The nurse working at the outpatient pediatric clinic is perform-ing an admission assessment
for a 7-year-old child who is ac-companied by their parent. The child reports right ear pain
for 3 days. The nurse documents the following assessment findings.
Health History Nurses' Notes Vital Signs Diagnostic Results
Reports right ear pain × 3 days described as constant, aching, nonradiating; denies dry
mucous membranes, eye drainage, nasal drainage, or throat pain; oropharynx pink, moist,
with no redness, swelling, exudate
Reports no sick contacts and has been attending full days of school; reports swimming daily
for the past week Denies neck stiffness; no swelling of the neck, or swollen lymph nodes
Denies cough, wheezing, difficulty breathing; lung sounds clear Tenderness noted on
palpation and manipulation of right auricle with ear canal erythema; no discharge; left
auricle nontender
Immunizations up-to-date Allergies: - ANSWER Options for 1 No sick contacts
Ear pain without fever
Attends full school days
Left auricle is nontender to manipulation
Options for 2
Denies neck stiffness
Immunizations up-to-date
Swimming daily for the past week
Lack of nasal drainage or throat pain
Options for 3
Denies cough No lymphoadenop-athy
Tenderness on manipulation of right auricle
1
, Lung sounds clear to auscultation bilaterally
Rationale for the Previous Question - ANSWER Otitis externa is also known as
swimmer's ear and is associated with inflam-mation and possibly exudate in the external
auditory canal. Otitis externa is confirmed when there are no other disorders such as otitis
media or mastoiditis. Fever is usually absent, and hearing is unaffected. Often there is
tenderness on palpation of the tragus and manipulation of the auricle. The lining of the
canal is erythematous and edematous, and discharge may be seen. Another factor that
suggests otitis externa is that the child has been swimming daily for the past week. The
other findings noted are not risk factors for this problem. Attending full school days
heightens the risk for otitis media, which can occur secondary to an upper respiratory
infection.
Client Finding Otitis Externa - ANSWER Ear pain
No fever
No sick contacts
Swimming daily for the past week
Tenderness noted on palpation and manipulation of the auricle
Erythema in the ear canal
Client Finding Otitis Media - ANSWER Ear pain
No fever
Attends full school days
Swimming daily for the past week
A 45-year-old client diagnosed with CKD requires dialysis. As a candidate for both
hemodialysis and peritoneal dialysis, the cli-ent decides that peritoneal dialysis is the better
option for their lifestyle. The client is hospitalized and undergoes insertion of the peritoneal
dialysis catheter, and the first dialysis procedure is ordered. The nurse documents predialysis
assessment data and reviews laboratory results.
Health History Nurses' Notes Vital Signs Laboratory Results
2
for a 7-year-old child who is ac-companied by their parent. The child reports right ear pain
for 3 days. The nurse documents the following assessment findings.
Health History Nurses' Notes Vital Signs Diagnostic Results
Reports right ear pain × 3 days described as constant, aching, nonradiating; denies dry
mucous membranes, eye drainage, nasal drainage, or throat pain; oropharynx pink, moist,
with no redness, swelling, exudate
Reports no sick contacts and has been attending full days of school; reports swimming daily
for the past week Denies neck stiffness; no swelling of the neck, or swollen lymph nodes
Denies cough, wheezing, difficulty breathing; lung sounds clear Tenderness noted on
palpation and manipulation of right auricle with ear canal erythema; no discharge; left
auricle nontender
Immunizations up-to-date Allergies: - ANSWER Options for 1 No sick contacts
Ear pain without fever
Attends full school days
Left auricle is nontender to manipulation
Options for 2
Denies neck stiffness
Immunizations up-to-date
Swimming daily for the past week
Lack of nasal drainage or throat pain
Options for 3
Denies cough No lymphoadenop-athy
Tenderness on manipulation of right auricle
1
, Lung sounds clear to auscultation bilaterally
Rationale for the Previous Question - ANSWER Otitis externa is also known as
swimmer's ear and is associated with inflam-mation and possibly exudate in the external
auditory canal. Otitis externa is confirmed when there are no other disorders such as otitis
media or mastoiditis. Fever is usually absent, and hearing is unaffected. Often there is
tenderness on palpation of the tragus and manipulation of the auricle. The lining of the
canal is erythematous and edematous, and discharge may be seen. Another factor that
suggests otitis externa is that the child has been swimming daily for the past week. The
other findings noted are not risk factors for this problem. Attending full school days
heightens the risk for otitis media, which can occur secondary to an upper respiratory
infection.
Client Finding Otitis Externa - ANSWER Ear pain
No fever
No sick contacts
Swimming daily for the past week
Tenderness noted on palpation and manipulation of the auricle
Erythema in the ear canal
Client Finding Otitis Media - ANSWER Ear pain
No fever
Attends full school days
Swimming daily for the past week
A 45-year-old client diagnosed with CKD requires dialysis. As a candidate for both
hemodialysis and peritoneal dialysis, the cli-ent decides that peritoneal dialysis is the better
option for their lifestyle. The client is hospitalized and undergoes insertion of the peritoneal
dialysis catheter, and the first dialysis procedure is ordered. The nurse documents predialysis
assessment data and reviews laboratory results.
Health History Nurses' Notes Vital Signs Laboratory Results
2
