Introduction
In this paper, two vital components of a human body will be discussed and assessed: the tympanic membrane and the thyroid gland. The tympanic membrane is an important segment of a human ear, also known as an eardrum (Hasso, 2012). This thin circular membrane exists between the middle ear and the external year. Its flexibility and toughness help to perform its main function that is to promote human hearing and protect all parts of the ear from sound wave strikes. The thyroid gland is one of the first endocrine glands to be developed (Moore, Persaud, & Torchia, 2016).
It is a ductless gland that is located in the neck. It secretes hormones with the help of which the regulation of the growth and development. Each organ can be damaged and cause the development of different diseases and health problems. It is necessary to investigate both in order to avoid complications and be ready for treatment.
Two Health Assessment Histories
With the help of health assessment histories, it is possible to clarify the complications, symptoms, and other aspects of the problems in the thyroid gland or the tympanic membrane.
The first patient visits the hospital because of some hearing problems, earache, and headache during the last three days. The patient is a 47-year-old married man with two children. He works at the bank and does not have evident financial or health problems. Besides, he does not like to visit hospitals without some reasons. One week ago, he had to go to another state because of his business affairs. He traveled by plane. He tried to use some drops (does not remember the name) to reduce pain. It helps for several minutes or hours (depends on the man’s activities and emotions). At the moment of his first physical examination, his BP is 123/85, and temp. – 99.5.
The second patient is a 38-year-old single mother (G1P1). She delivered the baby three months ago without any complications. Still, she faces such problems as the inability to lose weight, unstable menstrual cycle, constant depression, fatigue, and irritability. All these symptoms she tries to connect with her current emotional and physical changes and problems. Still, other signs she bothers of include dry hair (even hair loss) and skin and constantly hanging heart bit. Her V/S are BP 130/90, temp. – 98.2, HR is 125, and weight is 187.
Normal and Abnormal Findings for the Tympanic Membrane
It is easy to traumatize the tympanic membrane and cause certain challenges in work and during everyday activities. The examination of an ear should consist of several stages, including the examination of the area around the ear, the pinna, the meatus, and the external ear canal with the help of an otoscope (Bansal, 2016).
Normal findings include the presence of some hair and yellow or even brown cerumen, pinkish gray ear drum, and mobile membrane with air inflation. The membrane is also shiny, translucent, and pearly white in color (Bansal, 2016). The tympanic membrane is usually 0.1 mm thick and 8-10 mm in breadth. It is between the ear canal and the middle ear.
Abnormal findings that can be discovered while the examination of the tympanic membrane including the change of color (blue, red, or amber) and possible perforations, bulging, or retractions. Besides, a doctor can observe some kind of dullness, the change of size, or some damage. There can be some holes in the eardrum of patients. Finally, the mobility of the tympanic membrane is also an abnormal finding that cannot be neglected (Bansal, 2016).
Examination of the Thyroid Gland Using Anterior and Posterior Methods
The examination of the thyroid gland helps to define the main problems that can bother patients and construct the differential of the pathologies that can be present. The establishment of the thyroid’s functional status is crucial for any patient because its hormones regulate vital functions of the human body. There are two types of methods that can be used for the thyroid gland examination as soon as the location of the thyroid is identified during the inspection: the anterior and posterior approaches (Tintinalli, Stapczynski, Ma, Cline, & Meckler, 2016).
Anterior palpation is frequently used to identify the condition of the thyroid gland. A patient should sit or stand. The first task is to identify the location of the thyroid isthmus. The most frequent method is to palpate the cricoid cartilage and the suprasternal notch (Tintinalli et al., 2016). One hand is used to retract the sternocleidomastoid muscle, and another hand is used to palpate the thyroid. Several sips can be used to check the movement of the gland.
If it is possible, the patient should also be examined with the help of the posterior approach when the doctor stands behind the sitting or standing patient. The palpation of the cricoid cartilage and the suprasternal notch has to be repeated. The fullness of the thyroid can be defined. The sternocleidomastoid muscle can be felt when both hands move laterally.
The last stage of the examination of the thyroid gland is the synthesis of the data obtained from the anterior and posterior methods of palpation.
SOAP Notes
SOAP notes are usually used by nurses as the main problem-oriented technique in the primary health care settings. In this paper, two patients are introduced with different histories and health problems. A female patient has the disease connected with the thyroid gland disorder. A male patient suffers from hearing problems and earache.
SOAP for the Tympanic Membrane Problem
S: The male patient has no past ear problems or similar family cases. It is a single case when the patient suffers from intense pain after his travel to another state by plane. A headache and earache have been experienced during the last three days. The use of some drops (the patient does not specify the name) removes or reduces pain for some time. Still, it returns quickly.
O: BP – 123/85, temp. – 99.5.
A: Myringitis is the primary diagnosis due to the presence of such symptoms as a higher temperature, hearing impairment, and headache. Otitis, external ear inflammation, or middle ear perforations are the differential diagnoses.
P: The patient is informed about the inflammation process that occurred with his tympanic membrane as a consequence of the change of pressure in the airplane and the inability to avoid the infection that was in a closed space. As soon as support and explanations are given, the patient should be examined through otomicrosopy. Analgesics and anti-inflammatory medications should be prescribed. It is suggested to begin with Ibuprofen (2 pills per day), Tylenol (2 tablets every 8 hours), and Floxin drops (3 times per day, and may be increased in case pain disturbs). No swimming activities are allowed.
SOAP for the Thyroid Gland Problem
S: The patient tells about fatigue, depression, unstable menstrual cycle, and constant irritability. She gave birth to a baby three months ago. Body weight is 187, and she is unable to change her weight and lose the necessary pounds.
O: BP – 130/90, temp. – 98.2, HR – 125.
A: Hypothyroidism is the primary diagnosis that can be explained after the detection of a high level of the thyroid stimulating hormone because of the underactive thyroid gland. Differential diagnoses may vary because the symptoms are hard to recognize. These diagnoses may be depression, anxiety, and postpartum disorder.
P: The main task is to inform the patient that the level of the hormone has to be reduced. The main treatment includes the use of the synthetic thyroid hormone levothyroxine (Tintinalli et al., 2016). 10 mg of Synthroid three times per day after feeding can be appropriate. Insomnia can be the outcome of taking the drug, and the woman has to inform some family members to check on her from time to time.
Laboratory Tests and Normal Levels
The lab tests for the patient with a problematic tympanic membrane are not usually required. Palpation and physical examination are usually enough. The normal levels include the absence of any damage, holes, or inflammatory processes on the tympanic membrane. MRI is useful to identify other complications.
The patient with a problematic thyroid gland should pass through TSH testing and check the levels of T3 and T4 thyroid hormones in the blood. The test can show the following results: 0.4 is normal, 2.5 is at risk, and 10.0 is the disease of hypothyroidism.
References
Bansal, M. (2016). Essentials of ear, nose & throat. Philadelphia, PA: JP Medical.
Hasso, A.N. (Ed.). (2012). Diagnostic imaging of the head and neck: MRI with CT & PET correlations. Philadelphia, PA: Lippincott Williams & Wilkins.
Moore, K.L., Persaud, T.V.N., & Torchia, M.G. (2016). Before we are born: Essentials of embryology and birth defects (9th ed.). Philadelphia, PA: Elsevier Health Sciences.
Tintinalli, J., Stapczynski, J., Ma, O.J., Cline, D.M., & Meckler, G. (2016). Tintinalli’s emergency medicine: A comprehensive study guide (8th ed.). New York, NY: McGraw Hill Professional.