NSG 5003 FINAL EXAM SPRING-SUMMER SESSION
2023 (PRIORITY EXAM) COMPLETE
Week 2 Dialong
Case Study:
Janet, a 20 year-old college student, is experiencing a five-week history of itchy eyes and
nasal congestion with watery nasal discharge. She also complains of a “tickling” cough,
especially at night, and she has had episodes of repetitive sneezing. Janet gets frequent
“colds” every spring and fall.
Physical Examination
Vital Signs: Temp, 98.8; BP 110/68; Pulse 72; Respirations 18
Skin: Flaking erythematous rash on the flexor surfaces of both arms
Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and
slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares
with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx
slightly erythematous, with clear postnasal drainage
Lungs: Clear to auscultation and percussion
Dialong Questions:
1. Provide three differential diagnoses based on Janet’s subjective and objective data and
discuss your reasoning for each.
Diagnosis 1: Based on Janet’s physical exam symptoms of facial tenderness, nasal polyps,
postnasal drainage, and cough it is probable Janet is suffering from acute sinusitis.
Sinusitis or a sinus infection is caused when fluid is blocked within the sinus cavities
("Antibiotic Prescribing and Use in Doctor's Offices", 2017). Typically sinusitis is caused by a
virus, but can also be associated with allergies, pollutants, bacterial/fungal infections.
Allergies, nasal polyps, weakened immune systems and nasal structure issues are common
risk factors associated with sinusitis. In Janet’s case her sinusitis was probably brought
on by her allergies. Symptoms commonly associated with sinusitis may include headache,
facial pain/swelling, stuffy/runny nose, post nasal drip, scratchy/sore throat, coughing,
and possible fever.
Diagnosis 2: Allergic rhinitis is another possible diagnosis of Janet’s symptoms. Allergic
rhinitis can be seasonal, usually occurring in summer, spring or early fall, or perennial,
year round. In seasonal allergic rhinitis, Janet’s case, allergic sensitivities such as pollen,
grass, mold, and other irritants are the reasons behind symptoms. Common symptoms
seen in those suffering from allergic rhinitis are sneezing, itchy/watery eyes, dry cough,
and stuffy/runny nose.
Diagnosis 3: Atopic dermatitis (AD) is a common inflammatory condition seen mostly in
infants and children, but can persist in adulthood as well. Pruritus, erythema, induration, and
GUARANTEED A+ Topnurse
2023 (PRIORITY EXAM) COMPLETE
Week 2 Dialong
Case Study:
Janet, a 20 year-old college student, is experiencing a five-week history of itchy eyes and
nasal congestion with watery nasal discharge. She also complains of a “tickling” cough,
especially at night, and she has had episodes of repetitive sneezing. Janet gets frequent
“colds” every spring and fall.
Physical Examination
Vital Signs: Temp, 98.8; BP 110/68; Pulse 72; Respirations 18
Skin: Flaking erythematous rash on the flexor surfaces of both arms
Head, Eyes, Ears, Nose, and Throat: Tender over maxillary sinuses; sclera red and
slightly swollen with frequent tearing; outer nares with red, irritated skin; internal nares
with red, boggy, moist mucosa and one medium-sized polyp on each side; pharynx
slightly erythematous, with clear postnasal drainage
Lungs: Clear to auscultation and percussion
Dialong Questions:
1. Provide three differential diagnoses based on Janet’s subjective and objective data and
discuss your reasoning for each.
Diagnosis 1: Based on Janet’s physical exam symptoms of facial tenderness, nasal polyps,
postnasal drainage, and cough it is probable Janet is suffering from acute sinusitis.
Sinusitis or a sinus infection is caused when fluid is blocked within the sinus cavities
("Antibiotic Prescribing and Use in Doctor's Offices", 2017). Typically sinusitis is caused by a
virus, but can also be associated with allergies, pollutants, bacterial/fungal infections.
Allergies, nasal polyps, weakened immune systems and nasal structure issues are common
risk factors associated with sinusitis. In Janet’s case her sinusitis was probably brought
on by her allergies. Symptoms commonly associated with sinusitis may include headache,
facial pain/swelling, stuffy/runny nose, post nasal drip, scratchy/sore throat, coughing,
and possible fever.
Diagnosis 2: Allergic rhinitis is another possible diagnosis of Janet’s symptoms. Allergic
rhinitis can be seasonal, usually occurring in summer, spring or early fall, or perennial,
year round. In seasonal allergic rhinitis, Janet’s case, allergic sensitivities such as pollen,
grass, mold, and other irritants are the reasons behind symptoms. Common symptoms
seen in those suffering from allergic rhinitis are sneezing, itchy/watery eyes, dry cough,
and stuffy/runny nose.
Diagnosis 3: Atopic dermatitis (AD) is a common inflammatory condition seen mostly in
infants and children, but can persist in adulthood as well. Pruritus, erythema, induration, and
GUARANTEED A+ Topnurse
