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In this case, Richard shows several symptoms of a defect that include nasal congestion, rhinorrhea, sneezing and postnasal drainage. The symptoms are accompanied by itches in the ears, eyes, nose and the palate. Therefore, in order to determine or diagnose what he might be suffering from, a proper and well followed up health history is required. To start with, the nurse should determine whether Richard has had a history of experiencing the said symptoms in particular or specified periods of the year.
What follows is the determination of whether in his family there has been a history of allergies, whether mild or acute. The nurse should also question whether he has ever experienced malaise, fever, coughing or headaches. The last portion in his health history will be determining what medication that Richard has been taking, and if there are, collect the different kinds of medication that he has tried in the recent past.
Diagnostic tests and physical exams
What should be given the first priority in the diagnosis of Richard is the performance of a general assessment whereby there will be observation of Richard for the existence of any change in his mental status. The nurse should ensure that Richard’s face is observed for perirobital edema and allergic shiners, which can be observed through the presence of black circles underneath the eyes. There should be careful observation of vital signs to see whether Richard has been breathing, or is breathing through the mouth. This is to be able to determine whether he has got a fever, which would point out at the fact that he may be suffering from a bacterial infection.
The existence of periorbital edema would show that Richard may e suffering from bacterial sinusitis. On the other hand, if the examination to determine whether he has black circles underneath his eyes turns out to be positive, then it would indicate that he may be suffering from venous congestion and stasis. To determine whether Richard has a sinus infection or acute rhinitis, proper and thorough examination of his eyes, ears and lymph nodes will be required. There should also be a though examination of whether he has coryza, through the examination of his nasal cavity. Coryza is the inflammation o nasal mucous membranes.
If examination of his teeth and mouth result to a medical opinion that he has got halitosis, this is a pointer that he may be suffering from sinusitis or a severe dental abscess. The teeth should be examined in detail to determine whether he may be a victim of maxillary sinusitis. This is done through tapping on his maxillary teeth to check the extent of their tenderness.
Differential Diagnosis
The first differential diagnosis is nonallergic rhinitis. The nasal smear will reveal whether Richard has nonallergic rhinitis with eosinophilia syndrome (NARES). It is imperative that the advanced practice nurse ask Richard whether is he been taking nonsteroidal anti-inflammatory drugs or aspirin.
The second differential diagnosis is allergic rhinitis because Richard reports that he has been experiencing sneezing, nasal congestion, and rhinorrhea. Asking him about the onset of his symptoms in relation to seasons or exposure to allergens will help the advanced practice nurse to determine if he is suffering from perennial or seasonal.
The third differential diagnosis is rhinitis medicamentosa. This is caused by long-term use of nasal decongestants. Other drugs that have a vasodilatory effect on the nasal passages are hormones, psychotropic agents, and anti-hypertensive medications that alter adrenergic neuronal. I have chosen this diagnosis because Richard has presented with similar symptoms of patients who have rhinitis medicamentosa
The fourth differential diagnosis I have chosen is acute sinusitis. I chose this because Richard has erythema to his throat, which is indicative of post-nasal drip. Patients who are suffering from an acute sinus infection will typically present with post nasal drip.
The fifth differential diagnosis is nasal obstruction. Acute nasal obstruction is associated with edema from infectious antigens, exposure to chemical irritants, and allergic response to antigens. I chose this diagnosis because Richard keeps pressing against the bridge of his nose.
References
Dains, J., Baumann, L., Scheibel, P. (2012). Advanced Health Assessment & Clinical
Diagnosis in Primary Care, 4th Edition.
Sullivan, Jr., John B., Krieger, Gary R. (2011). Clinical environmental health and
toxic exposures.
Rondón, C; Canto, G; Blanca, Miguel (2010). “Local allergic rhinitis: A new
entity, characterization and further studies”. Current Opinion in Allergy and Clinical Immunology