NU 664B Week 1 Discussion 1: Telehealth/Transgender HPI: An otherwise healthy 35-year-old transgender woman on hormone suppressant therapy presents with a chief complaint of sinus congestion and runny nose that began 2 days ago

NU 664B Week 1 Discussion 1: Telehealth/Transgender

HPI: An otherwise healthy 35-year-old transgender woman on hormone suppressant therapy presents with a chief complaint of sinus congestion and runny nose that began 2 days ago. She tells you that her sinus infections always start off this way, and she has a wedding to go to this coming weekend and does not want to be sick for this event. She is requesting antibiotics and is quite insistent that she requires this treatment.

In the above presented case, the nurse practitioner would want to gather additional subjective information from the patient to elicit important details in developing a differential diagnosis and treatment plan. According to Dunphy et al. (2019), rhinitis can have several different etiologies including atrophic, medication related, hormonal, infectious, or irritant related causes. Therefore, the nurse practitioner would want to ask

Have you tried any over the counter or prescription medications or supplements to help relieve symptoms? Use of afrin nasal spray for more than 3-4 days can lead to rebound nasal congestion (Dunphy et al.,2019)

How long have you been on hormone suppressant therapy? Have you had any recent lab tests? Fluctuations in estrogen levels may cause nonallergic rhinitis (Dunphy et al.,2019).

Have you had a fever? Could you describe the nasal discharge? What is the color and quality including thickness? Do you have facial pain? According to Frerichs and Brateanu (2020), bacterial rhinosinusitis is suspected with fever high than 102 degrees Fahrenheit, purulent nasal discharge, and facial pain lasting 3 or more days.

Do you use any recreational drugs? According to Dains et al. (2016), acute or chronic cocaine use can cause rebound nasal congestion.

Have you been diving or swimming? This can help elicit possible causes such as an allergic response to chlorine exposure, infection from contaminated water, or barotrauma from diving (Dains et al.,2016).

In biological women it would always be important to inquire about possibility of pregnancy as pregnancy can cause nasal congestion due to hormonal changes (Dains et al.,2016). Pregnancy status would also need to be known prior to prescribing any medications.

Do your symptoms change with position changes? If the symptoms worsen with bending or leaning forward this suggests maxillary sinusitis (Dains et al.,2016).

Are your symptoms cyclic and seasonal? Do you have sneezing, or itching, or burning eyes? If patient responds positively to these questions it would be suggestive of allergic rhinitis (Dains et al.,2016)

Are the symptoms on one or both sides? Bilateral symptoms would indicate allergic or infectious etiology while unilateral symptoms may be caused by nasal polyps, unilateral choanal atresia, foreign body, or septal deviation (Dains et al.,2016).

Do you have any impairment in your ability to smell? Atrophic rhinitis may cause anosmia or a foul odor (Dunphy et al.,2019).

Have you taken an at home covid-19 test? Have you been exposed to anyone with covid-19? Covid-19 can present with rhinorrhea and nasal congestion (Reiss et al., 2020).