Discussion: Assessing Musculoskeletal Pain

Discussion: Assessing Musculoskeletal Pain

Case # 2 Ankle Pain:

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A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

Assignment:

Write an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each. Discussion: Assessing Musculoskeletal Pain

Wk 8-Discussion Review of Case Study 1

COLLAPSE

Patient Information: A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

CC Back pain

HPI: SK, a 42-year-old Caucasian man, has been complaining of lower back pain for the past two months and has undergone a

physical examination. His left leg is giving him sporadic radiating discomfort, he claims. An episode of severe leg discomfort that lasts for many hours has been described. SK’s discomfort has made it difficult for him to move around as he goes about his daily activities (ADLs) and at work. Pt says, “My back hurts, and it throbs.” The discomfort in my leg is like a “burning sensation” when it is inflamed. There’s a lot of pain. Lifting large objects is said to exacerbate the pain. A good night’s sleep helps to ease the discomfort. For the previous two weeks, the patient has been applying ice to her lower back and taking Ibuprofen 800 mg PO BID. Denies that back pain is accompanied by any other symptoms.

Medications in Use Today:

Back pain: ibuprofen 500 mg once daily

Taking atorvastatin 20mg PO once a day for high cholesterol levels.

There are no allergies to foods or latex, and there aren’t any to the environment.

Atorvastatin 20 mg PO once a day was prescribed to PMHx with a diagnosis of HLD in 2016. Up-to-date on all required vaccines. Immunization against influenza within a year of the visit. There is no prior surgical history to speak of. There are no prior hospitalizations on record. Until now, I haven’t had an annual physical. Discussion: Assessing Musculoskeletal Pain

As a construction worker, Soc Hx: SK maintains an active lifestyle. Has been married to his wife for three years and is currently having sex. They define themselves as “social drinkers” and can’t remember the last time they had a drink. Denies the use of any tobacco product, including cigarettes. Denies he has ever used drugs. She works out at least once a day. The diet changes regularly and does not keep track of how much food is consumed. Driving a corporate car and a personal automobile, he always buckles up. All homes have smoke detectors. His neighborhood is safe, according to his neighbors.

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Fam Hx:

Father: Alive, age 67, Hx HTN

Mother: Alive, age 69, Hx HTN, HLD, Mitral Valve Prolapse

Maternal Grandmother: Alive, age 87, Hx HTN, HLD

Maternal Grandfather: Deceased at age 89; GI Bleed.

Paternal Grandmother: Deceased at age 61; Melanoma

Paternal Grandfather: Deceased at age 48; Lung CA

ROS:

GENERAL: Denies fever, fatigue, sob, or recent illness.

SKIN: Denies pruritus, rash, or areas of hyperpigmentation.

CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema. HX of HLD

RESPIRATORY: No sob, dyspnea, cough, or hemoptysis.

MUSCULOSKELETAL: Pain in lumbar region of back. Episodic pain that radiates from back down left leg impairing gait. Range of motion impaired.

VS: BP: 145/90, RR: 16, HR: 84, T: 98.0 F, O2: 97% on RA; Ht. 5’10” wt. 220 lbs BMI: 31.75

GENERAL: Pt is calm and cooperative while sitting upright on the examination table. Pt appears to be in NAD at this time. Appears to have good hygiene maintenance. Answers all questions without contradiction. Speech is clear and coherent.

SKIN: No breakdown, lesions, abrasions, or rashes noted. No tenting.

CARDIOVASCULAR: S1, S2 heard with no murmur. S3 audible in mitral landmark. No edema noted in upper and lower extremities.

RESPIRATORY: Respirations even and unlabored. Equal chest rise and fall. Lung sounds clear throughout anterior and posterior landmarks.

MUSCULOSKELETAL: Pain in lumbar region of back. No deformity noted throughout lumbar region. Episodic pain that radiates from back down to left leg impairing gait. Range of motion impaired when attempting hyperextension of spine.

Diagnostic results: X Ray of Lumbar Spine, CT cervical and lumbar spine. MRI lumbar spine.

Plain radiographs, standing anteroposterior and lateral spine views, bone scan, electromyography, as well as a CT scan or an MRI scan, may be recommended to confirm the presence of the suspected cause of the patient’s pain (Dains, Baumann, & Scheibel, 2016).

1.Sciatica- A herniated disc causes nerve root irritation and acute lower back pain that radiates down the buttock to below the knee. Acute lower back pain is characterized by pain and burning that radiates down the lateral thigh, leg, and foot, and is occasionally accompanied by numbness in the dermatomal areas. Sciatica is a classic symptom of nerve root irritation caused by disk displacement that causes sharp and burning pain to radiate down the lateral and posterior aspect of the leg to the lateral ankle or foot (Dains, Baumann, & Scheibel, 2016). I will assess the patient’s muscle strength and reflexes during the physical exam. For example, will instruct the patient to walk on their toes or heels, rise from a squatting position, and lift their legs one at a time while lying supine. The pain caused by sciatica usually worsens during these activities. The primary diagnosis is sciatica, which is based on clinical symptoms, physical examination results, and diagnostics. Discussion: Assessing Musculoskeletal Pain

2. Herniated lumbar disc-A herniated disk is a problem with one of the disks that connect the vertebrae that make up the spine (Lama et al., 2014). A herniated disk can irritate nearby nerves, resulting in arm or leg pain, numbness, or weakness (Lama et al., 2014). A CT lumbar spine, X-ray, and an MRI are usually used to make a diagnosis.

3. Muscle strain- Muscle strain is defined as damage to a muscle or its tendons (Benjamin, 2014). This can happen when putting extreme pressure on muscles during normal daily activities, such as sudden heavy lifting, sports, or work tasks (Benjamin, 2012). To rule out other diagnoses, a physical exam and possibly an X-ray are performed. The most common course of treatment is rest with the use of NSAIDs (Benjamin, 2014).

4. Lumbar Stenosis- When combined with the word spinal, it defines a narrowing of the bone channel occupied by the spinal nerves or the spinal cord, lumbar stenosis affects the lower back, and cervical stenosis affects the neck. Spinal stenosis is most commonly caused by osteoarthritic wear-and-tear changes in the spine. Spinal stenosis is the most common cause of acute lower back pain in adults over the age of 50. The cause of lumbar spinal stenosis is commonly associated with aging (Ullrich, 2017). Facet joints (small stabilizing joints located between and behind vertebrae) degenerate and can compress the spinal nerve roots in the lower back, causing lumbar stenosis symptoms of pain, particularly with activity (Ullrich, 2017). Pain is associated with lumbosacral radiculopathy, and relief occurs with sitting or forward flexion of the spine, most commonly in the lower back and neck. Dains et al., 2016; Baumann et al., 2016; Scheibel et al., Based on the nature of the disease, including symptoms, this is not a likely diagnosis.

5. Ankylosing Spondylitis is a systemic inflammatory condition affecting the vertebral column and sacroiliac joints. Ankylosing Spondylitis (AS) is a type of arthritis that affects the hips, knees, and shoulders. AS, according to Dains, Baumann, and Scheibel (2016), can cause weak, brittle bones (osteoporosis). The most common symptom is hip and lower back pain and stiffness (Dains, Baumann, & Scheibel, 2016). This condition is typically described as chronic lower back pain that worsens in the morning and improves throughout the day. Physical examination reveals thoracic kyphosis and posterior thoracic spine rounding, as well as forward flexion of the head, neck, and lower back (Dains, Baumann, & Scheibel, 2016). Because of the inflammatory nature of the disease and the symptoms as presented, this condition is ruled out.

Week 8: Assessment of the Musculoskeletal System

A 46-year-old man walks into a doctor’s office complaining of tripping over doorways more frequently. He does not know why. What could be the causes of this condition?

Without the ability to use the complex structure and range of movement afforded by the musculoskeletal system, many of the physical activities individuals enjoy would be curtailed. Maintaining the health of the musculoskeletal system will ensure that patients live a life of full mobility. One of the most basic steps that can be taken to preserve the health of the musculoskeletal system is to perform an assessment.

This week, you will explore how to assess the musculoskeletal system.

Learning Objectives

Students will:

Evaluate abnormal musculoskeletal findings
Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the musculoskeletal system

Learning Resources

Required Readings (click to expand/reduce)

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 4, “Vital Signs and Pain Assessment” (Previously read in Week 6)

Chapter 22, “Musculoskeletal System”This chapter describes the process of assessing the musculoskeletal system. In addition, the authors explore the anatomy and physiology of the musculoskeletal system. Discussion: Assessing Musculoskeletal Pain

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 22, “Lower Extremity Limb Pain”
This chapter outlines how to take a focused history and perform a physical exam to determine the cause of limb pain. It includes a discussion of the most common tests used to assess musculoskeletal disorders.

Chapter 24, “Low Back Pain (Acute)”
The focus of this chapter is the identification of the causes of lower back pain. It includes suggested physical exams and potential diagnoses.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

Chapter 2, “The Comprehensive History and Physical Exam” (“Muscle Strength Grading”) (Previously read in Weeks 1, 2, 3, 4, and 5)

Chapter 3, “SOAP Notes”This section explains the procedural knowledge needed to perform musculoskeletal procedures.

Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Katz, J. N., Lyons, N., Wolff, L. S., Silverman, J., Emrani, P., Holt, H. L., … Losina, E. (2011). Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study. BMC Musculoskeletal Disorders, 12(1), 78–85.

This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.

Smuck, M., Kao, M., Brar, N., Martinez-Ith, A., Choi, J., & Tomkins-Lane, C. C. (2014). Does physical activity influence the relationship between low back pain and obesity? The Spine Journal, 14(2), 209–216. doi:10.1016/j.spinee.2013.11.010

Shiri, R., Solovieva, S., Husgafvel-Pursiainen, K., Telama, R., Yang, X., Viikari, J., Raitakari, O. T., & Viikari-Juntura, E. (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis & Rheumatism, 42(6), 640–650. doi:10.1016/j.semarthrit.2012.09.002

Document: Episodic/Focused SOAP Note Exemplar (Word document)

Document: Episodic/Focused SOAP Note Template (Word document)

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

Chapter 13, “The Spine, Pelvis, and Extremities” (pp. 585–682)In this chapter, the authors explain the physiology of the spine, pelvis, and extremities. The chapter also describes how to examine the spine, pelvis, and extremities.

Required Media (click to expand/reduce)

Online media for Seidel’s Guide to Physical Examination

In addition to this week’s resources, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 21 that relate to the assessment of the musculoskeletal system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/ Discussion: Assessing Musculoskeletal Pain

Discussion: Assessing Musculoskeletal Pain

Photo Credit: Getty Images/Fotosearch RF

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

To prepare:

By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
Review the following case studies:

Case 1: Back Pain

Photo Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

Case 2: Ankle Pain

Photo Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/8ankle/01anatomy.html. Used with permission of University of Virginia.

Case 3: Knee Pain

Photo Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.

A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

With regard to the case study you were assigned:

Review this week’s Learning Resources, and consider the insights they provide about the case study.
Consider what history would be necessary to collect from the patient in the case study you were assigned.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned. Discussion: Assessing Musculoskeletal Pain

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By Day 3 of Week 8

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 8

Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

Post by Day 3 of Week 8 and Respond by Day 6 of Week 8

To Participate in this Discussion:

Week 8 Discussion

Assignment: Lab Assignment (Optional): Practice Assessment: Musculoskeletal Examination

A description of symptoms alone is not enough to form an accurate diagnosis of musculoskeletal conditions. Before forming a diagnosis, advanced practice nurses need to perform a physical examination. Although the musculoskeletal examination is relatively simple, it still needs to be performed multiple times before it can be mastered.

In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing a musculoskeletal examination this week.

Note: This is an optional practice physical assessment.

To Prepare

Arrange an appropriate time and setting with your volunteer “patient” to perform a musculoskeletal examination.
Download and review the Musculoskeletal Checklist provided in this week’s Learning Resources as well as review the Seidel’s Guide to Physical Examination online media.

The Lab Assignment

Perform the musculoskeletal examination. Be sure to cover all of the areas listed in the checklist.

“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. Discussion: Assessing Musculoskeletal Pain
15 (15%) – 16 (16%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
N/A
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on three different days.
Total Points: 100
Name: NURS_6512_Week_8_Discussion_Rubric

A.S Age 42 year-old African American male

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Episodic/Focused SOAP Note Template

Patient Information:

A.S Age 42 year-old African American male

CC Lower back pain for the last one month

HPI: The patient is a 42-year-old male who came to the hospital with complaints of lower back pain for the last one month. The patient reported that the pain at times radiates to his left leg. The patient also reported that the pain has been increasing if he sits for a long time. The pain is relived when he stands. The patient denies any fever or pain. He pain rating at the time of assessment was reported to be 8/10. Discussion: Assessing Musculoskeletal Pain

Current Medications: The patient reported to be using acetaminophen 1 gram, TDS for the last one week, which has not been effective in relieving the pain.

Allergies: The patient denied any history of food, drug, or environmental allegy.

PMHx: The patient was admitted to the hospital in 2015 due to pneumonia. He also has a history of admission in 2010 due to anemia. The patient does not have any history of surgery. He also does not have any history of blood transfusion.

Soc Hx: The patient is married. He works as a librarian in a community lbrary. The patient does not smoke or uses alcohol. He engages in regular physical activity, which has been limited by his condition. He reported to live in a healthy environment with enhanced access to healthy diets. He has three children who are currently in college.

Fam Hx: The patient denied any history of chronic illnesses in his family. Both of his parents are alive, without any chronic illnesses.

ROS:

GENERAL: The patient was dressed appropriately for the occasion. There was no evidence of weight loss. The patient however had slowed movements due to lower back pain. The patient denied fever, chills, fatigue or weakness.

HEENT: Eyes: The patient denied visual loss, blurred vision, double vision or eye drainage. Ears, Nose, Throat: The patient denied hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN: The patient denied rash or itching.

CARDIOVASCULAR: The patient denied chest pain, chest pressure or chest discomfort. palpitations or edema.

RESPIRATORY: The patient denied shortness of breath, cough or sputum.

GASTROINTESTINAL: The patient denied anorexia, nausea, vomiting or diarrhea. He also denied abdominal pain or blood.

GENITOURINARY: The patient denied burning on urination increased urinary frequency or changes in urine color and smell.

NEUROLOGICAL: The patient denied headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. He also denied any changes in bowel or bladder control.

MUSCULOSKELETAL: The patient complained of lower back pain that radiates to the right leg. The self-reported pain rating of the client was 8/10. The client reported that the pain increases with prolonged sitting or turning in bed. The patient also reported the pain to have affected his ability to walk, as he is forced to walk slowly to minimize pain. The patient reported that the pain has persisted for the last one month. The pain radiates to the left leg when he walks. He denied any numbness. The pain is relieved when he stands. Acetaminophen has been effective in the past in relieving it. However, he feels that it is not helping, as he has to depend on it to minimize pain.

HEMATOLOGIC: The patient denied anemia, bleeding or bruising.

LYMPHATICS: The patient denied enlarged nodes.

PSYCHIATRIC: The patient denied any history of depression or anxiety.

ENDOCRINOLOGIC: The patient denied reports of sweating, cold or heat intolerance. He also denied polyuria or polydipsia.

ALLERGIES: The patient denied any history of food, drug or environmental allergens.

Physical exam:

Vitals: BP 123/76 P 70, R 20, T 98.7 F, SAT 98%, Wt 56 kg, Ht 5’9, pain 8/10

General: The patient is a 42-year-old, who appears well-dressed for the occasion. He does not have any evidence of weight loss. His walking pace is reduced due to lower back pain. He is oriented, alert, and cooperative. He has slight limp due to lower back pain.

HEENT: The head is normal in size and shape, with a well-defined hairline. There is no soreness in the face, with pink conjunctiva and white sclera and no jaundice present. Light causes the pupils to dilate. There is no leakage from the eyes or ears. The pharynx and nasopharynx do not have any erythema, lesions, or exudates that indicate an infection. Without dentures, the mucous membranes remain moist. Discussion: Assessing Musculoskeletal Pain

Neck: Lymph nodes are not enlarged, the neck is not rigid, and edema is not present.

In the chest and lungs, there is a symmetrical breathing pattern. There is no stridor, rhonchi, or wheezing. Cardiac palpitations and irregular heart sounds aren’t present in this state of health.

Abdominal: There is no edema, scarring, or visible blood vessels in the abdomen. A regular bowel movement is present as well as the lack of organomegalisms.

The patient refused to undergo a genitourinary examination.

Symptoms include numbness, paralysis, muscle weakness, inability to maintain balance, and incontinence of the urine or bowel systems.

Pain in the lower back has been noted. There was difficulty with a wide variety of movements. The lower limbs are not stiff. Walking with a slower pace can reveal a tendency to lurch forward. With a self-reported level of pain of 8/10, patellar reflexes are evident. As a result, joints and muscles are not strained.

Haematology: The absence of gum bleeding

lymphatic: no lymphadenopathy at all

Psychiatric: The patient is aware and oriented to their surroundings, as well as to themselves, people, and time. He hasn’t lost his sense of right and wrong. Delusions, illusions, and hallucinations are all things he denies having experienced in the past.

Insufficiency of the hormones that cause polyuria, polydipsia, and oliguria in the body

X-rays were shown to be the most appropriate initial diagnostic test for the patient in this case study. There may be misalignment of the bones, arthritis, or fractures of the cervical spine that require an X-ray in order to be detected. MRI and CT scans can also be used to detect if the nerves and internal organs have been affected. In addition, the scans allow for the detection of disorders such as disk herniation and blood vessel concerns. It is also possible that electromyography would be useful for determining the electrical impulses generated by neurons and the muscle reaction (Jensen et al., 2019). Diagnosis of spinal stenosis or disk herniation is aided by this test.

Using a Variety of Diagnosis

Sciatica is the patient’s major diagnosis in this case study. Sciatica is a form of back pain caused by nerve compression due to dick herniation or spinal stenosis. As a result of the sciatic nerve’s affliction, patients feel discomfort in their lower extremities. There is a numbness and sometimes a tingling sensation in the limb because of the nerve being compressed (Jensen et al., 2019). In patients with sciatica, symptoms include numbness and tingling in the afflicted limb, difficulty sitting, and increased pain with extended activities, such as sneezing (Maslak et al., 2020). These are the symptoms that the patient in this case study is experiencing. As a result, sciatica should be the primary diagnosis in the construction of the treatment plan.

For this patient, the secondary diagnosis of spinal claudication should be investigated. Because the spinal canal is severely constricting, claudication is caused. Pressure builds up on the cauda equina as a result of the constriction. Patients report leg and lower back pain when they move or engage in physical activity as a result of this condition. Aside from discomfort, weakness, tingling, and numbness, patients often report experiencing limb numbness and loss of feeling. In addition, the affected limbs have a sense of heaviness (Barbaro & Midgley, 2021). Spinal claudication is a secondary diagnosis in this case study because the patient does not exhibit the aforesaid symptoms.

There is also a possibility of peripheral neuropathy in this patient, which is another secondary diagnosis to investigate. Systemic diseases including metabolic syndrome, diabetes, and hereditary disorders like Charcot-Marie-Tooth disease cause peripheral neuropathy (Hicks & Selvin, 2019). Peripheral neuropathy is more likely in people who have leprosy, HIV, or nutritional deficits. Burning pain, tingling and numbness, and weakening in the affected limb are common sensations that patients report describing themselves (Iqbal et al., 2018). Systemic disease, infection, or deficiency are the least likely causes of the patient’s health concern in the case study.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses. Discussion: Assessing Musculoskeletal Pain

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Discussion: Assessing Musculoskeletal Pain

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Week 8: Assessment of the Musculoskeletal System

Learning Objectives

Learning Resources

Optional Resource

Discussion: Assessing Musculoskeletal Pain

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By Day 3 of Week 8

By Day 6 of Week 8

Submission and Grading Information

Grading Criteria

Post by Day 3 of Week 8 and Respond by Day 6 of Week 8

Assignment: Lab Assignment (Optional): Practice Assessment: Musculoskeletal Examination

To Prepare

The Lab Assignment

Related

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