NSG 3012 Week 2 Assessment of the Tympanic Membrane and Thyroid Gland

Using the South University Online Library or the Internet, research the tympanic membrane and the thyroid gland. Based on your findings, create a 3- to 4-page Microsoft Word document that includes:

· Information about a minimum of two health assessment histories.

· The possible findings for the tympanic membrane.

ORDER NSG 3012 Week 2 Assessment of the Tympanic Membrane and Thyroid Gland

Assessment of the Tympanic Membrane and Thyroid Gland Example Approach

Subjective

32 year old female who noticed an unusual mass in her neck for the last year that has gradually gotten worse. Patient brought in today by family friend into the emergency room with difficulty swallowing, tight feeling to throat, productive cough, unnecessary weight gain, and hoarseness. Family member states” When she attempts to drink or eat anything she coughs vigorously and has a hard time catching her breath since last night.” Denies any pain and tenderness to mass and no medical history. Patient has not seen a physician in last 5 years. Denies any possibility of pregnancy and has not traveled outside the United States with in the last 2 years. Current immunizations are up to date.

Objective

Patient presents lethargic with a productive cough and follows commands. Lungs clear to auscultate with tachypnea. Oximetry is 90%, placed on oxygen to keep saturation greater than 92%. Respirations 30-40 bpm. Noted deviated uvula shift to right. Inspected and palpated anterior thyroid by extending neck slightly and unable to swallow water. Lateral thyroid prominence >2mm to left. Posterior thyroid palpated not tolerated.

HPI: Mother states that the patient has been unusually fussy. She states that the pain seems to be worse at night and her daughter has been having some difficult sleeping. “Her ear is sticking out from her head; I’m really concerned!” Reports no history of otitis media.

PMH: Patient has no medical or surgical history, and is not taking any prescription or over-the-counter drugs.

PSxH: N/A

PSH: N/A

PFH: Mother and father are both 36 years old and have no knowledge of chronic health conditions within their family

Objective:

Physical Exam

Vital signs: Ht 31.5” Wt 21.5lbs, BP: 98/70, HR: 90, Resp: 20/min, SP02: 98%, Temp: 101.5 F

The physical exam revealed an uncomfortable appearing, female toddler with a fever, but all other vital signs are normal. She has a prominent right ear that is erythematous and tender to the touch posteriorly to include the mastoid and along the pinna. The patient’s neck was unaffected and maintains full range of motion. Her right tympanic membrane was bulging and erythematous with some fluid noted. The left tympanic membrane was normal; with a shiny, pearl-grey color. No perforation seen. A neurological exam was given to determine possible intracranial spread (Oestreicher-Kedem, Raveh, Kornreich, Popovtzer, Buller, & Nageris, 2005). The exam was normal with no neurological deficit.

Labs:

CBC: Hb 104 g/L, Ht 33%, Plat 408, WBC 13.2, Neutrophils 8.1, Lymphocytes 4.3

ESR: 48

CT: Revealed fluid in the right mastoid air cells with soft tissue swelling and abscess without bone destruction.

Assessment:

Pain r/t pressure in right ear AEB crying and pulling at ear.

Plan:

Myringotomy with placement of Tympanostomy tubes to provide aeration and pressure equalization. Obtain culture of fluid.
Monitor for purulent otorrhea.
Refer to otolaryngologist.

C.D. is a 30 year old Caucasian female who presents to the primary care clinic for weight gain. Her diet has not changed over the last couple of years; however, she states that her clothes do not fit well anymore, and she has gained approximately 15 pounds over the last year.

Subjective:

Chief Complaint: Unexplained weight gain

HPI: According to the patient, she has gained approximately 15 pounds over the last year. She reports that her diet has not changed, but she cannot stop gaining weight.

PMH: Has no past history of any medical, surgical or psychiatric problems. She does not take any prescription medication; however, endorses taking Advil for headaches on occasion.

PSH: No tobacco, alcohol, or substance abuse. She is currently in a monogamous relationship, but does not use contraception. Her last menstrual period was 3 months ago.

PFH: Mother died at age 55 from lung cancer, father has type 2 diabetes (controlled with diet). No sibilings.

Objective:

Physical Exam

Vital signs: Ht 5’2” Wt 210 lbs, BP: 110/85, HR: 75, Resp: 16/min, SP02: 98%, Temp: 98.6 F

The physical exam reveals a well-developed female, in no acute distress. AAOx3. The patient has fine, dark hair on her chin and sides of face. There is a notable amount of hair growth on her arms, legs, and sternal area.

The patient was asked to move into a seated position with her neck in a slightly extended position. Cross-lighting was turned on to improve the detection of masses. The patient was then instructed to swallow a sip of water so the upward movement of the thyroid could be observed. After observation, an attempt was made to locate the thyroid isthmus by palpating between the cricoid cartilage and the suprasternal notch. The right fingers were slightly curved to retract the sternocleidomastoid muscle while using the left hand to palpate the thyroid. The patient was instructed to take another sip of water and the thyroid was felt. The same exam was repeated from the posterior approach, and again, the thyroid was palpated (Jarvis, 2012). There were no other physical exam findings that contributed to this complaint.

Labs:

CBC w/ diff: RBC: 4.5, Hgb: 14, Hct: 40%, WBC 5,000, Neutraophils: 1%, Lymphocytes: 27%, Monocytes, 2%, Eosinophils: 1%, Basophils: 1%, Platelets: 300,000.

TSH: 1.32 (lower side of normal)

LH: 9.8 (elevated)

FSH: 2.1 (low)

Testosterone: 88 (elevated)

Prolactin: 102 (elevated)

HCG: Neg

Assessment:

Risk for myxedema coma

Planning:

Refer to endocrinologist
Plan activities around rest periods
Maintain blood pressure within normal limits

References

Jarvis, C. (2012). Physical Examination and Health Assessment [VitalSouce bookshelf version]. Retrieved from http://digitalbookshelf.southuniversity.edu/books/978-1-4377-0151-7/id/B9781437701517000133_p0170

Oestreicher-Kedem, K., Raveh, E., Kornreich, L., et al. (2005). Complications of mastoiditis in children at the onset of a new millenium. Ann Otol Rhinol Laryngol.,114(2):147-52. Retrieved from:
http://www.ncbi.nlm.nih.gov/pubmed/15757196Kilpatrick, R, Milne, JS, Rushbrooke, M, Wilson, ESB. A survey of thyroid enlargement in two general practices in Great Britain, 1963. BMJ. 1:29-34.