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Health & Medical Discussion Knee pain

Health & Medical Discussion Knee pain

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Knee pain is one of the most common musculoskeletal problems that patients present within clinical settings. According to Bunt et al. (2018), knee pain affects approximately 25% of adults, and its prevalence has increased by almost 65% over the past 20 years. Evaluation of knee pain requires the collection of significant patient history, including location, onset, duration, and quality of pain; associated mechanical or systemic symptoms; history of swelling; description of precipitating trauma; and pertinent medical or surgical history. Examination procedures for patients with knee pain include inspection, palpation, evaluation of range of motion and strength, neurovascular testing, and unique (provocative) tests (Bunt et al., 2018). Accurate diagnosis of the etiology of a patient’s knee pain depends on the effectiveness of history-taking and physical examination. The possible diagnostic considerations for the patient in the case study include anterior cruciate ligament (ACL) tear and meniscus tear. The lesser options are Patellofemoral syndrome, gout, and Pes anserine bursitis. ACL tear is a type of knee injury involving tearing the anterior cruciate ligament, one of two cruciate ligaments that aid in stabilizing the knee joint (Evans & Nielson, 2022). Meniscus tear is a condition associated with tearing the knee cartilage that cushions the shinbone from the thighbone.

Various factors play critical roles in diagnosing the causes of a patient’s knee pain, and nurse practitioners should be attentive to such factors during the assessment. The first factor is the location of the knee pain. Anterior pain, as in the case study, suggests that the patella, patellar tendon, or its attachments are involved in developing the pain (Bunt et al., 2018). Attention to the mechanical symptoms associated with knee pain is also essential. Bunt et al. (2018) state that a pop sound suggests meniscal or ligamentous tears. Swelling, mechanism of injury, and medical or surgical history also help diagnose knee pain. Such factors are combined with the results of physical examinations and tests to determine the accurate diagnosis.

The diagnostic considerations, in their order of importance, include ACL tear and meniscus tear are to be considered as the final diagnosis. The ACL is the principal stabilizer of the knee. Patients with ACL tears usually present with an acute injury, an associated “pop,” a sensation of tearing, and the immediate onset of effusion (Musahl & Karlsson, 2019). The patient presents with all three typical symptoms of ACL, including sudden left medial knee pain, giveaway weakness, and an audible pop. The patient’s positive anterior drawer sign and Lachman test confirmed the diagnosis. Lachman, anterior drawer, and pivot shift tests are significant provocative tests for ACL injury (Bunt et al., 2018). Therefore, the patient is most likely to be affected by ACL tears. The meniscus tear is the next diagnostic consideration based on the patient’s history and physical examination. Meniscal tears can cause various symptoms, including pain localizing to the joint line, swelling, clicking, catching, locking, and the knee’s classic “giving away” (Bhan, 2020). Meniscal tears arise from sudden twisting injuries of the knee or trauma. The patient has tenderness on the medial meniscus, a small effusion, and a positive McMurray test suggesting a combination of ACL and medial meniscus tear. Meniscus tear typically accompanies ACL tears.

A diagnostic workup is essential to guide the practitioner on the appropriate treatment plan for the patient. Based on the final diagnosis in the case study, the recommendations are as follows. First, an X-ray of the knee-AP lateral and tunnel view to rule out fractures of the femur, tibia, and fibula and detect osteoarthritis and joint pathology. Second, a knee MRI is necessary for soft tissue pathology, including ACL tear, meniscal tear, collateral ligament injury, and effusions.  Third, rest, ice, compression (with taping), and elevation (RICE) are standard measures for joint injury to reduce soft tissue swelling and pain.  Next are non-steroidal anti-inflammatory agents, which reduce pain and swelling in common injuries and arthritis when prescribed as a scheduled interval for a specific time. Lastly, rehabilitation exercises include physical therapy to improve muscle strength and range of motion.

References

Bhan, K. (2020). Meniscal tears: Current understanding, diagnosis, and management. Cureus12(6). https://doi.org/10.7759/cureus.8590Links to an external site.

Bunt, C. W., Jonas, C. E., & Chang, J. G. (2018). Knee pain in adults and adolescents: The initial evaluation. American Family Physician98(9), 576-585. https://www.aafp.org/pubs/afp/issues/2018/1101/p576.htmlLinks to an external site.

Evans, J., & Nielson, Jl. (2022). Anterior cruciate ligament knee injuries. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK499848/Links to an external site.

Musahl, V., & Karlsson, J. (2019). Anterior cruciate ligament tear. New England Journal of Medicine380(24), 2341-2348. https://doi.org/10.1056/NEJMcp1805931Links to an external site.

  • Participation: RN-to-BSNIn discussions, you, as a student, will interact with your instructor and classmates to explore topics related to the content of this course. You will be graded for the following.
    1. Attendance

    Discussions (graded): Discussions are a critical learning experience in the online classroom. Participation in all discussions is required.

    1. Guidelines and Rubric for Discussions

    PURPOSE: Threaded discussions are designed to promote dialogue between faculty and students, and students and their peers. In the discussions students:

    • Demonstrate understanding of concepts for the week
    • Integrate scholarly resources
    • Engage in meaningful dialogue with classmates
    • Express opinions clearly and logically, in a professional manner

    Participation Requirement: You are required to post a minimum of three (3) times in each graded discussion. These three (3) posts must be on a minimum of two (2) separate days. You must respond to the initial discussion question by 11:59 p.m. MT on Wednesday.

    Participation points: It is expected that you will meet the minimum participation requirement described above. If not:

    • You will receive a 10% point deduction in a thread if your response to the initial question is not posted by 11:59 p.m. MT on Wednesday
    • You will also receive a 10% point deduction in a thread if you do not post at least three (3) times in each thread on at least two (2) separate days.
    1. Threaded Discussion Guiding Principles

    The ideas and beliefs underpinning the threaded discussions (TDs) guide students through engaging dialogues as they achieve the desired learning outcomes/competencies associated with their course in a manner that empowers them to organize, integrate, apply and critically appraise their knowledge to their selected field of practice. The use of TDs provides students with opportunities to contribute level-appropriate knowledge and experience to the topic in a safe, caring, and fluid environment that models professional and social interaction. The TD’s ebb and flow is based upon the composition of student and faculty interaction in the quest for relevant scholarship. Participation in the TDs generates opportunities for students to actively engage in the written ideas of others by carefully reading, researching, reflecting, and responding to the contributions of their peers and course faculty. TDs foster the development of members into a community of learners as they share ideas and inquiries, consider perspectives that may be different from their own, and integrate knowledge from other disciplines.

    1. Participation Guidelines

    You are required to post a minimum of three (3) times in each graded discussion. These three (3) posts must be on a minimum of two (2) separate days. You must respond to the initial discussion question by 11:59 p.m. MT on Wednesday. Discussions for each week close on Sunday at 11:59 p.m. Mountain Time (MT). To receive credit for a week’s discussion, students may begin posting no earlier than the Sunday immediately before each week opens. For courses with Week 8 graded discussions, the threads will close on Wednesday at 11:59 p.m. MT. All discussion requirements must be met by that deadline

    1. Grading Rubric

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Health & Medical Discussion Knee pain

Health & Medical Discussion Knee pain

  • Discussion Criteria  A
    (100%)
    Outstanding or highest level of performance 
    B
    (87%)
    Very good or high level of performance
    C
    (76%)
    Competent or satisfactory level of performance
    F
    (0)
    Poor or failing or unsatisfactory level of performance
    Answers the initial graded threaded discussion question(s)/topic(s), demonstrating knowledge and understanding of concepts for the week.
    16 points
    Addresses all aspects of the initial discussion question(s) applying experiences, knowledge, and understanding regarding all weekly concepts.

    16 points

    Addresses most aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of most of the weekly concepts.

    14 points

    Addresses some aspects of the initial discussion question(s) applying experiences, knowledge, and understanding of some of the weekly concepts.

    12 points

    Minimally addresses the initial discussion question(s) or does not address the initial question(s).

    0 points

    Integrates evidence to support discussion. Sources are credited.*
    ( APA format not required)
    12 points
    Integrates evidence to support your discussion from:

    • assigned readings** OR online lessons, AND
    • at least one outside scholarly source.***

    Sources are credited.*

    12 points

    Integrates evidence to support discussion from:

    • assigned readings OR online lesson.

    Sources are credited.*

    10 points

    Integrates evidence to support discussion only from an outside source with no mention of assigned reading or lesson.

    Sources are credited.*

    9 points

    Does not integrate any evidence.

    0 points

    Engages in meaningful dialogue with classmates or instructor before the end of the week.
    14 points
    Responds to a classmate and/or instructor’s post furthering the dialogue by providing more information and clarification, thereby adding much depth to the discussion.

    14 points

    Responds to a classmate and/or instructor furthering the dialogue by adding some depth to the discussion.

    12 points

    Responds to a classmate and/or instructor but does not further the discussion.

    10 points

    No response post to another student or instructor.

    0 points

    Communicates in a professional manner.
    8 points
    Presents information using clear and concise language in an organized manner (minimal errors in English grammar, spelling, syntax, and punctuation).

    8 points

    Presents information in an organized manner (few errors in English grammar, spelling, syntax, and punctuation).

    7 points

    Presents information using understandable language but is somewhat disorganized (some errors in English grammar, spelling, syntax, and punctuation).

    6 points

    Presents information that is not clear, logical, professional or organized to the point that the reader has difficulty understanding the message (numerous errors in English grammar, spelling, syntax, and/or punctuation).

    0 points

    PARTICIPATION:
    Response to initial question: Responds to initial discussion question(s) by
    Wednesday, 11:59 p.m. M.T.
    0 points lost

    Student posts an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.

    -5 points

    Student does not post an answer to the initial discussion question(s) by Wednesday, 11:59 p . m. MT.

    PARTICIPATION
    Total posts: Participates in the discussion thread at least three times on at least two different days.
    0 points lost

    Posts in the discussion at least three times AND on two different days.

    -5 points

    Posts fewer than three times OR does not participate on at least two different days.

    NOTES:
    * Credited means stating where the information came from (specific article, text, or lesson). Examples: Our text discusses…. The information from our lesson states…, Smith (2010) claimed that…, Mary Manners (personal communication, November 17, 2011)…. APA formatting is not required.
    ** Assigned readings are those listed on the syllabus or assignments page as required reading. This may include text readings, required articles, or required websites.
    *** Scholarly source – per the APA Guidelines in Course Resources, only scholarly sources should be used in assignments. These include peer reviewed publications, government reports, or sources written by a professional or scholar in the field. Wikipedia, Wikis, .com website or blogs should not be used as anyone can add to these. For the discussions, reputable internet sources such as websites by government agencies (URL ends in .gov) and respected organizations (often ends in .org) can be counted as scholarly sources. Outside sources do not include assigned required readings.
    NOTE: A zero is the lowest score that a student can be assign

    Also read: Topic 6 DQ 2 a medical error and a good catch

 

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