Diagnosing for Various Scenarios

Jennifer experienced fever and palpable cervical nodes. This means she could have an infection as a result her tonsils. The infection could have led to lymphadenopathy. Since most patients that contract lymphadenopathy experience localized lymphadenopathy, Jennifer most likely has localized lymphadenopathy. "Distinguishing between localized and generalized lymphadenopathy is important in formulating a differential diagnosis. In primary care patients with unexplained lymphadenopathy, approximately three fourths of patients will present with localized lymphadenopathy and one fourth with generalized lymphadenopathy" (Ferrer, 2015, p. 1).

Palpable nodes are often swollen nodes that can be a result of an infection. Because her fever climbed over time and stayed relatively high, Jennifer may be experiencing acute infection since her patient history revealed no signs of previous disease. Causes for lymphadenopathy are often obvious. "The cause of lymphadenopathy is often obvious: for example, the child who presents with a sore throat, tender cervical nodes and a positive rapid strep test, or the patient who presents with an infection of the hand and axillary lymphadenopathy" (Ferrer, 2015, p. 1).

Tenderness on the left side also shows something possibly wrong from the side of the esophagus. The thoracic duct lies on the left side. GERD or Gastroesophageal reflux disease may be responsible for the infection Jennifer experienced leading up to the visit to the doctor. Stomach contents leaking back into the person's esophagus could cause damage to the lining of one's esophagus due to the strong stomach acids coming up with the stomach contents.

Although the child is only two and has no serious history of anything that would cause GERD like obesity or hiatal hernia, the child exhibited the feeling of a sore throat, which is a less common symptom. Scenario 2 Patient Jack reported no serious health concerns besides a rash on his hands. He explained he is otherwise healthy and only used chemicals without gloves a couple of times. His wife suggested allergies. Hand eczema or hand rash / hand dermatitis have many known causes.

Dry hands may end up red and flaky, even inflamed. Being exposed to too much water, dry air, detergents, cleaning agents, rubber gloves, even detergents can cause hand rash. Skin sensitivity may be inherited and it may be important to see if Jack has ever had a history of hay fever or asthma. The multiple ear infections he explained before do not appear connected to his current health problem. If it is irritation like overexposure to anything, the doctor will treat it differently than if it is caused by allergies.

Even though hand rashes are not contagious, they can lead to infection if left untreated. Medicated ointments and antibiotics are often the first line of treatment. Things to look for in Jack's scenario would be metallic dust particles that would otherwise not reach Jack's hand when he wears rubber gloves. Metallic dust particles may cause irritant skin reactions. "Fine metallic dust particles such as antimony trioxide and arsenic trioxide that are capable of imbedding into the clothing fabric can result in irritant skin reactions" (lni, 2015, p. 2).

Hand eczema often has the following symptoms that are the same as Jack described. Redness, dryness to the point of flaking and peeling, and itching. Although pain is also associated with hand rashes, because Jack decided to get it treated early, he did not reach a stage where he experienced pain. Hand rashes are hard to treat and reoccur over time. Protective gear is essential for someone like Jack to avoid another reoccurrence. Scenario 3 Patient Martha has experienced a decrease in sleep and appetite. She also has hypertension.

The state of her mother has her working more than she would like to, causing unneeded stress and anxiety. This may add to her desire to sleep less. Martha may be experiencing resistant hypertension as her age and stress levels may be attributing to her possibly worsening hypertension. Although it was not mentioned, Martha could also be experiencing obesity and because of her obesity, sleep apnea as sleep apnea makes it harder for someone to sleep and directly increases risk for resistant hypertension.

Another possible problem that could contribute to her lack of sleep and appetite is Cushing's syndrome, another condition that increases risk of resistant hypertension. In the end, the best line of treatment for anything revolving hypertension is lifestyle change as blood pressure lowering drugs do not solve the other underlying problems often related with blood pressure like stress and obesity. Resistant hypertension is usually multifactorial in etiology.

Possible treatment is predicated on assessment and reversal of lifestyle elements contributing to any possible treatment resistance; correct diagnosis and suitable treatment of ancillary causes of hypertension; and use of effective multi-drug procedures. Lifestyle changes, including weight loss;.