Tympanic Membrane and Thyroid Gland

Tympanic Membrane and Thyroid Gland Using the classroom resources or South University Online Library, research the tympanic membrane and the thyroid gland. In a Microsoft Word document of 4-5 pages formatted in APA style, address each of the following criteria. -Two focused health assessment histories -One assessment related to the tympanic membrane and the other focused on the thyroid gland. -The assessments can be hypothetical patients or patients you have had in the past (remember HIPAA if you are describing a previous patient). -A description of the normal and abnormal findings of the tympanic membrane. -Information on how to examine the thyroid gland using both the anterior and posterior methods. -A concise note in the subjective, objective, assessment (be sure to include the NANDA diagnosis as well as the medical diagnosis), and plan (SOAP) format with each patient\’s encountered findings. -Information about laboratory/diagnostic tests used for screening clients with tympanic membrane or thyroid gland issues. -Include the expected normal results for each test. -On a separate references page, cite all sources using APA format.Tympanic Membrane and Thyroid Gland

Focused Health Assessment History

Patient 1

A 30-year-old Caucasian female Mrs. B presented with complaints of excess fatigue, losing more than 16 pounds within the last month, health intolerance during the summer period, and random cramping in the legs while working. Mrs. B also informed that her appearance had started to change gradually, her eyes appeared as though they were “about to pop out of the head” and her hair shed each time she combed it. Mrs. B worked as an RN in the ED, an environment that is unusually busy with a stressful and heavy workload. While going to work each morning, Mrs. B reported felt exhausted, experienced SOB (shortness of breath), sweat profusely, and felt like her heartbeat out of her chest.

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S.O.A.P Note

Subjective Data

Unexplained loss of weight, loss of hair, SOB with fatigue, palpitations, neck, and facial changes.

Objective Data

The physical exam revealed that the client had a resting pulse rate of 124, denied pain, and on inspection and palpation, she had an enlarged thyroid gland and bilateral bulging eyes. On auscultation, a bruit was noted over the thyroid gland.Tympanic Membrane and Thyroid Gland

Assessment

Hyperthyroidism-Graves’ disease.

Plan

• Educate the patient about hyperthyroidism
• Organize for a further consultation with an endocrinologist for medical intervention and a dietician for nutrition management (Kravets, 2016).
• Encouraged the patient to supplement his diet with vitamins and to increase the intake of calories.
• Schedule a follow-up after two weeks.

Laboratory Test

Order for a TSH test to determine thyroid function. The normal range of TSH levels is between 0.47-4.68 MIU/ml (Bucci, Giuliani & Napolitano, 2017).

Patient 2

A 28-year-old mother presented to the clinic with a 7-year-old son Paul with complaints of a left-sided headache. The mother reportedly informed that the headache had lasted for three days and was associated with irritability and fever she unsuccessfully managed with Motrin and Tylenol.   The mother highlighted that his son has a history of sinus and ear infections that were managed with antibiotics. She further acknowledged that she tried to administer past antibiotics but was ineffective. To reduce nasal congestion in early mornings, the mother explains that she administers Flonase and Zyrtec. On presentation, his son had a temperature of 103.6 and inserting his finger in the left ear to scratch. The child admits that the left side of his head hurts that he just wants it to go away.

S.O.A.P. Note

Subjective data

Left-sided headache, itchiness in the left ear, history of sinusitis, and otitis media. The mother reportedly administered past antibiotics to manage ear infections with Motrin and Tylenol to manage fever but was unsuccessful. Every morning, Paul takes Flonase, 1 spray each nostril, and Zyrtec 5mg. The mother informs that child is exposed to secondhand tobacco smoke at home since his father smokes.

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Objective data

Temp-103.6, pain 7/10, inflamed, yellow-amber discolored eardrum. Close observation reveals fluid accumulation in the left eardrum. Tonsils are red and inflamed.

Assessment

Acute Otitis Media with Effusion (AOME)Tympanic Membrane and Thyroid Gland

Plan

• Educate the caregiver (mother) about AOME-include a discussion about exposure to tobacco smoke and how it correlates ear infections, essence of medication compliance, and finishing a prescription (Le Saux et al., (2016).
• Refer the patient to an ENT clinic (Ear, Nose, and Throat) for further evaluation and management by a specialist.
• Continue administering Tylenol alternating with Motrin when the temperate exceeds 101, and continue with Zyrtec and Flonase as initially prescribed.
• Prescribe a full course of antibiotics
• Schedule for a follow-up to evaluate progress after two weeks.

Laboratory Test

None

Normal and Abnormal Assessment Findings of the Tympanic Membrane

The tympanic membrane, alternatively referred to as the eardrum, is a tissue layer that separates the outer and middle ear. Therefore, it receives vibrations of sounds from the outer ear and transmits to the middle ear, particularly the auditory ossicles. Normally, the tympanic membrane is translucent and pearly gray. Using an otoscope, the light should reflect a cone. However, a yellow-amber appearance is abnormal and an indication of a serious ear infection, particularly serous otitis media (Le Saux et al., 2016). If the eardrum would be red, then that could suggest acute otitis media. Other abnormal findings of the tympanic membrane are; a perforated drum is usually due to pressure or trauma to the ear. A perforated drum is usually dark and round. The tympanic membrane can retract and this often happens when there is no reflection of the cone shape when examined with an otoscope. A retracted tympanic membrane can be due to the otitis media with fluids, presence of air, displacement of the Eustachian tube (Jarvis, 2016).

Anterior and Posterior Examination of the Thyroid Gland

The thyroid gland plays a vital role in the endocrine system with an adequate supply of blood containing highly vascularized glands that synthesize and secrete triiodothyronine (T4) and thyroxine (T3) (Jarvis, C. (2008).  This gland is located in the middle of the neck thus can be difficult to feel. To examine it more effectively, there are two techniques that a provider must use namely; anterior and posterior examination.

Before beginning the assessment, a provider must ensure that the room has optimal lighting. When inspecting the thyroid anteriorly, the patient should tilt his/her head backward to increase the visibility of the thyroid. During a posterior examination, a provider should ensure that the patient sits straight, bend the head forward slightly to the right. A provider can also move trachea to the right and use the right hand to transition amidst the steno-mastoid muscle and trachea. Alternatively, a provider might request the patient to sip some water to feel the thyroid move up and suddenly back to its place.Tympanic Membrane and Thyroid Gland

References

Bucci, I., Giuliani, C., & Napolitano, G. (2017). Thyroid-stimulating hormone receptor antibodies in pregnancy: clinical relevance. Frontiers in endocrinology, 8, 137.

Jarvis, C. (2016). Physical examination & health assessment. (7^th ed.). St. Louis: Elsevier.

Jarvis, C. (2008). pocket companion for physical examination and health assessment. (5^th ed.).  St. Louis:  Elsevier.

Le Saux, N., Robinson, J. L., Canadian Paediatric Society, & Infectious Diseases and Immunization Committee. (2016). Management of acute otitis media in children six months of age and older. Paediatrics & child health, 21(1), 39-44.

Kravets, I. (2016). Hyperthyroidism: diagnosis and treatment. American family physician, 93(5), 363-370. Tympanic Membrane and Thyroid Gland