Question

B.W. is a 44-year-old man who presents to the family practice with complaints of sore throat, hoarseness, and a dry cough that worsens at night. He states that the cough started 6 days ago, and the sore throat and hoarseness began 3 days ago and appear to be getting worse The patient has a history of prediabetes, which is controlled through diet and exercise. Vital signs are T 99.5, P 58, R 16, and BP 110/55.The patient’s teeth are stained yellow. The patient states that he chews one bag of tobacco every other day.

Respond to each question for the following scenario. Use rationale to support your responses.

1. Beyond what has already been presented, what would be four (4) other examples of subjective information the nurse should obtain?

2. The nurse is assessing the structures of the oral cavity. What are the expected normal physical features?

3. Considering the patient's presenting complaints, his age, and his other history, what would be three (3) important health promotion concepts the nurse should include in the teaching plan?

4. What are two (2) likely causes of this patient’s cough, sore throat, and hoarseness? Use rationale to support your response.

Answer 1

Sore throat : An inflammation of pharynx, that causes soreness. It is a symptom of bacterial or viral infections.

hoarseness : The quality of being hoarse, of having a dry harsh voice.

dry cough at night : Coughing without expectoration ( ejecting phlegm or mucous).

1. Four other examples of subjective information

* Nurse can ask regarding the fever, whether fever accompanied with cough and the severity ( mild or high)

Rationale: Bacterial or viral infection may trigger body's immune response such as fever. Usually cold or flu may accompany with mild or high fever.

* Night sweat; nurse can obtain information regarding night sweat.

Continuous   Coughing with frequent night sweats may indicate pneumonia or Tuberculosis.

* Chest pain or breathing difficulty

Chest pain and shortness of breath along with cough may indicates the presence of Pneumonia or bronchitis

* Coughing up of blood or discolored phlegm

Coughing up of blood or discolored sputum in green or yellow is an indication of a medical condition that should be treated as soon as possible, or it may develop into other complications.

Along with these enquiries a nurse can ask about loss of appetite, weight loss.( symptoms of Tuberculosis)

2. Normal physical features of oral cavity

Cavity of mouth is called oral cavity. In physical examination, Patient teeth are stained with yellow due to chewing of tobacco leaves.

Other normal features

*Lips: Symmmeyrical, smooth , moist, pink

* Tongue : Symmetrical, slightly rough ( presence of papillae), a thin whitish coating, without any lesions

* Soft palate, uvula, hard palate: no lesions or enlargement, hard palate is whitish in color, soft palate and uvula light pink

*Teeth: no decay or discoloration

* Gums and oral mucosa: Symmetrical, pink and moist , no signs of inflammation or lesions .

3.Health promotion concept in teaching

a) Encourage the patient for healthy diet that contains less carbohydrates . Avoid artificial sweeteners, caffeinated drinks, sweets to prevent the occurance of diabetes.

b) Physical activity and exercise: Encourage him to adapt a healthy lifestyle with regular exercise and physical activity to keep body fit and to prevent chronic diseases such as hypertension, heart diseases.

c) Educate the client regarding the health risks of chewing tobacco leaves ( Addiction due to nicotine , cancer, dental diseases, precancerous mouth lesions)

4. Two likely causes of cough, sore throat and hoarseness

a) Acute bronchitis with cold: Inflammation of the bronchi of the lungs is called bronchitis. cough initially may be dry later may become productive. If acute bronchitis occur with cold ( viral infection), then the patient may complain about sore throat and hoarseness.

b)Laryngitis: Inflammation of larynx, usually present with sore throat, hoarseness of voice and cough due to irritation of vocal cord.

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