A 79 year old woman presents today with complaints of nasal drainage, clearing of throat, and occasional nasal congestion, especially on waking in the morning. She has recently moved into an independent living center after living in her home for 40 years. She states that, although she has had these symptoms before, generally the symptoms appeared in the spring, and she associated the nasal drainage with pollination. Because it is winter, she could not identify the trigger of her symptoms

A 79 year old woman presents today with complaints of nasal drainage, clearing of throat, and occasional nasal congestion, especially on waking in the morning. She has recently moved into an independent living center after living in her home for 40 years. She states that, although she has had these symptoms before, generally the symptoms appeared in the spring, and she associated the nasal drainage with pollination. Because it is winter, she could not identify the trigger of her symptoms

A 79 year old woman presents today with complaints of nasal drainage, clearing of throat, and occasional nasal congestion, especially on waking in the morning. She has recently moved into an independent living center after living in her home for 40 years. She states that, although she has had these symptoms before, generally the symptoms appeared in the spring, and she associated the nasal drainage with pollination. Because it is winter, she could not identify the trigger of her symptoms

A 79-year-old woman presents today with complaints of nasal drainage, clearing of throat, and occasional nasal congestion, especially on waking in the morning. She has recently moved into an independent living center after living in her home for 40 years. She states that, although she has had these symptoms before, generally the symptoms appeared in the spring, and she associated the nasal drainage with pollination. Because it is winter, she could not identify the trigger of her symptoms.

Chief complaint: Persistent “runny nose” for 4-week duration, associated clearing of throat, and nasal congestion on awakening in the morning.

VS: BP 130/84, temperature 98.6, pulse 78, respiratory rate 16 02 Sat 98%

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ANSWER THESE QUESTIONS:

1. What further ROS questions will you want to ask her? List at least three.

2. What physical exam (PE) will you perform on this patient? List at least three.

3. What are the differential diagnoses that you are considering? Describe at least three.

4. What laboratory tests will help you rule out some of the differential diagnoses?

5. You have determined, by choosing your ROS, PE, and differential diagnosis, that this patient has allergic rhinitis (AR). Describe the treatment options for your diagnosis, and what specific information about the prescription will you give to this patient? List at least two treatment options: medications with dose, side effects and/or cautions in the older adult.

6. Describe any health promotion topics for this patient, when will you have the patient follow up? Be specific.

To prepare:

Review the Week 4 Case Assignment and questions provided by your instructor.

Reflect on the patient’s symptoms and aspects of disorders that may be present.

Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.

The Assignment:

After reviewing the case and the accompanying case analysis questions, included in the document, answer the questions directly in a word document. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting, including a cover page and reference.

LEARNING RESOURCES

Required Readings

Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Head, neck, and face disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 165-185). F.A. Davis.

Goldberg, C. (2018b). The eye examLinks to an external site.. In C. Goldberg, Practical guide to clinical medicine. Regents of the University of California. https://meded.ucsd.edu/clinicalmed/eyes.htm.

NRNP_6540_Week4_Assignment_Rubric

NRNP_6540_Week4_Assignment_Rubric
Criteria Ratings Pts

This criterion is linked to a Learning OutcomeCreate documentation in the document about the patient in the case study to which you were assigned. Provide thorough answers to the questions asked in the assignment.
25 to >23.0 pts

Excellent

The response thoroughly and accurately answers the questions presented. The answers inform a differential diagnosis and a thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

23 to >20.0 pts

Good

The response answers the questions presented. The answers inform a differential diagnosis and a thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

20 to >18.0 pts

Fair

The response partially answers the questions presented. The answers inform a differential diagnosis, but is somewhat vague or contains minor inaccuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.

18 to >0 pts

Poor

The response provides an incomplete or inaccurate answers to questions presented. The answers may partially inform a differential diagnosis, but is somewhat vague or contains minor inaccuracies. A cross-check of medications against the Beers Criteria has not been completed. Or, other subjective documentation is missing.

25 pts

This criterion is linked to a Learning OutcomeIn the Assessment section, provide: • At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case.
25 to >23.0 pts

Excellent

The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.

23 to >20.0 pts

Good

The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected.

20 to >18.0 pts

Fair

The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

18 to >0 pts

Poor

The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
25 pts

This criterion is linked to a Learning OutcomeIn the Plan section, list the treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. • A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors.

25 to >23.0 pts

Excellent

he response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies need, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided.

23 to >20.0 pts

Good

The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies need, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided.

20 to >18.0 pts

Fair

The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains inaccuracies.

18 to >0 pts

Poor

The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, inaccurate, or missing.
25 pts

This criterion is linked to a Learning OutcomeProvide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care.
10 to >9.0 pts

Excellent

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

9 to >8.0 pts

Good

The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions.

8 to >7.0 pts

Fair

Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

7 to >0 pts

Poor

Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.
10 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.

5 to >4.0 pts

Excellent

Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.0 pts

Good

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 to >2.0 pts

Fair

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.

2 to >0 pts

Poor

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation
5 to >4.0 pts

Excellent

Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 pts

Good

Contains a few (one or two) grammar, spelling, and punctuation errors.

3 to >2.0 pts

Fair

Contains several (three or four) grammar, spelling, and punctuation errors.

2 to >0 pts

Poor

Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
5 pts

This criterion is linked to a Learning OutcomeWritten Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.
5 to >4.0 pts

Excellent

Uses correct APA format with no errors.

4 to >3.0 pts

Good

Contains a few (one or two) APA format errors.

3 to >2.0 pts

Fair

Contains several (three or four) APA format errors.

2 to >0 pts

Poor

Contains many (≥ five) APA format errors.
5 pts

Total Points: 100