NAME OF STUDENT: Capua, Christianne, Dyle

SUBJECT: HEALTH ASSESSMENT

TOPICS: ASSESSMENT OF THE EAR, NOSE, MOUTH AND THROAT (Chapter 12)

Activity 1:

A retired truck driver arrives at the clinic for a routine physical exam. While conversing
with him, you note that his voice sounds “hoarse.” The health care provider asks,
“Have you noticed any changes in your mouth or throat?” He replies, “Many people
keep telling me I sound ‘hoarse’ but I don’t feel like I have a sore throat.” Upon further
questioning, the nurse finds out that he has a 35-year history of smoking/chewing snuff
while he was “on the road, trucking.” You want to differentiate by asking questions to
see if the problem is acute or chronic. The hoarseness has been going on for many
years, therefore it is a chronic problem.

Guide Questions:

1 Identify possible disease entities that are associated with hoarseness

benign vocal cord nodules, cysts or polyps, vocal cord paralysis, smoking, cancer of
the larynx

2 Give examples of questions one would ask this patient using the “OLD CART”
mnemonic.

Old carts mnemonic

O = onset - where was the person or what was the person doing when the symptom
started

L = location - ask person to point, radiating?

D = duration - constant, intermittent, cycle

C = characteristics of symptom or complaint - burning, sharp, dull, aching, gnawing,

throbbing, shooting, vicelike,

A = aggravating or associated factors - burning and frequent urinating associated with

fever or chills, what makes pain worse sitting, standing, eating, meds

R = relieving factors-rest, medication, ice pack, what have you tried, what seems to
help

T = treatment (what has been used to relieve symptom) or timing

S= severity- how does it effect daily activities

3 Make a Nursing Care Plan using the available data.

 Nursing Outcomes & Interventions Evalution Discharge

Diagnosis Evaluation Planning
Ineffective Client will be 1. Obtain Goal met, 1. Patient should
able to
finish
airway history of client any prescription
clearance demonstrate injury. Note able to for
related to clear 
presence of demonstrate antibiotics, even
edema breath preexisting clear breath if
sounds,
he/she is feeling
secondary to respiratory sounds, normal
respiratory well.
circumferential conditions, respiratory rate, If there is any
rate within

burns history of free of dyspnea concern of an

normal range,
as evidenced smoking. and allergic
be free
reaction, please
by burned areas of dyspnea 2. Assess gag/ cyanosis as call
in neck and
swallow evidenced by: the doctor.
and chest, cyanosis reflexes; note Absence of 2. Patients shoul
difficulty of within
drooling, wheezing d start
with small,
breathing, 2 days of inability to Absence of frequent
cyanosis nursing
swallow, dyspnea meals. Diet
and RR of 10 intervention hoarseness, Absence of restrictions on
bpm wheezy cough. cyanosis discharge vary
from
3. Monitor patient to
respiratory rate, patient, and
rhythm, will be reviewed
depth; note with
the patient
presence before
of pallor/ discharge.
cyanosis and 3. Taking naps a
carbonaceous nd
engaging in light
or pink-tinged activity will
sputum. help.
4. Auscultate Patients should
lungs, noting avoid
strenuous
stridor, activity,
wheezing/ driving, heavy
crackles, lifting,
diminished and contact
sports,
breath sounds, until cleared by
brassy cough. the
5. Note doctor at the
presence of follow-
up visit
pallor or 4. Patients may h
cherry- ave physical or
red colour of occupational
unburned skin. therapy
home visits to
6. Investigate assist
changes in in their recovery.
behaviour/
Activity 2:

A nurse is preparing educational materials for an older adult couple to focus on the
prevention and/or early detection of hearing problems including hearing loss.

Guide Question:

1 What topics should the nurse include in this couple’s education information?

Hearing loss affects approximately one-third of adults 61 to 70 years of age and more than 80
percent of those older than 85 years. Men usually experience greater hearing loss and have
earlier onset compared with women. The most common type is age-related hearing loss;
however, many conditions can interfere with the conduction of sound vibrations to the inner ear
and their conversion to electrical impulses for conduction to the brain. Screening for hearing loss
is recommended in adults older than 50 to 60 years. Office screening tests include the whispered
voice test and audioscopy. Older patients who admit to having difficulty hearing may be referred
directly for audiometry. The history can identify risk factors for hearing loss, especially noise
exposure and use of ototoxic medications. Examination of the auditory canal and tympanic
membrane can identify causes of conductive hearing loss. Audiometric testing is required to
confirm hearing loss. Adults presenting with idiopathic sudden sensorineural hearing loss should
be referred for urgent assessment. Management of hearing loss is based on addressing underlying
causes, especially obstructions (including cerumen) and ototoxic medications. Residual hearing
should be optimized by use of hearing aids, assistive listening devices, and rehabilitation
programs. Surgical implants are indicated for selected patients. Major barriers to improved
hearing in older adults include lack of recognition of hearing loss; perception that hearing loss is
a normal part of aging or is not amenable to treatment; and patient non-adherence with hearing
aids because of stigma, cost, inconvenience, disappointing initial results, or other factors