NURS 6512 Week 8 Discussion: Assessing Musculoskeletal Pain
NURS 6512 Week 8 Discussion. 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 NURS 6512 Week 8 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 NURS 6512 Week 8 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:NURS 6512 Week 8 Discussion
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 (THIS ONE)
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.
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?
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.NURS 6512 Week 8 Discussion
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.NURS 6512 Week 8 Discussion
NURS 6512 Week 8 Discussion Answer
Review of Case Study 2: Ankle Pain
Subjective Data:
Chief Complaint (CC): The patient presents with ankle pain.
History of Present Illness (HPI): The patient reports bilateral ankle pain, which worsened after hearing a “pop” sound while playing soccer. She is experiencing difficulty bearing weight.
Medications: No prior medications reported.
Allergies: No known allergies.
Past Medical History (PMH): Not disclosed.
Past Surgical History (PSH): Not documented.
Reproductive History: Not mentioned.
Immunization History: Not available.
Significant Family History: Not provided.
Lifestyle: The patient is physically fit.
Possible Additional Questions: Where is the exact location of your pain? On a scale of 0-10, what is the worst pain you have experienced? Is there any relief for your pain? When did the pain first start? Have you ever had an injury to either ankle previously? Is this the first time you have experienced pain in the ankle?NURS 6512 Week 8 Discussion
Objective Data:
Review of Systems (ROS):
Vital Signs: Vital signs are not provided.
General: The patient denies fatigue, fever, or headache but experiences discomfort while bearing weight.
HEENT: No details available.
Neck: No specific information.
Breasts: No evidence is provided.
Respiratory: Details not available.
Cardiovascular/Peripheral Vascular: Information not provided.
Gastrointestinal: Information not available.
Genitourinary: Details not provided.
Musculoskeletal: The patient experiences ankle pain with discomfort in the right ankle during ambulation.
Psychiatric: No psychiatric information is provided.
Neurological: The patient is attentive and oriented to time and event.
Skin: No skin-related data is provided.
Hematologic: Hematologic information is not available.
Endocrine: Endocrine-related information is not disclosed.
Allergic/Immunologic: No information regarding allergies or immunologic history is available.
Assessment:
Differential Diagnosis:
Ankle Sprain: Ankle sprains are common among athletes. They typically present with pain shortly after the injury and discomfort while bearing weight (Chen, McInnis, & Borg-Stein, 2019).
Ankle Fracture: Patients with an ankle fracture often exhibit an inability to bear weight on the injured foot and report throbbing pain as a chief complaint (Kitamura, Chung, & Moore, 2019).
[Note: References are provided for the medical conditions in the assessment section.]References:
Chen, M. S., McInnis, K. C., & Borg-Stein, J. (2019). Ankle Sprains. In StatPearls [Internet]. StatPearls Publishing.
Kitamura, R., Chung, H., & Moore, B. (2019). Ankle Fractures. In StatPearls [Internet]. StatPearls Publishing.
