NRNP 6540 Assessing, Diagnosing, and Treating Head, Neck, and Face Disorders

NRNP 6540 Assessing, Diagnosing, and Treating Head, Neck, and Face Disorders

Assessing, Diagnosing, and Treating Head, Neck, and Face Disorders

In primary care, head, neck, and facial ailments are common, particularly in older individuals. If not appropriately diagnosed and treated, these conditions—which include sinusitis, allergic rhinitis, vision impairment, and oral health issues—can have a significant negative influence on a patient’s general health and quality of life (Kennedy-Malone & Duffy, 2023). The purpose of this paper is to review the case of a 79-year-old woman with nasal drainage and congestion, discuss key assessment considerations, provide differential diagnoses, and develop an evidence-based treatment and health promotion plan tailored to her needs.

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Further Review of Systems (ROS) Questions

A few more reviews of systems questions are crucial for getting a more thorough history from this patient. As these symptoms are typical of allergic rhinitis, it might be beneficial to start by finding out if she has ever experienced sneezing, watery eyes, or itching (Terada & Kawata, 2022). Next, she should be asked whether she has noticed a reduction in her sense of smell or taste, which could indicate chronic rhinitis or sinus involvement. Finally, questions regarding headaches, cough, or sore throat related to postnasal drip would help in determining whether sinusitis or pharyngitis may be contributing to her symptoms.

Physical Exam (PE) to Perform

A thorough physical examination will help reduce the number of potential causes of her symptoms. To check for conditions like polyps, mucosal inflammation, or pale or wet nasal tissue—all of which are common in individuals with allergic rhinitis—an otoscope is required (Trincianti et al., 2023). To check for cobblestoning of the pharyngeal wall, erythema, or postnasal drip, an oropharyngeal examination should also be carried out. Additionally, auscultation of the lungs is important to assess for wheezing or other abnormal breath sounds, as respiratory involvement can sometimes complicate upper airway conditions in elderly patients.

Differential Diagnoses

Given her history of seasonal nose symptoms, persistent congestion, and throat clearing without fever or systemic illness, the patient is most likely diagnosed with nonspecific allergic rhinitis (J30.9) (Trincianti et al., 2023). Chronic sinusitis, nonspecific (J32.9), which is characterized by postnasal drip, persistent nasal congestion, and throat irritation that lasts longer than 12 weeks, is another possible diagnosis (Payne et al., 2025). Vasomotor rhinitis (J31.0), a non-allergic condition that is often brought on by environmental irritants or temperature changes, is a third differential diagnosis that is especially common in older people (Chiu et al., 2025).

Laboratory Tests

Lab tests help rule out other conditions and confirm the most likely cause of symptoms as part of the diagnosis process. Eosinophilia, which is frequently observed in allergic reactions, can be detected by a complete blood count (CBC) (Siddiqui et al., 2022). Allergy testing, such as serum IgE or a skin prick test, can help identify specific allergens and strengthen a diagnosis of allergic rhinitis. A sinus CT scan may be required to look for anatomical blockages or chronic inflammation if sinusitis is suspected and symptoms persist after treatment.

Treatment Options for Allergic Rhinitis

Once allergic rhinitis is diagnosed, treatment should prioritize symptom management and enhancing the patient’s quality of life. An intranasal corticosteroid, such as fluticasone 50 mcg/spray, is one of the first-line treatments for allergic rhinitis. It should be applied once daily to each nostril (Trincianti et al., 2023). Patients should be informed about potential side effects, such as nasal irritation, headache, or epistaxis, and advised to use the spray consistently to achieve optimal results. Another choice is a second-generation antihistamine, like loratadine 10 mg taken by mouth once a day. This helps lessen sneezing and rhinorrhea with less sedation than first-generation drugs. Older people should avoid anticholinergic drugs, which can cause confusion, difficulty urinating, and falls.

Health Promotion and Follow-Up

For older people with allergic rhinitis, health improvement is significant. The patient should be advised to stay away from common causes like dust, mold, and potent allergens in the environment. People also say that she should be told about how regular nose rinses can help keep her nasal passages clear (Kennedy-Malone & Duffy, 2023). By showing her the right way to use a nose spray, she can help ensure that the medicine works well and has as few side effects as possible. It is also important to stress the importance of staying hydrated and eating a healthy diet, as these habits help the immune system and general health. Her growth and ability to handle the medicines should be checked at a follow-up visit in four to six weeks. If her problems persist, she may need to consult an allergist or an otolaryngologist.

Conclusion

Older adults frequently experience upper respiratory issues, which require careful assessment and treatment. Based on their symptoms, the patient appears to have allergic rhinitis. She can feel better with medications like second-generation antihistamines and intranasal corticosteroids. It is crucial to educate patients, help them make lifestyle changes, and follow up with them regularly to maintain control over their conditions and improve their quality of life. By providing research-based care, advanced practice nurses can help older adults with problems related to the head, neck, and face.

References

Chiu, R. G., Eldeirawi, K., Dick, A. I., Nyenhuis, S. M., Vajaranant, T. S., Caskey, R., & Lee, V. S. (2025). Association of Menopause and Rhinitis Among Adult Women in the United States: Findings from the All of Us Research Program. The Laryngoscope. https://doi.org/10.1002/lary.32015

Kennedy-Malone, L., & Duffy, E. G. (2023). Advanced practice nursing in the care of older adults (3rd ed.). F.A. Davis Company.

Payne, S. C., McKenna, M., Buckley, J., Colandrea, M., Chow, A., Detwiller, K., Donaldson, A., Dubin, M., Finestone, S., Filip, P., Khalid, A., Peters, A. T., Rosenfeld, R., Akrami, Z., & Dhepyasuwan, N. (2025). Clinical Practice Guideline: Adult sinusitis update. Otolaryngology, 173(S1). https://doi.org/10.1002/ohn.1344

Siddiqui, Z., Walker, A., Pirwani, M., Tahiri, M., & Syed, I. (2022). Allergic rhinitis: diagnosis and management. British Journal of Hospital Medicine, 83(2), 1–9. https://doi.org/10.12968/hmed.2021.0570

Terada, T., & Kawata, R. (2022). Diagnosis and treatment of local allergic rhinitis. Pathogens, 11(1), 80. https://doi.org/10.3390/pathogens11010080

Trincianti, C., Tosca, M. A., & Ciprandi, G. (2023). Updates in the diagnosis and practical management of allergic rhinitis. Expert Review of Clinical Pharmacology, 16(7), 669–676. https://doi.org/10.1080/17512433.2023.2225770

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Assessing, Diagnosing, and Treating Head, Neck, and Face Disorders

Head, neck, and face disorders are common, and thus you will likely care for elderly patients with these disorders. In your role as an advanced practice nurse, you must be able not only to correctly assess and diagnose patients but also help patients manage the disorder by planning necessary treatments, assessments, and follow-up care.

Resources

 

Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.

WEEKLY RESOURCES

 

Learning Resources

Required Readings

  • Kennedy-Malone, L., & Groenke-Duffy, E. (2023). Head, neck, and face disorders. In Advanced practice nursing in the care of older adults (3rd ed., pp. 165-185). F.A. Davis.
  • Goldberg, C. (2018b). The eye exam

Required Media

Recommended Media

  • Links to an external site. [Video]. https://engageil.com/modules/oral-health-and-the-older-adult

    Note: View the Oral Health and the Older Adult video module available in this free course.

To prepare:

  • Review the Week 4 Case Assignment and questions provided by your instructor.
  • Reflect on the patient’s symptoms and aspects of disorders that may be present.
  • Consider how you might assess, perform diagnostic tests, and recommend medications to treat patients presenting with the symptoms in the case study.

The Assignment:

After reviewing the case and the accompanying case analysis questions, included in the document, answer the questions directly in a word document. When providing evidence to support your answers, be sure they evidenced-based, current (no more than 5 years old), and follow current standards of care. Follow APA 7th edition formatting, including a cover page and references.

By Day 7

Submit your Assignment.

submission information

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Rubric

NRNP_6540_Week4_Assignment_Rubric

NRNP_6540_Week4_Assignment_Rubric
Criteria Ratings Pts
This criterion is linked to a Learning Outcome Create documentation in the document about the patient in the case study to which you were assigned. Provide thorough answers to the questions asked in the assignment. 25 to >23.0 pts Excellent The response thoroughly and accurately answers the questions presented. The answers inform a differential diagnosis and a thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

23 to >20.0 pts Good The response answers the questions presented. The answers inform a differential diagnosis and a thorough cross-check of medications against the Beers Criteria has been completed and appropriate alternative drugs recommended if applicable.

20 to >18.0 pts Fair The response partially answers the questions presented. The answers inform a differential diagnosis, but is somewhat vague or contains minor inaccuracies. A cross-check of medications against the Beers Criteria has been completed but alternatives may be missing.

18 to >0 pts Poor The response provides an incomplete or inaccurate answers to questions presented. The answers may partially inform a differential diagnosis, but is somewhat vague or contains minor inaccuracies. A cross-check of medications against the Beers Criteria has not been completed. Or, other subjective documentation is missing.

 25 pts
This criterion is linked to a Learning Outcome In the Assessment section, provide: • At least three (3) differentials with supporting evidence. Explain what rules each differential in or out, and justify your primary diagnosis selection. Include pertinent positives and pertinent negatives for the specific patient case. 25 to >23.0 pts Excellent The response lists in order of priority at least three distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study, and provides a thorough, accurate, and detailed justification for each of the conditions selected.

23 to >20.0 pts Good The response lists in order of priority at least three different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the conditions selected.

20 to >18.0 pts Fair The response lists three possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or inaccuracy in the conditions and/or justification for each.

18 to >0 pts Poor The response lists two or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.

 25 pts
This criterion is linked to a Learning Outcome In the Plan section, list the treatment plan for the patient that addresses each diagnosis, as applicable. Includes documentation of diagnostic studies that will be obtained, referrals to other health-care providers, therapeutic interventions, education, disposition of the patient, and any planned follow up visits. • A discussion related to health promotion and disease prevention taking into consideration patient factors, PMH, and other risk factors. 25 to >23.0 pts Excellent he response thoroughly and accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies need, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. A thorough and accurate discussion of health promotion and disease prevention related to the case is provided.

23 to >20.0 pts Good The response accurately outlines a treatment plan for the patient that addresses each diagnosis and includes diagnostic studies need, referrals, therapeutic interventions, patient education and disposition, and planned follow-up visits. An accurate discussion of health promotion and disease prevention related to the case is provided.

20 to >18.0 pts Fair The response somewhat vaguely or inaccurately outlines a treatment plan for the patient. The discussion on health promotion and disease prevention related to the case is somewhat vague or contains inaccuracies.

18 to >0 pts Poor The response does not address all diagnoses or is missing elements of the treatment plan. The discussion on health promotion and disease prevention related to the case is vague, inaccurate, or missing.

 25 pts
This criterion is linked to a Learning Outcome Provide at least three evidence-based peer-reviewed journal articles or evidenced-based guidelines which relate to this case to support your diagnostics and differentials diagnoses. Be sure they are current (no more than 5 years old) and support the treatment plan in following current standards of care. 10 to >9.0 pts Excellent The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents the latest in standards of care and provides strong justification for treatment decisions.

9 to >8.0 pts Good The response provides at least three current, evidence-based resources from the literature to support the treatment plan for the patient in the assigned case study. Each resource represents current standards of care and supports treatment decisions.

8 to >7.0 pts Fair Three evidence-based resources are provided to support treatment decisions, but may not represent the latest in standards of care or may only provide vague or weak justification for the treatment plan.

7 to >0 pts Poor Two or fewer resources are provided to support treatment decisions. The resources may not be current or evidence-based, or do not support the treatment plan.

 10 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 to >4.0 pts Excellent Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 to >3.0 pts Good Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.

3 to >2.0 pts Fair Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment is vague or off topic.

2 to >0 pts Poor Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.

 5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting—English writing standards: Correct grammar, mechanics, and proper punctuation 5 to >4.0 pts Excellent Uses correct grammar, spelling, and punctuation with no errors.

4 to >3.0 pts Good Contains a few (one or two) grammar, spelling, and punctuation errors.

3 to >2.0 pts Fair Contains several (three or four) grammar, spelling, and punctuation errors.

2 to >0 pts Poor Contains many (≥ five) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

 5 pts
This criterion is linked to a Learning Outcome Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. 5 to >4.0 pts Excellent Uses correct APA format with no errors.

4 to >3.0 pts Good Contains a few (one or two) APA format errors.

3 to >2.0 pts Fair Contains several (three or four) APA format errors.

2 to >0 pts Poor Contains many (≥ five) APA format errors.

 5 pts

Total Points: 100

 



		


		
		
		
		
	


	
		
			


	


	



	

		

			
			
				
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