NURS 6512 Case Study Assignment Assessing Neurological Symptoms

Sample Answer for NURS 6512 Case Study Assignment Assessing Neurological Symptoms Included After Question

Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.

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

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.

Case 1: Headaches

A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

Case 2: Numbness and Pain

A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Case 3: Drooping of Face

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

To prepare:

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 9”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Post a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two 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.

A Sample Answer For the Assignment: NURS 6512 Case Study Assignment Assessing Neurological Symptoms

Title: NURS 6512 Case Study Assignment Assessing Neurological Symptoms

Episodic/Focused SOAP Note Template

 Patient Information:

Initials: H.F. Age: 47 Years Sex: Female Race: Caucasian

CC (chief complaint): “I am experiencing pain in my right wrist”

HPI: H.F., a 47-year-old Caucasian female with obesity, sought medical attention at the clinic due to her primary concern of experiencing pain in her right wrist, accompanied by sensations of numbness and tingling in the index, middle finger, and thumb. The patient has provided an account of experiencing these symptoms approximately fourteen days prior. Nevertheless, she expresses apprehension regarding the discomfort, as it causes her to inadvertently release her hairstyling implements.

Location: Right wrist

Onset: two weeks ago

Character: Numbness and pain in her right wrist

Associated signs and symptoms: Thumb, middle, and index finger tingling

Timing: the whole day

Exacerbating/ relieving factors: Worse while doing tasks with the wrist joint. When the wrist is stationary, the discomfort is reduced.

Severity: 6/10

Current Medications:

Ibuprofen at a dosage of 400mg taken orally as needed,
Hydrochlorothiazide at a dosage of 25mg taken orally every morning
Amlodipine at a dosage of 10mg taken orally once daily.

Allergies: Allergic to sulfur. No environmental or food allergies.

PMHx: The patient exhibits obesity and has a documented history of hypertension.

Immunization status: The patient has received all necessary vaccinations, including Tdap in October 2020, the Influenza Vaccine during the current season, and completed the COVID-19 Vaccines with Boosters in 2021.
Surgeries: without any prior surgical history
Hospitalization: There is no record of any hospitalizations.

Soc Hx: The patient is a hairdresser who works five blocks from her house in a neighborhood spa. She claims to have a history of sometimes consuming alcohol while smoking cigarettes. She does not, however, admit to using marijuana or any other illegal substance. She presently lives as a family with her husband and three kids. During her free time, she enjoys singing and reading. She exercises by taking the dog for a 30-minute walk every evening. She affirms that she eats a healthy diet and sleeps well for around 8 hours each night.

Fam Hx: The patient has two siblings, the younger of whom has just received an asthma diagnosis while the other is well. Both of her parents are still living; the mother has a history of T2DM and HTN, while the father has a history of HTN and esophagostomy. She is unaware of the medical history of her grandparents.

ROS:

GENERAL: denies any symptoms of heat or cold sensitivity, reduced appetite, sluggishness, chills, fever, or recent weight changes.

HEENT: Head: denies experiencing seizures, headaches, or dizziness. Eye: denies any discomfort, discharge, vision disturbances, photophobia, or blurriness. Ear: denies discharge, tinnitus, discomfort, or hearing loss. Nose: denies having sneeze fits, sinus pain, a runny nose, or nose bleeding. Throat: denies pain, swallowing issues, or voice hoarseness.

SKIN: denies rash or itching.

CARDIOVASCULAR: denies having orthopnea, arrhythmias, elevated blood pressure, or palpitations.

RESPIRATORY: denies having a cough, producing phlegm, having breathing problems, or breathing quickly.

GASTROINTESTINAL: denies experiencing vomiting, heartburn, heartburn pain, discomfort, or abdominal distention.

GENITOURINARY: denies having hematuria, vaginal discharge, incontinence, dysuria, oliguria, frequent urination, or burning pain.

NEUROLOGICAL: denies experiencing ataxia, a headache, paralysis, syncope, or abnormalities in bowel or bladder control. reports tingling and numbness in the middle, index, and thumb fingers.

MUSCULOSKELETAL: a right wrist ache is reported. denies muscular pain, joint stiffness, or joint swelling. demonstrates the complete range of motion in other joints.

HEMATOLOGIC: denies bleeding issues, easy bruising, or anemia.

LYMPHATICS: denies splenectomy or lymphadenopathy.

PSYCHIATRIC: denies experiencing hallucinations or other psychological symptoms such as anxiety, sadness, or thoughts of homicide or suicide.

ENDOCRINOLOGIC: denies a tendency to sweat excessively, polyuria, polydipsia, or sensitivity to heat and cold.

ALLERGIES: Sulfur allergy is reported.

Physical exam: Vital signs: BP- 138/86 mmHg, PR-86, RR-19, Temp- 98.9, SpO2-98% on room air, Ht- 5’9”, Wt- 210 lbs., BMI-31.01

GENERAL: a female who is obese and adequately attired. Clear speaking, the patient is focused and aware X4. The patient responds to inquiries adequately and is not visibly distressed.

HEENT: Head: normal-sized, trauma-free, and without scars. Eye: Sclera and conjunctiva are clear. No significant redness, discharge, or tearing. Ear: Typical pinna with an unobstructed tympanic membrane. It is normal for the external auditory canal. Nose: nasal mucous membrane that is wet. No sinuses or discomfort to the touch. Throat: pink, wet mucous membrane in the mouth. The tonsils and posterior pharynx are not erythematous, and the uvula is in the middle.

MUSCULOSKELETAL: Gait and musculoskeletal development are normal. displays a healthy body posture without any joint or bone swelling or abnormalities. Right thumb abduction shows weakness, with a 3/5 poor strength. Positive Hoffmann-Tinel and Phalen indicators. All the muscles of the other limb are strong and their tendon reflexes are normal.

NEUROLOGICAL: Aware and well-grounded in time, location, and people. quite helpful throughout the assessment. All of the cranial nerves are mostly unharmed. demonstrates typical reactions. The right hand’s middle finger, thumb, and index finger all feel numb and tingly.

Diagnostic results: The complete blood count (CBC) reveals a white blood cell count (WBC) of 8.9. Additionally, a comprehensive metabolic panel (CMP) including differentials is performed. The glucose level is measured at 125, while the HgbA1c level is recorded as 4.5%, indicating the need to exclude any potential presence or occurrence. Neuropathy associated with type 2 diabetes mellitus (T2DM). The concentration of C-reactive protein in the sample is 4.2 mg/L (Attal & Didier Bouhassira, 2023).

Diagnostic Tests:

An X-ray examination of the right wrist was conducted to assess the presence of arthritic changes (Genova et al., 2020).
Test for bone density to rule out osteoporosis.
nerve conduction analysis.
Manual: Tinel sign and Durkans Test (Zhang et al., 2020).

Differential Diagnoses:

Carpal tunnel syndrome (CTS): This condition is characterized by symptoms such as tingling and numbness in the fingers, which occur due to compression of the median nerve within the carpal tunnel (Malakootian et al., 2022). This condition is commonly regarded as an occupational disease characterized by repetitive wrist and finger extension and flexion. However, certain cases of CTS may have an unknown cause, and the risk of developing CTS can be influenced by various factors, including genetic and acquired factors. A nerve conduction study is a precise diagnostic tool used to identify both normal and abnormal values of nerve function. Diagnostic laboratory results can also be utilized for the identification of increased levels of inflammatory markers. The patient exhibits multiple risk factors for developing this disease, including occupational factors and obesity.

Peripheral neuropathy: This condition is linked to hand numbness. The patient’s gender, familial history, and weight contribute to their increased risk of developing type 2 diabetes mellitus (T2DM) (Selvarajah et al., 2019). Peripheral neuropathy is a frequently observed symptom associated with T2DM, characterized by a gradual onset. A two-point discrimination test was conducted, revealing decreased sensitivity in the patient’s right arm. The patient reports no decrease in sensation in the lower extremities. If the patient experiences altered symptoms and exhibits new-onset neuropathy in the lower extremities, I will contemplate reevaluating the A1C levels and potentially diagnose diabetic peripheral neuropathy based on diagnostic assessments. Diabetic individuals exhibit significant declines in hand and finger dexterity relative to their healthy counterparts.

Wartenberg’s syndrome: This condition presents as paresthesia or pain occurring along the radial aspect of the forearm, with symptoms radiating toward the thumb and middle fingers. The pain arises due to the compression of the superficial radial nerve. Potential external factors may include the presence of a wristwatch or objects exerting pressure on the nerve (Kuschner & Berihun, 2021). The technique of palpation in the vicinity of the radial nerve region is employed to detect potential masses located both superficially and deeply. The utilization of the Tinel’s sign aids in the confirmation of this particular diagnosis.

Lupus: This is an autoimmune disease characterized by immune system dysfunction, resulting in inflammation, a high body temperature, joint pain, malaise, and rash. DNA methylation is a specific and reliable biomarker for the diagnosis of lupus, exhibiting cell-type specificity (Fanouriakis et al., 2020). DNA methylation is more prominent in patients with active disease compared to those in remission. The lupus band test (LBT) is a direct immunofluorescent approach conducted through skin biopsy. It is particularly valuable in cases where clinical and laboratory data are inconclusive for diagnosing lupus.

Type 2 Diabetes Mellitus (T2DM): The patient is at a heightened risk of developing T2DM. In the event of a gradual increase in the patient’s HbA1c, it is recommended to implement a prediabetes protocol involving lifestyle modifications such as dietary changes, exercise, and regular monitoring of HbA1c levels. Diabetic peripheral neuropathy (DNP) is characterized by progressive metabolic and inflammatory alterations that result in impaired daily functioning and reduced independence (Wu et al., 2021). Fasting lipid levels should be included in laboratory tests to assess cholesterol levels and provide education on cholesterol, triglycerides, LDL, and HDL levels.

References

Attal, N., & Didier Bouhassira. (2023). Neuropathic Pain. https://doi.org/10.1093/med/9780197616345.001.0001

Fanouriakis, A., Tziolos, N., Bertsias, G., & Boumpas, D. T. (2020). Update Οn the Diagnosis and Management of Systemic Lupus Erythematosus. Annals of the Rheumatic Diseases, 80(1), annrheumdis-2020-218272. https://doi.org/10.1136/annrheumdis-2020-218272

Genova, A., Dix, O., Saefan, A., Thakur, M., & Hassan, A. (2020). Carpal Tunnel Syndrome: A Review of Literature. Cureus, 12(3). https://doi.org/10.7759/cureus.7333

Kuschner, S. H., & Berihun, H. (2021). Robert Wartenberg Syndrome and Sign: A Review Article. The Open Orthopaedics Journal, 15(1), 13–16. https://doi.org/10.2174/1874325002115010013

Malakootian, M., Soveizi, M., Gholipour, A., & Oveisee, M. (2022). Pathophysiology, Diagnosis, Treatment, and Genetics of Carpal Tunnel Syndrome: A Review. Cellular and Molecular Neurobiology. https://doi.org/10.1007/s10571-022-01297-2

Selvarajah, D., Kar, D., Khunti, K., Davies, M. J., Scott, A. R., Walker, J., & Tesfaye, S. (2019). Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention. The Lancet Diabetes & Endocrinology, 7(12), 938–948. https://doi.org/10.1016/s2213-8587(19)30081-6

Wu, B., Niu, Z., & Hu, F. (2021). Study on Risk Factors of Peripheral Neuropathy in Type 2 Diabetes Mellitus and Establishment of Prediction Model. Diabetes & Metabolism Journal, 45(4), 526–538. https://doi.org/10.4093/dmj.2020.0100

Zhang, D., Chruscielski, C., Blazar, P., & Earp, B. (2020). Accuracy of Provocative Tests for Carpal Tunnel Syndrome. Journal of Hand Surgery Global Online, 2(3), 121–125. https://doi.org/10.1016/j.jhsg.2020.03.002

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A Sample Answer 2 For the Assignment: NURS 6512 Case Study Assignment Assessing Neurological Symptoms

Title: NURS 6512 Case Study Assignment Assessing Neurological Symptoms

Patient Information:

Initials: N.T, Age: 46 years, Sex: Female, Race: White

CC ” I have pain in both ankles”

HPI: N.T. is a forty-six-year-old white female patient who reported to the facility for a check. She complains of pain in both her ankles, even though she expresses more concern with the right ankle. The patient was playing soccer during the weekend when she heard a pop sound, which led to uncomfortable pain. The patient also experienced swelling following the pop sound. Consequently she is also unable to bear her weight. The pain is throbbing and more concentrated on the right ankle. She also rates the pain while resting. The pain is also radiating up the right lower extremity.

Current Medications: The patient is not using any medication currently.

Allergies: There are no records of allergies to food, medication, or environment.

PMHx: The patient indicated that she took her full dose of COVID-19. All other immunizations and annual flu tests are up to date.

Soc Hx: The patient is currently a single parent with three children. She works in the hotel industry. She likes playing soccer, which she does mostly during weekends but also occasionally in the evenings. She denies the previous or current use of alcohol. She also denies smoking or use of other illegal drugs.

Fam Hx: The patient’s parents are still alive; the father is eighty years old, and the mother is seventy-seven years old. The father is living with diabetes and hypertension while the mother has been treated for depression before and is currently living with osteoporosis. She has one elder brother and a younger sister and both are fairly healthy with no major health concerns.

ROS:

GENERAL: No fatigue, weakness, chills, fever, and weight loss.

HEENT: The patient’s head is normal; No visual loss, blurred vision, or double vision. She also denies reduced hearing, sneezing, congestion, sore throat, or even runny nose.

SKIN: No signs of rash, itching, or bruising.

CARDIOVASCULAR: No chest discomfort, chest pain, or pressure. Denies palpitations or edema.

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

GASTROINTESTINAL: The patient denies anorexia, nausea, vomiting, or abdominal pain.

GENITOURINARY: No burning or pain during urination. She denies pregnancy. NEUROLOGICAL: She denies headache, dizziness, paralysis, ataxia, or numbness.

MUSCULOSKELETAL: She reports bilateral ankle pain. The pain is more concentrated on the right ankle as compared to the left ankle. She also reports swelling in the right ankle and is unable to bear her weight.

HEMATOLOGIC: No anemia or bleeding.

LYMPHATICS: No history of splenectomy; denies enlarged nodes.

PSYCHIATRIC: No history of headache or mental illness.

ENDOCRINOLOGIC: No Polydipsia or polyuria.

ALLERGIES: No known allergies, either to food, medication, or environment

Physical exam:

Vital signs: BP: 116/75, Temp: 97.0, RR: 18, HR: 76, Height: 6.2, Weight: 141 lbs

General: The patient is well-dressed and groomed. She is alert and oriented. She appears concerned regarding her ankle pain which started after hearing a pop sound when playing soccer during the weekend.

HEENT: The head is atraumatic and Normocephalic. No ear pain or discharge. No loss of vision, no runny or stuffy nose. The patient’s neck is supple.

Skin: The skin is warm and dry, with no wounds and no skin rashes. Bruising was seen in the right lateral ankle.

Chest: The heartbeat and heart rate are both regular, with no gallops, murmurs, or extra sounds. No cough or dyspnea. The patient’s lungs are clear.

The musculoskeletal system: The patient’s right ankle has bruises, and the fibula’s lower aspects are tender upon palpation. Less motion range was observed in the ankles. The swelling was also observed. Pain experienced on the leg when bearing weight. The left ankle had no bruising, swelling, or tenderness.

Diagnostic results: The Ottawa Ankle rule is to be used to help determine if the patient needs an X-ray to confirm or rule out a fracture (Morais et al.,2021). Ultrasound can be conducted to assess the structure of the soft tissues such as ligaments and tendons.

Differential Diagnoses

An Ankle sprain: This is a condition which usually occurs when the ligaments supporting a person’s ankle are torn or stretched. In most cases, the foot can forcefully turn outward or inward. Ankle sprains are known to be common when individuals participate in activities such as soccer and go for a sudden directional change (Halabchi & Hassabi, 2020). The condition can have varied severity, usually from mild to severe. This condition may present with various symptoms, such as finding it difficult to walk, joint stiffness, soreness, bruising, swelling, and pain. The patient was playing soccer when she heard a pop sound, leading to pain and swelling in her right ankle. The patient showed several of these symptoms which makes an ankle sprain one of the diagnoses.
Achilles tendonitis: This is a condition that may present with pain and discomfort due to tendon injuries like a tear or inflammation. The condition is sometimes known as Achilles tendinitis. In most cases, the illness may come due to a repetitive strain or overuse of the Achilles tendon, which then makes a patient to experience swelling and pain. It can also result due to weak or tight calf muscles which is known to lead to higher strain on the Achilles tendon. Other causes include a sudden increase in physical activity which can be characterized by an increased frequency, duration or intensity of the physical exercise or activity that a person engages in. Some of the symptoms include pain in the back of a person’s leg, pain exacerbated with activity, a stiff Achilles tendon, and swelling (Touzell, 2020). In addition, a patient may experience a mild thickening of the tendon, tenderness and a significant reduced range or motion. The patient heard a pop sound when playing soccer, which makes this condition suspect.

Chronic Ankle Instability: This is a condition that may result from multiple cases of ankle sprains, which then makes the patient prone to injuries. This condition may present with various symptoms such as ankle instability, injuries, swelling, pain, and re-injuries for more than half a year (Herzog et al.,2019). The patient may also experience recurrent sprains, complications maintaining balance and feelings of giving away. The condition is also known to substantially impact a persons, stability, mobility and the overall quality of life. The patient reported some of these symptoms, which makes this condition to be a potential diagnosis. However, the patient has no history of incomplete healed ligaments, which again makes this condition less likely.

Ankle fracture: This is a condition that entails cracking or breaking of one or more of the bones which make up the ankle joint. It can occur in either the talus, fibula or tibia. Ankle fracture may happen when a person experiences events such as an awkward landing or forceful impact. The condition can also be caused by osteoporosis which causes the bones to weaken, hence exposing the person to the condition. Sudden rolling or twisting of the ankle with force can also lead to this condition. Consequently, a person may put stress on the ankle, leading to the condition. Some of the symptoms include complications bearing weight, bruising, and swelling (Briet et al.,2019). Other symptoms may also include misalignment or deformity of the ankle and pain. The patient presented with some of these symptoms, making this a potential diagnosis.
Muscle soreness: Muscle soreness can be experienced after an individual takes part in physical activity or exercise. The condition is sometimes known as a delayed onset of muscle soreness. The condition is in most cases experienced when an individual takes part in physical exercise or activity that entail the eccentric muscle contraction, or lengthening of the muscle under tension. In addition, it is known to typically begin twenty four hours to forty eight hours after an exercise can have its peak around seventy two hours. The patient may experience reduced flexibility and strength and pain or discomfort in the skeletal muscles (Heiss et al.,2019). Other symptoms may include muscle discomfort, tenderness and stiffness. An individual with the condition may also experience an exacerbation of the soreness when the affected muscles are stretched or moved. The patient experienced pain when playing soccer, which makes this a potential diagnosis.

References

Briet, J. P., Hietbrink, F., Smeeing, D. P., Dijkgraaf, M. G., Verleisdonk, E. J., & Houwert, R. M. (2019). Ankle fracture classification: an innovative system for describing ankle fractures. The Journal of Foot and Ankle Surgery, 58(3), 492-496. https://doi.org/10.1053/j.jfas.2018.09.028

Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World Journal of Orthopedics, 11(12), 534. https://doi.org/10.5312%2Fwjo.v11.i12.534

Heiss, R., Lutter, C., Freiwald, J., Hoppe, M. W., Grim, C., Poettgen, K., … & Hotfiel, T. (2019). Advances in delayed-onset muscle soreness (DOMS)–part II: treatment and prevention. Sportverletzung· Sportschaden, 33(01), 21-29. DOI: 10.1055/a-0810-3516

Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of ankle sprains and chronic ankle instability. Journal of Athletic Training, 54(6), 603-610. https://doi.org/10.4085/1062-6050-447-17

Morais, B., Branquinho, A., Barreira, M., Correia, J., Machado, M., Marques, N., … & Diogo, N. (2021). Validation of the Ottawa ankle rules: Strategies for increasing specificity. Injury, 52(4), 1017-1022. https://doi.org/10.1016/j.injury.2021.01.006

Touzell, A. (2020). The Achilles tendon: Management of acute and chronic conditions. Australian Journal of General Practice, 49(11), 715–719. Doi: 10.3316/INFORMIT.553809190362672.