Chamberlain College of Nursing - NR 507Week 1 Case Study NR507: And Discussion Part 2 and Part 3. Grade A.

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INITIAL HISTORY: James is a 24-year-old male financial advisor who seeks relief from itchy eyes, repetitive sneezing, and nasal congestion that worsens at night. He says “If I could only sleep at ... night, I could handle this.” Discussion questions part one: What are the most likely diagnoses? What should you focus on during your examination? Reference Segboer, C., Holland, C., Reinartz, S., Terreehorst, I., Gevorgyan, A., Hellings, P., & Fokkens, W. (2013). Nasal hyper-reactivity is a common feature in both allergic and nonallergic rhinitis. Allergy, 68(11), 1427-1434. Discussion Part Two (graded) ADDITIONAL HISTORY: The history revealed that these symptoms occur every spring/summer and last for 6 to 8 weeks. As a teenager, he worked in his father’s hay fields. His mother had asthma as a child. The physical examination showed that his internal nares were swollen and moist and there was a clear discharge without purulence. There was no wheezing and the lungs were clear to auscultation and percussion. Discussion questions part two: What is your diagnosis now? How would you begin treatments? Reference Scullion, J., & Holmes, S. (2015). Assessing and treating allergic rhinitis. Practice Nursing, 26(5), 224-230. Discussion Part Three (graded) James now tells you that he is tired of taking drugs and fears they may stop working like they have in the past. He says he has tried 2-3 nose sprays in the past as well as loratidine, cetirizine and fexotenadine. Discussion questions part three: What other treatment options are there? What else might you do with James? References Bozek A, Ignasiak B, Filipowska B, & Jarzab J. (2013). House dust mite sublingual immunotherapy: a double-blind, placebo-controlled study in elderly patients with allergic rhinitis. Clin Exp Allergy, 43(2), 242-248. Weber, R. (2009). Immunotherapy with allergens. JAMA, 278(22), 1881-1887. [Show More]

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