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Association Of Allergic Rhinitis With Hypothyroidism, Asthma, And Chronic Sinusitis Essay

Association Of Allergic Rhinitis With Hypothyroidism, Asthma, And Chronic Sinusitis Essay

Episodic SOAP Note

CC: “Runny nose and itchy eyes with full ears.”

HPI: 28-year-old female patient comes into clinic complaining of a runny nose, itchy eyes and ears feeling full for the last 9 days. She also complains of rhinorrhea, with clear mucus. She has struggled with sneezing on and off all day, and claims that her eyes itch so much that she wants to scratch them out. She experiences a tickle in her throat, with an occasional pop in the ear from the fullness. She took Claritin with relief last year. She is alert and oriented and has a mildly erythematous throa Association Of Allergic Rhinitis With Hypothyroidism, Asthma, And Chronic Sinusitis Essay.

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Location: nose, ears, throat, and eyes.

Onset: 9 days ago

Character: pale, boggy nasal mucosa, clear thin secretions, enlarged nasal turbinates, mildly erythematous throat.

Associated signs and symptoms: Full ears with an occasional pop, tickle in the throat, postnasal drainage, sneezing, itchy eyes, runny nose.

Timing: Occurring over a 9-day period.

Exacerbating factors: Relief from Claritin

Severity: 2/10 with wanting to scratch out eyes.

Current Medications: None

Allergies: No known drug and food allergies

PMHx:

  • Hip fracture at 21 years old.
  • Severe dysmenorrhea

Past Surgical History: None

Immunization:

  • Up to date with childhood and adult immunizations.
  • COVID vaccine June 2021

Social Hx: Patient currently lives with her brother and mother to save on rent after recently acquiring a new job. Her parents are divorced and live separately. She likes to hike especially in the spring and often moves to Nevada to live with her father as she hikes. She enjoys the outdoors and going to the woods during spring time. She likes to swim, talk power walks, and try out meat recipes online. She denies smoking, and enjoys three glasses of red wine weekly with her meals Association Of Allergic Rhinitis With Hypothyroidism, Asthma, And Chronic Sinusitis Essay.

FMHx:

Mother, 49- HTN

Father, 54- Type II diabetes

Brother, 21- no health issues

ROS:

General: Denies weight loss or gain, fever, chills, fatigue, weakness, and night sweat.

HEENT: Denies ear pain, discharge, eye pain, vision loss or blurry vision, stiff neck, dental pain, and difficulty when swallowing. Complains of nasal congestion, post nasal drip, tickle in throat, itchy eyes, and full ears.

Respiratory: Admits to sleep apnea, denies dyspnea, coughing, stridor, and chest pain.

Cardiovascular: Denies palpitations, chest pain.

Neurological: x4 oriented, denies ataxia, tingling in extremities.

Endocrinological: Denies fever, night sweats, cold and heat intolerance.

Objective

General: Appears healthy, no signs of weakness or fatigue, straight gait, and well oriented.

HEENT: Watery eyes, itchy red eyes, post nasal drainage, nasal congestion, rhinorrhea with clear mucus, mildly erythematous throat, pale, boggy nasal mucosa, and enlarged nasal turbinates. Abnormal tympanic membrane mobility.  Swollen palpebral conjunctivae, Dennie-Morgan lines  noted. No ear discharge with normal appearing external structures, normal Weber and Rinne tests. No nasal polyps or tumors noted.

Respiratory: Clear lung sounds, no abnormal retractions during breathing, chest is symmetrical and AP diameter is normal.

Cardiovascular: Regular rate and rhythm, no peripheral edema, no bruit.

Skin: Allergic shiners around eyes.

Assessment

  • Allergic rhinitis- This is likely the most cause with definitive symptoms such as postnasal drip, nasal congestion, runny nose, rhinorrhea, and erythematous throat. To add to this, the nasal turbinates are enlarged with a boggy nasal mucosa. The patient also notes that this condition occurs when she visits her father in Nevada, mostly during spring when she hikes. It is likely that her condition presents during this period because of allergens from plants such as junipers, daisies, cypress, and sunflowers which bloom during spring when she visits the woods. Allergic rhinitis is the most probable diagnosis given that her symptoms present during spring and when she hikes in the woods and exposes herself to tree pollen (Small et al., 2018).
  • Chronic sinusitis- It is possible to consider chronic sinusitis given it also presents with symptoms such as runny nose, postnasal drainage, nasal congestion, and inflammation. However, to rule it out, the patient’s condition appears to be acute, does not have pain around neck and eyes, headache, pain in jaws and teeth, sore throat, bad breath, and hyposmia (Hoffmans et al., 2018)Association Of Allergic Rhinitis With Hypothyroidism, Asthma, And Chronic Sinusitis Essay
  • Irritant rhinitis- This is a possible diagnosis because patients also present with symptoms such as sneezing, postnasal drip, nasal congestion, runny nose, rhinorrhea, and erythematous throat. However, it is caused by exposure to irritants such as volatile chemicals or odors, which are not the trigger in this case (Liva et al., 2021).
  • Non allergic rhinitis- Symptoms that make NARES a consideration include nasal obstruction, itchiness, sneezing, rhinorrhea. However, to rule it out, NARES occurs without allergens or any triggers (Becker et al., 2016).
  • Hormonal rhinitis- The symptoms are similar to allergic rhinitis; however, in this case, the patient is not pregnant or on any oral contraceptive. Hypothyroidism is also another causative factor which is not a concern in this case (Fawzan et al., 2022).

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Plan

  • Administer Cetirizine 10mg PO per day
  • Administer Qvar (Beclomethasone Dipropionate HFA) 160 mcg twice daily.
  • Advise client to avoid visiting the woods in the spring. Nevada has tree species such as the cypress, junipers, and daisies which could be triggering the allergic reactions. The goal is to avoid exposure to allergens which trigger the reactions.

A 28 year old female comes in complaining of a runny nose and itchy eyes. States runny nose, itchy eyes, and ears felt full approximately 9 days ago. “I get this every spring and it seems to last six to eight weeks”. Describes nose is runny with clear mucus. Sneezes on and off all day. Eyes itch so bad she just wants to scratch them out, sometimes feels a tickle in her throat and ears feel full and sometimes pop. Last year took Claritin with relief. Charlotte is alert and oriented. She has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but her lungs are clear. Her tonsils are not enlarged but her throat is mildly erythematous.Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP Notes have specific data included in every patient case. You will need to put in the missing information in the note (some may be made up ie meds, hx, parts of the ROS and PE). I’m looking to make sure you know what information to include. In the Assessment/Plan, you will document your differential diagnoses as per the assignment. Document the assignment on the Episodic/focused SOAP note exemplar located in the Resource list. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each Association Of Allergic Rhinitis With Hypothyroidism, Asthma, And Chronic Sinusitis Essay.

References

Becker, S., Rasp, J., Eder, K., Berghaus, A., Kramer, M. F., & Gröger, M. (2016). Non-allergic rhinitis with eosinophilia syndrome is not associated with local production of specific IgE in nasal mucosa. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology – Head and Neck Surgery, 273(6), 1469–1475. https://doi.org/10.1007/s00405-015-3769-4

Fawzan, A., Assiri, S., Althaqafi, R., Alsufyani, A., & Alghamdi, A. (2022). Association of allergic rhinitis with hypothyroidism, asthma, and chronic sinusitis: clinical and radiological features. World Journal Of Otorhinolaryngology – Head And Neck Surgery. https://doi.org/10.1016/j.wjorl.2020.12.001

Hoffmans, R., Wagemakers, A., van Drunen, C., Hellings, P., & Fokkens, W. (2018). Acute and chronic rhinosinusitis and allergic rhinitis in relation to comorbidity, ethnicity and environment. PloS one, 13(2), e0192330. https://doi.org/10.1371/journal.pone.0192330

Liva, G. A., Karatzanis, A. D., & Prokopakis, E. P. (2021). Review of Rhinitis: Classification, Types, Pathophysiology. Journal of clinical medicine, 10(14), 3183. https://doi.org/10.3390/jcm10143183

Small, P., Keith, P., & Kim, H. (2018). Allergic rhinitis. Allergy, Asthma &Amp; Clinical Immunology, 14(S2). https://doi.org/10.1186/s13223-018-0280-7 Association Of Allergic Rhinitis With Hypothyroidism, Asthma, And Chronic Sinusitis Essay