Power Point Presentation Realistic Clinical Case Study

Sample Answer

Introduction

In this presentation, I will present a clinical case for a patient with Meniere’s Disease. The presentation will include:

• Subjective data
• Objective data
• Differential and primary diagnoses
• Plan
• Clinical guidelines and role of the NP.

Subjective Data- Demographics

• Initials– B.L
• Age 34 years.
• Sex Female.
• Race/ Ethnicity– Caucasian.
• Outpatient number– 23498/023

Subjective Data

• Medications- Collagen supplements.
• Allergies– No drug/food allergies
• Past medical history– No chronic illnesses.
• Immunization- Up to date.
• Family history– Maternal grandmother had HTN and MI; Father has Type 1 DM.
• Past surgical history- Tonsillectomy at 6 years.
• Social history- Insurance agent; Married; 2 children 6 and 3 years. Report
• ETOH (3-4 beers on most days); Smoke 1PPD.

Hobbies are baking and swimming.

ROS

• General– Denies weight changes, fever, chills, or fatigue.
• HEENT Reports rapid eye movements, tinnitus, vertigo, and right-sided hearing loss.
• Respiratory– Denies SOB, chest pain, cough, sputum, or wheezing.
• Cardiovascular– Denies palpitations, dyspnea on exertion, or edema.
• GI– Reports nausea and vomiting.
• Neurological- Reports headache, dizziness, and spinning sensation.

Objective Data

Vital signs

• BP- 142/90
• HR-118
• RR-24
• Temp-98.5
• HT- 5’4
• WT- 167
• BMI- 28.7

General

• Alert, oriented, and in no significant distress. The patient is currently symptom free.

Otoscopy

• Normal findings.
• Hearing is diminished on the right ear.

Romberg test and gait testing

• Reveal some instability.

Diagnostic tests

• No tests were ordered at this point.

Differential diagnoses

Labyrinthitis

This is an infection of the labyrinth that can be caused by a complication of acute or chronic otitis media. Clinical symptoms include tinnitus, hearing loss, nystagmus to the affected side, and vertigo with nausea and vomiting (Taxak & Ram, 2020). The patient has positive symptoms like tinnitus, unilateral hearing loss, and vertigo accompanied with nausea and vomiting.

Vertigo

This is a sensation of whirling or turning in space. Clinical manifestations include nausea, vomiting, falling, nystagmus, hearing loss, and tinnitus (Turner et al., 2020). The patient has vertigo with tinnitus, hearing loss, nausea, and vomiting.

Primary Diagnosis

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 of the vestibular system and contributes to tinnitus. Other common manifestations include nausea and vomiting, rapid eye movements, and severe headaches (Kutlubaev et al., 2020).

The patient reports having attacks characterized by one-sided hearing loss, tinnitus, and vertigo. She states that the vertigo attacks are so intense and are accompanied by nausea and vomiting, rapid eye movements, and headaches.

Plan

Laboratory and diagnostic tests

• Audiometry will be helpful for documenting the patient’s current hearing acuity and detecting future change.

Pharmacologic treatment plan

• Dimenhydrinate 50 mg IM during an acute attack; 25 mg PO four times daily for maintenance.

It lowers the severity of or prevents an acute attack. It reduces vestibular stimulation and depresses labyrinthine function (Ahmadzai et al., 2020).

• Promethazine 12.5 mg orally every 4-6 hours PRN to alleviate the nausea and vomiting (Ahmadzai et al., 2020).

Non-pharmacologic treatment plan

• Meniett device– It applies low pressure micropulses to the inner ear for 5 minutes three times daily. This displaces inner ear fluid and relieves symptoms of Meniere’s Disease (Ahmadzai et al., 2020).
• Surgical management will be considered if pharmacologic treatment fails.

Plan

Anticipatory guidance (primary prevention strategies)

• The patient was instructed to move the head slowly to prevent worsening of the vertigo.
• The patient was encouraged to quit smoking because nicotine has constricting effects on the blood vessels (Ahmadzai et al., 2020).
• Nutrition and lifestyle changes were recommended to reduce the amount of endolymphatic fluid (Ahmadzai et al., 2020). They include

1. Distributing food and fluid intake evenly throughout the day and from day to day.
2. Avoiding foods or fluids with a high salt content.
3. Avoid foods with high carbohydrate content.
4. Avoid excessive sweets and candy.
5. Taking adequate amounts of fluids (low in sugar) daily.
6. Avoiding caffeine-containing fluids and foods.
7. Limiting alcohol intake
8. Avoiding foods containing monosodium glutamate (MSG) like processed foods.

Follow up plan.

• Follow-up after two weeks to assess response to treatment.

Current clinical guidelines & Role of the NP

According to Clinical guidelines, the goals of Meniere’s Disease treatment are to prevent or reduce vertigo severity and frequency, relieve or prevent hearing loss, tinnitus, and aural fullness, and improve patients’ quality of life (Basura et al., 2020). The guidelines recommend treatment approaches to Meniere’s Disease including modifications of lifestyle factors like diet and medical, surgical, or a combination of therapies.

A limited course of vestibular suppressants should be offered to patients for management of vertigo only during Menière’s disease attacks. Diuretics and/or betahistine should also be prescribed for maintenance therapy to reduce symptoms or prevent Menière’s disease attacks (Basura et al., 2020). They also recommend that a person should receive an audiogram when assessed for the diagnosis of Menière’s disease.

The NP has a role of assessing patients presenting with signs of Meniere’s disease, make a correct diagnosis, develop a treatment plan, and educate patients about their diagnosis. Besides, the NP should counsel the patient about the natural history of the disease, interventions for symptom control, treatment options, and anticipated outcomes.

References

• Ahmadzai, N., Cheng, W., Kilty, S., Esmaeilisaraji, L., Wolfe, D., Bonaparte, J., Schramm, D., Fitzpatrick, E., Lin, V., Skidmore, B., & Hutton, B. (2020). Pharmacologic and surgical therapies for patients with Meniere’s disease A systematic review and network meta-analysis. PloS one, 15(9), e0237523. https //doi.org/10.1371/journal.pone.0237523
• Basura, G. J., Adams, M. E., Monfared, A., Schwartz, S. R., Antonelli, P. J., Burkard, R., … & Buchanan, E. M. (2020). Clinical practice guideline Ménière’s disease. Otolaryngology–Head and Neck Surgery, 162, S1-S55. https //doi.org/10.1177/0194599820909438
• 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
• 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