Nova Southeastern University Health & Medical Discussion
Nova Southeastern University Health & Medical Discussion
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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. Cureus, 12(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 Physician, 98(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 Medicine, 380(24), 2341-2348.
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| Excellent | Good | Fair | Poor | ||
| Main Posting | 45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.
Supported by at least three current, credible sources.
Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. |
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.
At least 75% of post has exceptional depth and breadth.
Supported by at least three credible sources.
Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. |
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).
One or two criteria are not addressed or are superficially addressed.
Is somewhat lacking reflection and critical analysis and synthesis.
Somewhat represents knowledge gained from the course readings for the module.
Post is cited with two credible sources.
Written somewhat concisely; may contain more than two spelling or grammatical errors.
Contains some APA formatting errors. |
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.
Lacks depth or superficially addresses criteria.
Lacks reflection and critical analysis and synthesis.
Does not represent knowledge gained from the course readings for the module.
Contains only one or no credible sources.
Not written clearly or concisely.
Contains more than two spelling or grammatical errors.
Does not adhere to current APA manual writing rules and style. |
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| Main Post: Timeliness | 10 (10%) – 10 (10%)
Posts main post by day 3. |
0 (0%) – 0 (0%) | 0 (0%) – 0 (0%) | 0 (0%) – 0 (0%)
Does not post by day 3. |
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| First Response | 17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
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. |
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. |
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| Second Response | 16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.
Responds fully to questions posed by faculty.
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. |
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| Participation | 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days. |
0 (0%) – 0 (0%) | 0 (0%) – 0 (0%) | 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days. |
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| Total Points: 100 | |||||