Allergic Seasonal Rhinitis, Acute Sinusitis, and the Common Cold

Respiratory Disease
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1 What other subjective data would you obtain?
It is crucial to complete the history of present illness in the subjective data, as this will provide us more information to formulate differential diagnoses. The “OPQRST” technique should be applied in gathering these data. The acronym includes the onset of the illness, palliation (i.e., actions, medications, or the factors that relieve the symptoms), provocation of the symptoms, quality of pain, radiation, radiation, severity, and timing. The associated symptoms should also be investigated (Bickley & Szilagyi, 2012).
At this point, the presenting symptoms point to allergic rhinitis. This is an inflammation of the nasal mucosa that is typically chronic. It is present in 10 to 20% of the population. Establishing the history of the present illness will help in recognizing the chronicity of the disease. Moreover, this will help in understanding the type of allergic rhinitis. For example, seasonal occurs in particular seasons (i.e., spring, summer) or perennial, which means the symptoms are present throughout the year. The data can also identify the type of allergens. In this case, pollens trigger the allergy. In addition, the history can determine the persistence and severity of the disease. For example, symptoms that persist for less than four days per week for four consecutive weeks are classified under intermittent allergic rhinitis. Those that persist for more than four days in four consecutive weeks are classified under persistent. Lastly, the severity can be based on how it affects the activities of daily living (Small et al., 2018).
The past medical history is also essential as the disease can be associated with other diseases, such as asthma and conjunctivitis. Moreover, the allergies to food and drugs should be investigated, as the patient might miss out on the other possible triggers. Family history should also be established since the disease is common in families with atopic diseases, determining the patient’s comorbidities (Small et al., 2018; Bickley & Szilagyi, 2012).
2 What other objective findings would you look for?
Bickley and Szilagyi (2012) explained that it is essential to describe the findings instead of stating that it is normal or otherwise unremarkable to prevent missing out on the critical negatives. Moreover, the patient already has a fever and yellowish nasal discharge, which shows a possible co-infection of the upper respiratory or lower respiratory tract. However, this cannot be ruled out correctly due to the improper assessment of the sinuses (i.e., for sinusitis), chest and lungs (i.e., lower respiratory tract infection), and presence of lymphadenopathies or lymphadenitis to ensure that there is an active ongoing infection. These details are essential since patients with allergic rhinitis are more likely to suffer from an upper respiratory tract infection. (Thomas & Bomar, 2021; Nevis et al., 2016).
3 What diagnostic exams do you want to order?
Typically, the diagnosis is clinically made to diagnose the disease and rule out upper respiratory tract infection. However, it might be necessary to determine the allergens for the patient, indicating a skin prick or puncture or scratch test. This diagnostic exam introduces more than fifty different allergens onto the patient’s skin. It typically involves allergens like mold, pet dander, pollen, various foods, and dust mites. The allergens shall be applied onto the patient’s forearm using a lancet. The body’s reaction to the allergens shall be observed after fifteen minutes, and the health provider will measure the presence of a wheal to rule in or rule out an allergen (Thomas & Bomar, 2021; Mayo Clinic, 2020).
The patient can also undergo endoscopy or fluoroscopy to ensure that the nasal obstruction is not secondary to a polyp and pneumatic o...