Create documentation or an episodic/focused note in SOAP format about the patient in the case study

Learning Goal: I’m working on a nursing multi-part question and need an explanation and answer to help me learn.

CASE STUDY:

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. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.

INSTRUCTIONS:

· Provide evidence from the literature to support diagnostic tests that would be appropriate for your case.

List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

3 APA SCHOLARLY FORMAT REFERENCES

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