CTE 1 - Critical Thinking Exercises PDF

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CRITICAL THINKING EXERCISES: Management of Patients with Upper Respiratory Tract Disorders

1. A 21-year-old female nursing student comes to the student health clinic with complaints of a sore throat. She states she had a fever last night but does not have an elevated temperature at present. She states she has not been feeling well and is tired “all the time” but attributes these symptoms to studying late into the night for midterm examinations this week. She states she has difficulty swallowing and has not had anything to eat or drink for 2 days. She says she does not want to miss clinical because she does not want to have to make it up. What further questions do you have regarding her symptoms? Ask patient if she is experiencing pain on her throat especially when swallowing, the quality and intensity of pain. What is your priority focus for your physical examination? The throat area, check for fiery pharyngeal membrane and tonsils Palpate neck for any swollen lymph nodes. What diagnostic tests and treatments may you anticipate? For diagnostic test, the Rapid strep test because it is use for simple and quick detection of group A streptococcal infection (highly specific, sensitivity 70–90%). A throat swab is needed for this test. But when a rapid strep testing is negative, throat culture can be used as a follow-up test. Treatments may include antibiotics if it’s a bacterial infection. If it’s a viral infection it doesn’t require medical treatment and it will last from 5 to 7 days Tell patient to have a liquid or soft diet, to get plenty of rest especially sleep, to avoid irritants like cigarette smoke, and to drink plenty of fluids to keep the throat moist. 2. A 59-year-old man presents to the family health clinic because of increased fatigue and difficulty staying awake during the day. His wife, who accompanies him, tells you that he “stops breathing and then makes unusual loud noises” at night, and has generally become more irritable. The patient is obese, with a body mass index of 38. You suspect that this patient may have OSA. What risk factors for OSA will your health history focus on? Obesity, since the patient is overweight with a BMI of 38 he is at risk for sleep apnea What are the common signs and symptoms of OSA? Common signs and symptoms of OSA includes Excessive daytime sleepiness, Frequent nocturnal awakening, Insomnia, Loud snoring, Morning headaches, Intellectual deterioration Personality changes, irritability, Impotence , Systemic hypertension, Dysrhythmias, Pulmonary hypertension, cor pulmonale, Polycythemia, and Enuresis

Describe how a patient with OSA is diagnosed and the treatment(s) that might be prescribed. The diagnosis for OSA is based on clinical feature plus Polysomnography. Polysomnography is a sleep study in which during the sleep of the patient, the patient is hooked up to equipment that monitors your heart, lung and brain activity, breathing patterns, arm and leg movements, and blood oxygen levels while you sleep. Treatment will include Lifestyle changes, such as losing weight, reducing use of hypnotics, avoidance of alcohol and sleeping on your side .Another common treatment is nightly use of a continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) machine. CPAP is used to prevent airway collapse, whereas BiPAP makes breathing easier and results in a lower average airway pressure. What is the strength of the evidence that commonly prescribed therapies (such as CPAP) may be effective in alleviating symptoms and improving quality of life for patients with OSA? Research shows that CPAP decreases daytime sleepiness, especially in those who have moderate to severe sleep apnea. This will surely help in improving the quality of life of the patient because the patient will have a productive day and will not be distracted by daytime sleepiness. 3. You are a spectator at a baseball game. A pitched baseball forcefully hits the batter in the face, striking him in the nose. You rush to aid the batter and suspect that there is a fractured nose. Briefly describe what you would do in this situation. What are your priority assessments? Airway. Ensure a patent What are the signs and symptoms of a fractured nose? The signs and symptoms of a nasal fracture are pain, bleeding from the nose externally and internally into the pharynx, swelling of the soft tissues adjacent to the nose, periorbital ecchymosis, nasal obstruction, and deformity. What are your priority interventions? Immediately after the fracture, apply ice and encourage the patient to keep the head elevated. Instruct the patient to apply ice packs to the nose for 20 minutes four times a day to decrease swelling. 4. As a home health nurse, you are caring for a 75-year-old male patient who has undergone a total laryngectomy for the treatment of cancer of the larynx. You are responsible to provide patient education regarding tracheostomy care and gastric tube feedings. The overall plan is for the patient to begin to assume responsibility for his own care and to consider speech therapy. The patient lives alone in a rural area and has no next of kin nearby.

What are your priorities in terms of assessment of this patient? Preoperative education to help them cope with these changes and to recover quickly after surgery. A priority for patients who have undergone a total laryngectomy is for them to learn how to care for their new airway.

What is your plan to address the patient’s fear, anxiety, communication, and nutrition needs? The patient may use pen and paper, picture charts, and gestures in order to communicate. Introduce patient to people who have already undergone a laryngectomy and who are coping well in order to reduce fear and anxiety of the patient. Tube feedings will be administered through a nasogastric tube....