discussion replies

I have posted 2 post that i need to reply to

******* First post: Choice #1 22-year-old Jonas

Otitis externa is an infection of the outer ear, with the severe painful movement of the pinna and tragus, redness and swelling of the pinna and canal, scanty purulent discharge, scaling, itching, fever, etc. (Jarvis, 2016, p. 342). It is also known as swimmer’s ear as it often occurs during the summer and in tropical climates and having retained water in the ears increases the risk for it. The most common cause of acute otitis externa is a bacterial infection. It may be associated with allergies, eczema, and psoriasis., more common in hot, humid weather. Swimming causes canals to become waterlogged and swell (Blasini & Sharman, 2022).

Some questions to ask Jonas are

When did the symptoms start? How long has he been experiencing these symptoms? What are the characteristics of the pain? Is it Sharp, dull, stabbing, throbbing? What are some of the aggravating Factors: Is there anything that makes the pain worse or better? Does it radiate anywhere else? Any Relieving Factors: Taking any pain medication? Has he tried anything to relieve the pain?

SOAP

Subjective: 

Chief complaint: Jonas is a 22-year-old athlete who presents with complaints of irritation and fullness in his right ear. He has been training for six hours a day, including swimming, running, cycling, and weightlifting. He is concerned that the fullness in his ear and the irritation could require him to limit his training. He denies any recent upper respiratory infections, nausea, vomiting, or dizziness.

Present Health History: patient reports irritation and fullness in his right ear.

Past Medical Health History: patient denies any medical history or past surgical procedures.

Allergies: NKDA

Family History: none reported 

Social History: The patient is an athlete and has been training for six hours a day, including swimming, running, cycling, and weightlifting.

Objective:

General: Well appearing, well nourished, in no distress. Oriented x 3, normal mood and affect. Ambulating without difficulty.

Skin: Good turgor, no rash, unusual bruising, or prominent lesions

Head: Normocephalic, no visible or palpable masses, depressions, or scaring

Eyes: No blurring of vision or any eye discomfort; no scleral icterus

Ears, Nose, Mouth, Throat: Presence of significant tenderness of right ear, exudate, and edema on the right ear canal. Patent nostrils, no sinus tenderness; no dysphagia, sore throat, or hoarseness; trachea at the midline, no lymphedema

Cardiovascular: No palpitations, irregular heartbeats, and chest pain; no murmurs; no jugular vein distention

Respiratory: Normal breath sounds bilateral; no cough or difficulty breathing

Gastrointestinal: Soft, non-tender, and non-distended; no palpable masses; no abdominal pain, nausea, or vomiting; appetite remains the same

Musculoskeletal: normal gait, no muscle aches, weakness, or fatigue; no joint pain or tenderness

Neurological: No seizure, fainting, or weakness; normal speech; memory and motor coordination intact

Psychiatric: Cooperative; appropriate mood and affect; denies recent changes in mood; denies anxiety and depression

Endocrine: No cold or heat intolerance; no dysuria, nocturia, or polyuria

Hematologic/Lymphatic: No abnormal bleeding

Allergic/Immunologic: No known allergies to food and drugs.

Assessment:

A thorough medical history and physical examination are necessary for the clinical diagnosis of otitis externa. The physical examination should include a pneumatic otoscopy, evaluation of the auricle, and evaluation of the surrounding skin and lymph nodes. An erythematous, edematous, and debris-filled ear canal will be seen during an otoscopy (yellow, white, or gray).

Due to edema of the external auditory canal, the tympanic membrane may occasionally be erythematous or partly visible (Schaefer & Baugh, 2012).

Acute otitis externa is diagnosed clinically based on signs and symptoms of canal inflammation. The presentation can range from mild discomfort, itching, and minimal edema to severe pain, complete canal obstruction, and involvement of the pinna and surrounding skin.

Primary Diagnosis: Otitis Externa

Pertinent positive: symptoms of ear canal inflammation: ear pain, itching, or fullness, ear canal edema/erythema

Pertinent negative: Otitis media is usually unilateral, associated with otalgia, and decreased or muffled hearing. The pain may be mild, moderate, or severe. Significant tenderness around the right ear, irritation, and fullness, exudate from the ear canal and edema, and cerumen impaction.

Pertinent negative: Myringitis, tympanic membrane inflammation, may have vesicles; pain is often severe, no canal edema (Schaefer & Baugh, 2012).

Pertinent negative: Otomycosis: itching is the predominant symptom. Thick material in the canal, less edema; may see fungal elements on otoscopy

Plan

Culture or microscopic evaluation of the discharge

Common topical antibiotics indicated for otitis externa include:

• Polymyxin B, neomycin, and hydrocortisone 3 to 4 drops to the affected ear four times a day
• Ofloxacin 5 drops to the affected ear twice daily
• Ciprofloxacin with hydrocortisone 3 drops to the affected ear twice daily (Wiegand et al., 2019).

Pain medications like ibuprofen or acetaminophen may help reduce discomfort

The canal may be cleaned with gentle suction before treatment to improve visualizing the ear canal and eardrum

Health Education

• Keep your ears as dry as possible. Avoid submerging your head under water while receiving treatment.
• While showering, you can place a cotton ball coated with petroleum jelly in the ear. However, you should not swim for 7 to 10 days after starting treatment.
• Avoid wearing hearing aids and in-ear headphones until the pain improves.

It is important to apply the ear drops correctly so that they reach the ear canal:

• The patient should lie down with their affected side facing upward, apply two to five drops depending on the prescribed drug, and remain in that position for about 3 to 5 minutes.
• Finish the entire course of treatment, even if you begin to feel better within a few days

Follow Up

Within 48 to 72 hours, the effectiveness of the therapy should be evaluated.

If there is no improvement, the accuracy of the diagnosis and the efficacy of the current course of therapy would be carefully reviewed, and if at all feasible, the causal pathogen would be identified. To prevent further infections, known risk factors should be avoided. It is very important to keep the ear canal dry (Wiegand et al., 2019).

Otorhinolaryngology is usually consulted for severe cases presenting with complete occlusion of the external ear canal or cases that do not respond to treatment in 72 hours. Guidelines recommend aural toilet by gentle lavage suctioning or dry mopping under otoscopic or microscopic visualization to remove obstructing material and to verify tympanic membrane integrity (Wiegand et al., 2019).

Blasini, Y. M., & Sharman, T. (2022, April 30). Otitis externa – statpearls – NCBI bookshelf. National Library of Medicine. Retrieved September 6, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK556055/

Jarvis, C. (2016). Physical Examination & Health Assessment (7th ed.). Elsevier.

Schaefer, P., & Baugh, R. F. (2012, December 1). Acute Otitis Externa. American Family Physician. Retrieved September 6, 2022, from https://www.aafp.org/pubs/afp/issues/2012/1201/p10…

Wiegand, S., Berner, R., Schneider, A., Lundershausen, E., & Dietz, A. (2019). Otitis externa: Investigation and evidence-based treatment. Deutsches Ärzteblatt International. https://doi.org/10.3238/arztebl.2019.0224

Second Post the professor asked the following question:

********Marisol is confident that being vaccinated against COVID will prevent her from getting the disease, how would you explain/correct this misinformation?