NU 664B Discussion 1: Telehealth/Transgender

Sample Answer for NU 664B Discussion 1: Telehealth/Transgender Included After Question

Noncontributory. No one else at home is sick.

ROS (completed by the medical assistant):

Constitutional: The patient denies fevers, chills, sweats, and weight changes.
EYES: The patient denies any visual symptoms.
EARS, NOSE, AND THROAT: No difficulties with hearing. Endorses sinus congestion and rhinitis.
Cardiovascular: Patient denies chest pains, palpitations, orthopnea, and paroxysmal nocturnal dyspnea.
RESPIRATORY: No dyspnea on exertion, no wheezing or cough.
GI: No nausea, vomiting, diarrhea, constipation, abdominal pain, hematochezia, or melena.
GU: No urinary hesitancy or dribbling. No nocturia or urinary frequency. No abnormal urethral discharge.
Musculoskeletal: No myalgias or arthralgias.
Neurologic: No chronic headaches, no seizures. The patient denies numbness, tingling, or weakness.

Complete the following:

Initial Post by Wednesday (Day 3) at 11:59 p.m.

  • List 10–20 additional questions of subjective information that you would need to elicit from your patient to help formulate your differential diagnoses and plan. You may not ask questions that were already addressed in the HPI/ROS. Make sure to watch the telehealth modules, which include how to complete the physical exam via telehealth. You will need two scholarly references for the questions that you ask of your patient. See the rubric for more detail.
    • Make sure to address a health maintenance item for this patient (primary or secondary) and the social determinants of the health barrier questions. (See Reply Post for additional information.)
    • If there is a screening tool for the disorder, this would count as ONE question. Example PHQ-9 has nine individual questions but would count as one for the purpose of this assignment.

A Sample Answer For the Assignment: NU 664B Discussion 1: Telehealth/Transgender

Title: NU 664B Discussion 1: Telehealth/Transgender

Four appropriate differential diagnoses and rationales with references. For each differential diagnosis, explain why this is an appropriate differential and how it was/would be ruled in or out. Support your answers with references.

Acute viral sinusitis- inflammation of nasal mucosa, purulent drainage, facial pressure, fever

Bronchitis- because of productive cough

Acute bacterial sinusitis- this can be ruled out if patient symptoms resolve within 7-10 days. If persistent s/s then we can see If it is bacterial and treat with antibiotics

Covid 19- similar to covid symptoms, will need to perform covid test to rule out

Pick one differential and create a plan of care for that patient.

Acute Viral Sinusitis

Pharmacology
Non-Pharmacology

Viral sinusitis is treated symptomatically. This means we are treating the symptoms that are bothersome to the patient. This typically resolves within 7-10 days. OTC antipyretics and analgesics. Saline irrigation and intranasal glucocorticoids have shown to improve symptoms. It is important to educate that nasal decongestants cannot be used long term due to causing rebound congestion. Mucolytics such as guaifenesin can help loosen secretion.

If symptoms persist, it is most likely from a bacterial cause and amoxicillin or Augmentin will need to be prescribed.

No lab tests are needed but if symptoms persist longer than 10 days then Culture and biopsy can be done to see if the cause bacterial or even fungal sinusitis (Battisti, et al., 2023).

Patient Education (10–15 individual items minimum) and follow up.
The patient will initially needed to be educated that the s/s need to be persistent for longer than 10 days to be given antibiotics for bacterial sinusitis. Topical steroids can be used but is mainly helpful in allergic and chronic sinusitis (Battisti, et al., 2023). Saline irrigation and the use of a humidifier can help alleviate the patients symptoms. Increase use of Flonase to help with inflammation and increase nasal drainage. If headaches accompany symptoms, be sure to check blood pressure.

Make sure to pick one health maintenance item for this patient (primary or secondary) and explain to the patient why this is important.

Due to the patient having elevated blood pressures on occasion, it is important to educate the patient on blood pressure monitoring and following up with any persistent headaches. Keep a blood pressure log would be helpful for prolonged elevated blood pressures.

Address one social determinant of the health this patient may face during your visit. How will you help the patient overcome this obstacle to health care?


Research shows that the transgender population have higher rates of developing chronic conditions and having HIV/ AIDS. Research will also indicate that the transgender population also have a higher rate of mental health issues (Wesp et al., 2019). Taking sensitivity courses can help us as providers, to ask questions pertinent to the patient without triggering any trauma from their past.



References:

Battisti AS, Modi P, Pangia J. Sinusitis. [Updated 2023 Mar 2]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2023
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470383/

Linda M. Wesp and others, “Intersectionality Research for Transgender Health Justice: A Theory-Driven Conceptual Framework for Structural Analysis of Transgender Health Inequities,” Transgender Health 4 (1) (2019): 287–296, available at https://www.liebertpub.com/doi/pdf/10.1089/trgh.2019.0039.

UpToDate. (n.d.). https://www.uptodate.com/contents/acute-sinusitis-and-rhinosinusitis-in-adults-clinical-manifestations-and-diagnosis?search=sinusitis&source=search_result&selectedTitle=3~150&usage_type=default&display_rank=3

A Sample Answer For the Assignment: NU 664B Discussion 1: Telehealth/Transgender

Title: NU 664B Discussion 1: Telehealth/Transgender

Probable diagnosis: Sinusitis

  • Based on the patient’s symptoms of sinus congestion and runny nose, along with her history of recurring sinus infections, the probable diagnosis in this case is sinusitis. Sinusitis refers to the inflammation of the sinuses, which can cause symptoms such as facial pain, nasal congestion, and thick nasal discharge. It can be acute or chronic, with acute sinusitis typically lasting less than four weeks while recurrent sinusitis is four episodes lasting less than 4 weeks with complete symptom resolution between episodes. Recurrent Sinusitis is probable diagnosis because of patient history of recurrent sinusitis, hormone suppressant therapy and presenting symptoms (Khalid et.al, 2022).

Differential diagnoses to consider:

  • Allergic rhinitis, also known as hay fever, is a condition characterized by an allergic response to certain substances, such as pollen, dust mites, or pet dander (Small et.al, 2018).
  • Nasal polyps are noncancerous growths that develop in the lining of the nasal cavity or sinuses. They can cause symptoms similar to sinusitis, including nasal congestion, facial pain, and a reduced sense of smell.
  • Chronic rhinosinusitis is a persistent inflammation of the sinuses that lasts for more than 12 weeks. However, chronic rhinosinusitis is often associated with more subtle symptoms and may require additional diagnostic tests to differentiate it from acute sinusitis (Hoffmans et.al, 2018).
  • Drug-Induced Rhinitis: hormone suppressants, can cause drug-induced rhinitis. Symptoms include nasal congestion, runny nose, and sometimes sneezing. The symptoms of hormone-induced rhinitis are thought to be mediated by elevated levels of estrogen (Papadopoulos et.al, 2016).

Pharmacology:

  1. Decongestants: Oral or nasal decongestants help alleviate nasal congestion by reducing swelling of the nasal passages. They can be available over-the-counter or as prescription medications (Mortuaire et.al, 2013)
  2. Analgesics: Over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve sinus pain and headache.
  3. Nasal corticosteroids: These medications reduce inflammation in the nasal passages and can help relieve symptoms such as nasal congestion, runny nose, and sneezing. They are available as nasal sprays and may require a prescription.
  4.  Antibiotics: If sinusitis is caused by a bacterial infection, antibiotics may be prescribed.  The update group made recommendations that clinicians (1) should either offer watchful waiting (without antibiotics) or prescribe initial antibiotic therapy for adults with uncomplicated ABRS; (2) should prescribe amoxicillin with or without clavulanate as first-line therapy for 5 to 10 days (Rosenfeld et.al, 2015).

Non-pharmacology:

  1. Nasal irrigation: This involves rinsing the nasal passages with a saline solution using a neti pot or a nasal irrigation device. It helps flush out mucus and allergens, reducing congestion and promoting sinus drainage (Kanjanawasee et.al, 2018).
  2. Steam inhalation: Inhaling steam from a bowl of hot water or using a steam inhaler can help moisten the nasal passages, relieve congestion, and promote sinus drainage.
  3. Humidification: Using a humidifier or placing a bowl of water near a heat source can increase humidity in the air, preventing nasal passages from drying out and reducing symptoms.
  4. Warm compresses: Applying warm compresses to the face can help alleviate pain and pressure in the sinuses.

Labs/Diagnostics: (Saltagi et.al, 2020),

  1.  Imaging studies: X-rays, CT scans, or MRI scans may be performed to evaluate the sinuses, identify any structural abnormalities, or assess the extent of inflammation.
  2. Nasal endoscopy: This procedure involves inserting a thin, flexible tube with a camera into the nasal passages to visualize the sinuses and identify any abnormalities.
  3. Allergy testing: Allergy tests such as skin prick tests or blood tests can help identify specific allergens that may be triggering sinusitis symptoms.

Referrals/Interprofessional Communications:

  1. Ear, Nose, and Throat (ENT) specialist/Otolaryngologists : If the sinusitis is recurrent or persistent, an ENT specialist may be consulted to evaluate the sinuses, perform nasal endoscopy, and recommend further treatment options.
  2. Allergist: If allergies are suspected to be the underlying cause of sinusitis, an allergist can help identify specific allergens and provide appropriate treatment, such as allergen immunotherapy.
  3. Infectious disease specialist: In cases of severe or complicated sinusitis, an infectious disease specialist may be involved in the management to ensure appropriate antibiotic therapy and prevent complications.
  4. Endocrinologist managing the hormone suppression therapy.

Patient Teaching on Managing Sinusitis

  • Start by explaining what sinusitis is, emphasizing that it is an inflammation of the sinuses caused by a viral or bacterial infection.
  • Educate patients on the common symptoms of sinusitis, which may include facial pain or pressure, nasal congestion, headache, and thick nasal discharge.
  • Encourage patients to drink plenty of fluids to help thin mucus and promote sinus drainage.
  • Teach patients how to perform nasal irrigation using a saline solution to help flush out mucus and relieve congestion.
  • Explain the benefits of using humidifier, as it can help moisturize nasal passages, soothe inflammation, and promote sinus drainage.
  • Advise patients to use over-the-counter medications such as decongestants or nasal sprays to relieve congestion, but caution against long-term use.
  • Emphasize the need for ample rest and sleep to aid in the body’s healing process.
  • Suggest applying warm compresses to the face to alleviate pain and pressure associated with sinusitis.
  • Educate patients on common and encourage them to avoid exposure to these triggers.
  • Educate patients about the signs that indicate the need for medical intervention, such as severe headache, high fever, worsening symptoms, or persistent sinusitis that lasts longer than a weeK

References

Hoffmans et.al. (2018). Acute and chronic rhinosinusitis and allergic rhinitis in relation to comorbidity, ethnicity and environment. PLOSONE. doi:https://doi.org/10.1371/journal.pone.0192330

Kanjanawasee et.al. (2018). Hypertonic Saline Versus Isotonic Saline Nasal Irrigation: Systematic Review and Meta-analysis. American journal of rhinology & allergy. doi:https://doi.org/10.1177/194589241877356

Khalid et.al. (2022). A prospective study of acute sinusitis, clinical features and modalities of management in adults, Sudan. The Egyptian Journal of Otolaryngology volume. doi:https://doi.org/10.1186/s43163-022-00316-9

Mortuaire et.al. (2013). Rebound congestion and rhinitis medicamentosa: nasal decongestants in clinical practice. Critical review of the literature by a medical panel. European annals of otorhinolaryngology, head and neck diseases.

Papadopoulos et.al. (2016). Rhinitis Subtypes, Endotypes, and Definitions. Immunology and Allergic Clinics. doi:https://doi.org/10.1016/j.iac.2015.12.001

Rosenfeld et.al. (2015). Clinical Practice Guideline (Update): Adult Sinusitis. Otolaryngology–Head and Neck Surgery. doi:https://doi.org/10.1177/0194599815572097

Saltagi et.al. (2020). Diagnostic Criteria of Recurrent Acute Rhinosinusitis: A Systematic Review. American Journal of Rhinology & Allergy. doi:https://doi.org/10.1177/1945892420956871

Small et.al. (2018). Allergic rhinitis. Allergy, Asthma & Clinical Immunology. doi:https://doi.org/10.1186/s13223-018-0280-7