integration of Evidence
Integrate relevant scholarly sources as defined by program expectations. Links to an external site.
- Cite a scholarly source in the initial post.
- Cite a scholarly source in one faculty response post.
- Cite a scholarly source in one peer post.
Accurately analyze, synthesize, and/or apply principles from evidence with no more than one short quote (15 words or less) for the week.
Include a minimum of two different scholarly sources per week. Cite all references and provide references for all citations.
Engagement in Meaningful Dialogue
Engage peers and faculty by asking questions, and offering new insights, applications, perspectives, information, or implications for practice.
Peer Response
- Respond to at least one peer. Substantive posts contribute new, novel perspectives to the discussion using original dialogue (not quotes from sources).
Faculty Response
- Respond to all questions posed directly to the student.
Communicate using respectful, collegial language and terminology appropriate to advanced nursing practice.
Professionalism in Communication
Communicate with minimal errors in English grammar, spelling, syntax, and punctuation.
Reference Citation
Use current APA format to format citations and references and is free of errors.
Tuesday Participation Requirement
Provide a substantive response to the graded discussion question(s) or topic(s), posted by the course faculty (not a response to a peer), by Tuesday, 11 59 p.m. MT of each week.
Total Participation Requirement
Provide at least three substantive posts (one to the initial question or topic, one to a student peer, and one to a faculty question) on two different days during the week.
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Sample Answer
The area where I had the lowest score based on the APEA predictor exam results is Eye, Ear, Nose and Throat. The purpose of this paper is to present a case study of a patient with a chief complaint involving the Eye, Ear, Nose, and Throat.
C.C
Humming sound in the ear and a spinning sensation
HPI
A.D. is a 29-year-old White female who presents with a chief complaint of a humming sound in the ear and a spinning sensation. She has been experiencing attacks characterized by tinnitus, a sensation of spinning, and temporary hearing loss in the right ear. The attacks started seven days ago, each lasting 1-2 hours. She describes tinnitus as a humming sound in the ears, exacerbating before and during an attack. Besides, she reports that the spinning sensation is often severe, and she feels like she is about to fall.
The sensation is so intense that even when lying down, she holds the bed or ground to avoid falling. The hearing loss started with low-frequency tones but has worsened after recurring episodes. The patient states that the attacks are associated with nausea, vomiting, rapid eye movements, and generalized headaches. The attacks have no aggravating or alleviating factors. The attacks have no specific timing and occur at any time. She reports that the attacks are so severe that they leave her almost totally incapacitated.
Previous medical history
No chronic illnesses.
Previous surgical history
Adenoidectomy at 7 years.
Allergies
No drug/food allergies.
Lifestyle
Sales representative; Married; 2 children, 5 and 2 years. Report ETOH (3-4 beers on most days); Smoke 1PPD. Hobbies are traveling and swimming.
Differential Diagnoses
Meniere’s Disease
It presents with tinnitus, one-sided sensorineural hearing loss, and vertigo. This is caused by overproduction or reduced reabsorption of endolymphatic fluid, which results in the distortion of the entire inner canal system. This distortion impairs hearing by dilating the cochlear duct (Kutlubaev et al., 2020). It also causes vertigo due to the damage to the vestibular system and contributes to tinnitus.
Other common manifestations include nausea and vomiting, rapid eye movements, and severe headaches (Kutlubaev et al., 2020). Meniere differs from vertigo and labyrinthitis in that the vertigo attacks are usually intense and often accompanied by nausea and vomiting, rapid eye movements, and headaches. Meniere’s disease is a differential diagnosis, given that the patient reports having attacks characterized by one-sided hearing loss, tinnitus, and vertigo.
Labyrinthitis
This is an infection of the labyrinth that can be caused by a complication of acute or chronic otitis media. The infection is caused by an erosion of the bony capsule, which allows microbes to invade the inner ear. Like Meniere’s disease, labyrinthitis presents with tinnitus, hearing loss, rapid eye movements to the affected side, and vertigo with nausea and vomiting (Taxak & Ram, 2020).
However, it differs from Meniere because it often occurs with an upper respiratory infection or mononucleosis. The patient has positive symptoms like tinnitus, unilateral hearing loss, and vertigo accompanied with nausea and vomiting.
Vertigo
Vertigo is a sensation of whirling or turning in space. Problems in either the visual, vestibular, or proprioceptive systems lead to a disturbed sense of balance and motion, causing vertigo. It presents with symptoms common in Meniere’s disease and labyrinthitis, such as nausea, vomiting, nystagmus, hearing loss, and tinnitus (Turner et al., 2020). Patients with vertigo have incidences of falls, which differentiate them from others. The patient has vertigo with tinnitus, hearing loss, nausea, and vomiting, making this a differential diagnosis.
Relevant Testing
Meniere’s Disease
Audiometry can be used to document the patient’s current hearing acuity and detect future changes. Multiple audiometry tests help to document fluctuating hearing loss and facilitate diagnosing Meniere (Kutlubaev et al., 2020).
Labyrinthitis
No specific tests are available to diagnose labyrinthitis. However, if middle ear effusions are present, culture and sensitivity testing is recommended (Taxak & Ram, 2020).
Vertigo
Electronystagmography (ENG) can be used to measure the changes in the electrical field within the eye and detect involuntary rapid eye movement in a patient in response to various stimuli (Saha et al., 2023).
References
- Kutlubaev, M. A., Pyykko, I., Hardy, T. A., & Gürkov, R. (2020). Menière’s disease. Practical Neurology, practneurol-2020-002734. Advance online publication. https //doi.org/10.1136/practneurol-2020-002734
- Saha, S., Haldar, A., & Mondal, H. (2023). Evaluation of Types of Vertigo With Electronystagmography An Experience From a Tertiary Care Hospital in West Bengal, India. Cureus, 15(2), e35496. https //doi.org/10.7759/cureus.35496
- Taxak, P., & Ram, C. (2020). Labyrinthitis and Labyrinthitis Ossificans – A case report and review of the literature. Journal of Radiology Case Reports, 14(5), 1–6. https //doi.org/10.3941/jrcr.v14i5.3706
- Turner, H., Lavender, C., & Rea, P. (2020). Sudden-onset dizziness and vertigo symptoms assessment and management of vestibular causes.
- The British Journal of General Practice The Journal of the Royal College of General Practitioners, 70(695), 310–311. https //doi.org/10.3399/bjgp20X710369
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