Scenario: HEENT and Cardiology Scenario: HEENT and Cardiology
Scenario:
You are an FNP student working in a busy primary care office. A patient, Mrs. Johnson, 48-year-old female busy model and swim instructor, presents to the office with complaints of nasal congestion with purulent nasal discharge, facial fullness, intermittent throat soreness, and intermittent fevers responsive to Tylenol. She reports she has been managing her symptoms with over-the-counter medications such as Mucinex and Motrin for about 10 days, and while they appeared to be improving initially, the symptoms appear persistent and are possibly getting worse. She further reports anosmia, left ear pain and fullness, and mildly reduced hearing over the past 3-4 days. Lastly, she states that about 3 days ago she spent a day at the spa and went to a black tie gala and concert with her friends. She reported when she woke up yesterday she noticed redness and swelling in her right lower eyelid which is now painful to the touch 4/10 without decreased visual acuity. During the examination, her significant other, Mr. Smith, who is also in the room, starts experiencing symptoms related to his extensive cardiac history including HTN, Congestive Heart Failure (CHF), and Atrial Fibrillation (AFib), his blood pressure was noted at 172/105 in the right arm with a pulse of 108bpm, Oxygen 96% RA, temp 97.9F, BMI 38.
As an FNP, you need to manage Mrs. Johnson’s symptoms effectively while addressing the acute presentation of Mr. Smith.
Answer the following:
Complaint 1
• Based on current evidence-based guidelines and the patient’s presenting congestion symptoms, what is/are the most appropriate differential diagnosis and what diagnostic criteria will you use to confirm Mrs. Johnson’s diagnosis?
• What are the first-line treatment options, and how would you explain the importance of completing the full course of treatment to Mrs. Johnson?
• Discuss the role of patient education in managing her condition. What should Mrs. Johnson be advised to monitor, and when should she seek further medical evaluation?
• Complaint 2 Based on Mrs. Johnson’s ocular complaints,
o How would you differentiate similar eye conditions (at least 2) to determine your ocular diagnosis?
• What treatment and home care instructions would you provide to Mrs. Johnson to manage her ocular complaint?
• When would it be necessary to consider further intervention or referral to an ophthalmologist?
• Complaint 3 – With regard to Mrs. Johnson’s Otic complaints
o List your primary differential diagnosis and describe the physical examination findings that are typically indicative of this diagnosis in adults.
o What are the recommended treatment strategies, and what factors would influence your decision to prescribe antibiotics?
o How would you educate Mrs. Johnson on pain management and the prevention of future episodes?
• Managing Mr. Smith’s Acute Symptoms:
While examining Mrs. Johnson, Mr. Smith begins to experience shortness of breath, chest discomfort, and an irregular pulse. How would you prioritize and manage these acute symptoms?
What are the immediate steps to take in addressing Mr. Smith’s potential congestive heart failure exacerbation?
Discuss the management of Mr. Smith’s atrial fibrillation in the context of his hypertension and potential CHF. What pharmacological and non-pharmacological interventions would you consider?
Holistic Approach and Family Education:
Considering the health conditions of both Mrs. Johnson and Mr. Smith, how would you involve both patients in a discussion about lifestyle modifications that could benefit their health?
What specific dietary and lifestyle advice would be beneficial for both patients, particularly focusing on cardiovascular health for Mr. Smith and infection prevention for Mrs. Johnson?
How can you use this opportunity to educate Mrs. Johnson about recognizing early warning signs of cardiac issues, given her proximity to Mr. Smith?
• Instructions for Students:
o Address complaint 1 and EITHER complaint 2 or 3 for Mrs. Johnson above, incorporating evidence-based practices and references from the text and external sources. Explain how you later managed the complaint you deferred.
o Answer all questions pertaining to Mr. Smith’s presentation
o Answer Holistic Education questions
o Use critical thinking to integrate the information from different HEENT and cardiovascular conditions, emphasizing the importance of holistic care in primary practice settings.