Sample Answer for NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS Included After Question
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.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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
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
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
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: When you submit your initial post, please include a header as the first line indicating your assigned case study. For example, “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.
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 Reply button to complete your initial post. Remember, once you click on Post Reply, you cannot delete or edit your own posts and you cannot post anonymously. Please check your post carefully before clicking on Post Reply!
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.
A Sample Answer For the Assignment: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
Title: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
SUBJECTIVE DATA:
Chief Complaint (CC): “Pain in my lower back for the past one month”
History of Present Illness (HPI): S.K is a 42-year-old Caucasian male patient who reported to the clinic with pain in his lower back that had lasted for about a month. he reports that the pain radiates to his left leg sometimes. The patient reports that the pain is worse when working, and is less disturbing when resting. He has been taking ibuprofen which he claims to provide minimal relief.
Location: lower back
Onset: about a month ago
Character: constant and sharp pain radiating to the left leg
Associated signs and symptoms: None
Timing: When handling strenuous work
Exacerbating/ relieving factors: Any movement worsens the pain. Resting and Ibuprofen provides minimal relief.
Severity: 7/10 on a pain scale
Medications:
- Ibuprofen 800mg PO PRN for the back pain
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Allergies:
No known environmental, food, or drug allergies.
Past Medical History (PMH):
Denies any history of a serious medical diagnosis
Past Surgical History (PSH):
Denies ever undergoing any surgical procedure in the past.
Sexual/Reproductive History:
Heterosexual
Personal/Social History:
Married with 3 children
Works in a book store downtown.
Has never smoked tobacco or marijuana.
Confirms taking 2 to 3 beers occasionally when with friends.
Immunization History:
Flu shot 17/2/2022
Covid Vaccine #1 2/1/2021 #2 3/1/2021 Moderna
All other immunization up to date
Significant Family History:
Mother- with HTN and DM
Father- with gout and kidney disease
Maternal grandmother- with kidney disease
Maternal grandfather- died from a stroke
Paternal grandmother- with COPD
Paternal grandfather with CAD, HTN, and COPD.
He has 2 daughters and one son who are all healthy with no significant health complications.
Lifestyle:
The patient works in a bookstore downtown. He is happily married to a junior school teacher with 3 children. They live on the
outskirts of the city in a 3 bedroom apartment in a safe neighborhood. The means of transport is good, with easily accessible fresh water and healthcare services. He tried as much as possible to eat a healthy diet together with his family. He walks the dog every evening for about a kilometer as a form of exercise. Uses seat belts when in the car, with safety equipment such as a first-aid kit available in their home. He is a strong church member and socializes with his friends mostly over the weekend.
Review of Systems:
General: No recent changes in body weight. Complains of pain in his lower back. Denies constipation, fatigue, chills, fever, or generalized body weakness.
HEENT: Head: No signs of trauma or headache reported. Eyes: Denies blurred vision, use of corrective lenses, excessive tearing, or redness. Ears: No tinnitus, itchiness, or hearing loss. Nose: no congestion, running nose, sinus problems, or nose bleeding. Throat & Mouth: No sore throat, coughing, swallowing difficulties, or dental problems. Neck: No tenderness, signs of injury, enlarged tonsils, or a history of disc disease or compression.
Respiratory: No wheezing, coughing, shortness of breath, or breathing difficulties.
CV: Denies chest pain, edema, PND, orthopnea, syncope, or palpitations. Dyspnea on exertion
GI: No abdominal tenderness, constipation, diarrhea, distention, changes in bowel movement, or jaundice.
GU: Denies incontinence, urinary frequency, hematuria, dysuria, or burning sensation when urinating.
MS: Reports lower back pain which sometimes radiates to the left leg. He rates the pain at 7/10 on a pain scale. The severity of the pain however worsens when walking or turning when sleeping. The patient confirms that the pain has lasted for about a month, making it harder to exhibit a full range of movement on the left leg. No numbness, swelling, or redness was reported.
Psych: Denies paranoia, hallucinations, delirium, suicidal ideation, mental disturbance, memory loss, anxiety or depression, or a history of psychosis.
Neuro: Reports back pain that radiates to the left leg. Denies vertigo, tremors, syncope, seizures, paresthesia, or transient paralysis.
Integument/Heme/Lymph: No bruising, ecchymosed, ulcers, lesions, or rashes. No signs of enlarged lymph nodes.
Endocrine: Denies heat intolerance, cold intolerance, polyuria, polyphagia, or polydipsia.
Allergic/Immunologic: Denies hay fever, urticaria, persistent infections, or HIV exposure.
A Sample Answer 2 For the Assignment: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
Title: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
OBJECTIVE DATA
Physical Exam:
Vital signs: B/P 140/96, left arm, sitting, regular cuff; P 88 and regular; T 98.9 Orally; RR 18; non-labored; Wt: 215 lbs; Ht: 5’8; BMI 32.69
General: The patient appears healthy, and well oriented in person, place, and time. Seems to be uncomfortable and in moderate pain.
HEENT: External ears normal, with no deformities or lesions. External nose normal with no deformities or lesions. Bilaterally clear canals. Intact tympanic membrane with good movement and no fluid. Grossly intact bilateral hearing. Normal nasal mucosa, septum and turbinates. Complete and good hygienic dentation.
Neck: Supple with no masses. Trachea midline, No thyroid nodules, tenderness, or masses.
Chest/Lungs: Bilaterally clear to auscultation. Tactile fremitus normal. No signs of egophony. Normal respiratory effort displayed with no use of accessory muscles.
Heart/Peripheral Vascular: S1, and S2, note. Normal cardiac rhythm with no murmur, gallop, or rubs.
ABD: Suprapubic surgical scar, obese, non-tender, soft, and non-distended abdomen with no masses.
Genital/Rectal: The patient did not consent to this examination.
Musculoskeletal: Low back pain noted, radiating to the left lower leg. No evidence of trauma affecting the area was noted. Tenderness increases with extension, flexion, and twisting. Limited ROM in the left leg.
Neuro: Cranial nerves: II – XII grossly intact; 2+, symmetric, reflexes.
Diagnostics/Lab Tests and Results:
CBC – To evaluate for spinal infections
CSF analysis- For suspected spinal infection or inflammatory etiologies
X-ray of the spine- for flexion-extension views to identify spondylolisthesis and spinal instability.
MRI of the spine- to assess for suspected myelopathy or radiculopathy.
Electromyography (EMG)- to confirm compressions caused by spinal stenosis or herniated disks (Urits et al., 2019).
Assessment:
Differential Diagnosis (DDx):
- Sciatica: This condition is characterized by pain that normally radiates along the sciatic nerve path, which branches from the patient’s lower back through to the buttocks and hip, and down to each leg (Kim et al., 2018). However, sciatica normally affects one side of the body. The patient in the provided case study presents with lower back pain that radiates to the left leg, which is a great indication of sciatica as the primary diagnosis.
- Lumbar disc herniation: LDH is characterized by lower back pain and is common among adults between the age of 35 and 50 years. It normally results from changes in the structure of the lower lumbar spinal disk between the 4th and 5th vertebrae and between the 5th lumbar vertebra and the 1st sacral vertebra (Benzakour et al, 2019). Most patients normally present with symptoms such as lower back pain, radicular pain, limited trunk flexion, and weakness at the lumbosacral nerve roots distribution. The patient in the provided case study displayed lower back pain, however, an MRI of the spinal column is needed to confirm this diagnosis.
- Lumbar spinal stenosis: LSS is associated with narrowing of the spinal canal located in the lower back resulting in pain. Stenosis causes pressure on the patient’s spinal cord or nerves connecting the spinal column and the muscles (Deer et al., 2019). As such patients will present with lower back pain just like the one in the provided case study. However physical examination is required to assess for the presence of loss of sensation, abnormal reflexes, and weakness to confirm this diagnosis.
- Lumbar muscle strain: LMS is described as an injury to the lower back characterized by mild to moderate lower back pain. The injury can lead to damage to the muscle or tendons causing spasms and soreness (Urits et al., 2019). An x-ray is however needed to confirm the impact of the injury on the tendon or muscle to confirm the diagnosis
- Ankylosing spondylitis: This is an inflammatory disorder, that can lead to some of the spinal bones fusing over time. It is characterized by pain in the joints and the back (Ogdie et al., 2019). Symptoms normally appear early in life, including reduced flexion of the spine. The patient only presented with back pain which radiates to the left leg with no joint pain or reduced flexion of the spine.
Primary Diagnoses:
1.) Sciatica
PLAN: [This section is not required for the assignments in this course, but will be required for future courses.]
References
Benzakour, T., Igoumenou, V., Mavrogenis, A. F., & Benzakour, A. (2019). Current concepts for lumbar disc herniation. International orthopedics, 43(4), 841-851. https://doi.org/10.1007/s00264-018-4247-6
Deer, T. R., Grider, J. S., Pope, J. E., Falowski, S., Lamer, T. J., Calodney, A., … & Mekhail, N. (2019). The MIST guidelines: the Lumbar Spinal Stenosis Consensus Group guidelines for minimally invasive spine treatment. Pain Practice, 19(3), 250-274. https://doi.org/10.1111/papr.12744
Kim, J. H., van Rijn, R. M., van Tulder, M. W., Koes, B. W., de Boer, M. R., Ginai, A. Z., … & Verhagen, A. P. (2018). Diagnostic accuracy of diagnostic imaging for lumbar disc herniation in adults with low back pain or sciatica is unknown; a systematic review. Chiropractic & manual therapies, 26(1), 1-14. https://doi.org/10.1186/s12998-018-0207-x
Ogdie, A., Benjamin Nowell, W., Reynolds, R., Gavigan, K., Venkatachalam, S., de la Cruz, M., … & Park, Y. (2019). Real-world patient experience on the path to diagnosis of ankylosing spondylitis. Rheumatology and Therapy, 6(2), 255-267. https://doi.org/10.1007/s40744-019-0153-7
Urits, I., Burshtein, A., Sharma, M., Testa, L., Gold, P. A., Orhurhu, V., … & Kaye, A. D. (2019). Low back pain, a comprehensive review: pathophysiology, diagnosis, and treatment. Current pain and headache reports, 23(3), 1-10. https://doi.org/10.1007/s11916-019-0757-1
A Sample Answer 3 For the Assignment: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
Title: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
A 15-year-old Caucasian male Justin Timberland presents to the clinic with reports of dull pain in both knees. He states sometimes one or both knees click, and he describes a catching sensation under the patella.
To begin my assessment of my patient’s knee pain, I’ll approach the interview initially by utilizing “a useful framework to differentiate whether the limb pain involves symptoms that are caused by musculoskeletal injury, musculoskeletal or joint disease, or systemic disease, or a combination of factors. Pain can result from direct reaction in tissues, secondary reaction in adjacent tissues, or reaction from a proximal or distal lesion, or from organs such as the heart or kidney”.(Dains,2019.p.1.).knowing this information, I decided to start with a Focused history, where I would begin by asking the patient questions such as, does he have any of the common childhood bone diseases, that would make him prone to bone injury or pain, i.e. Osteogenesis Imperfecta or as commonly known as brittle bone disease, as it is usually diagnosed at birth as a bone is broke during the delivery process, from the fetus traveling down the bony structures of the birth canal. Next, I will ask him if the pain if from an injury? If it was an injury, how did the injury occur? Is this a new injury, or is this an old injury that has recurred? And finally, I will ask him to state his level of pain, on a scale from 0-10, with 0 being the least pain, and 10 being the worst pain?
According to research, the location of pain, has a strong influence on a patient’s functional status, my next step will be to differentiate his knee pain, corresponding to a research article based on elderly and knee pain, “the most common knee patterns are tibiofemoral only pain (62%), followed by patellofemoral only pain(23%), and combined pain (15%). The combined pain pattern was associated with odds of reporting pain, symptoms, sports or recreational activity limitations and lower knee-related quality of life compared to either isolated knee pain patterns, after adjusting for demographics and radiographic disease severity. The research article also mentioned using a “knee map” on the participants, so the participants can classify their pain into three categories of localized, regional, or diffuse.”.(Farrokhi,2016.p.).The medical assessment is a vital means to correctly diagnose and treat knee pain and problems “ many maneuvers are available to rule out the type of stability and test the knee structures involved. All tests can be divided in 4 groups: stress tests, slide tests, pivot shift(jerk) tests, and rotational tests.
1.Stress Tests- the standard stress tests include valgus (abduction), and varus (adduction) tests; additionally, Cabot maneuver is a commonly used stress test. The key point in performing these tests is taking care not to perform them carelessly. The test should be conducted at 30 degree flexion, rather than in full knee extension: by flexing the knee all tendinous structures and posterior capsule are released allowing to evaluate the MCL and LCL isolated.
2.Bohler’s test- a varus and a valgus stress are applied to the knee: pain is elicited by compression, of the tear.
- Squat test, duck walking test Thessaly test consist in several repetitions of full weightbearing flexions on the knee, in various positions (squatting, walking in full flexion, and at a 5 and 20 degree flexion, respectively).
4.Merke’s test is like Thessaly test performed in a weightbearing position: pain with internal rotation of the body produces an external rotation of the tibia and medial joint line pain when medial meniscus is torn. The opposite occurs when lateral meniscus is torn.
- Helfet’s test, in this test, the knee is locked and cannot c externally while extending, and the Q angle cannot reach normality with extension.
6.In test, the patient is asked to sit in Turkish position, thus stressing the medial joint line: if the position raises pain, the test is positive for a medial meniscal lesion.
7.In Steinmann’s first test, the knee is held flexed at 90 degree, and forced to external rotation, then internal rotation: the test is positive for medial meniscal tear if raises pain upon externally rotating, while it is positive for lateral meniscal tears in case of pain during internal rotation.
8.Apley’s (grinding) test is conducted with the patient prone, and the knees flexed to 90 degrees, then the leg is twisted and pulled, then pushed. If pain is only felt while pushing, a meniscal lesion is diagnosed, while if no difference between distraction and compression is detected, a chondral lesion is more likely”.(Rossi,2011.p.5.). In addition to the physical exams, there are some diagnostic tests physicians use to gather information about the patient’s condition. Some of the tests that may be ordered are a Computed Tomography scan, as the scanner circles the body, and the cross-sectional images of the knee, will allow the physician to better pinpoint the place of injury, a Magnetic Resonance Image MRI, uses a powerful magnetic field, radio waves, and a computer to create in-depth images of the structures inside the knee joint, an Arthroscopy, is a surgical procedure, where a small camera is inserted into the knee joint through tiny cuts to look for problems within the knee joint, or a knee x-ray, that can locate the origin of pain, deformity, swelling of the knee, it can also display dislocated joints or broken bones.
(DDX)
1.Rheumatoid arthritis.
- Gout.
- Baker’s cyst.
- Meniscal tear
5.Patellofemoral pain syndrome.
References
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 Retrieved August 1,2022 from
Farrokhi S, Chen YF, Piva SR, Fitzgerald GK, Jeong JH, Kwoh CK. The Influence of Knee Pain Location on Symptoms, Functional Status, and Knee-related Quality of Life in Older Adults with Chronic Knee Pain: Data from the Osteoarthritis Initiative. Clin J Pain. Retrieved August 2,2022 from doi: 10.1097/AJP.0000000000000291. PMID: 26308705; PMCID: PMC4766069.
Rossi R, Dettoni F, Bruzzone M, Cottino U, D’Elicio DG, Bonasia DE. Clinical examination of the knee: know your tools for diagnosis of knee injuries. Sports Med Arthrosc Rehabil Ther Technol. Retrieved August 4, 2022, from doi: 10.1186/1758-2555-3-25. PMID: 22035381; PMCID: PMC3213012.
A Sample Answer 4 For the Assignment: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
Title: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
Back Pain
Subjective Data
Back pain can be experienced in various ways, including stinging, muscle spasms, or achy pain (Aish et al., 2021). Back pain is the most common musculoskeletal condition and is often associated with potential or actual tissue damage (Ball et al., 2015). The low back/lumbar spine is a strategic structure of interconnected bones, nerves, ligaments, joints, and muscles that work harmoniously to provide strength, support, and flexibility. The complexity of the structure makes it more vulnerable to repetitive injury, blunt impact, or sudden stress due to lifting or pulling. Below is a list of subjective data of interest.
Chief Complaint: Back pain
Location: Lower back
Onset: One month ago
Character: At times, the pain radiates to his left leg
Duration: Ongoing pain. the health care professional will assess how long did the pain start
Associated Factors: Will enquire such as headache, chills, and dizziness.
Relieving Factors: Will enquire what alleviates the pain, such as position, or a massage
Severity: I will enquire how bad is the pain using the numeric tool assessment, with “0” being no pain and “10” being the worst pain
Family History: I will enquire; it is very important to ask about the family history. Doing this will help determine if genetics is involved.
Social history: Will inquire about drinking or smoking habits and assess if the patient is taking illicit drugs. Also, the nurse will ask about the kind of work the patient is doing.
Past surgical history: None; I will assess past surgical history
Timing: The healthcare professional will enquire specific time
Was the pain gradual or sudden: I will enquire how the pain started and also assess if the pain is sudden or gradual
Medications: as a nurse practitioner, its important to assess what kind of medication the patient has been taking for the pain and also assess if the medication is working
Endocrine: will enquire
Hematologic: I will assess if the pain has a history of blood clots, bleeding disorders, bone marrow, lymph node and spleen
Objective Data
Physical Assessment:
Vital signs: Key signs to consider in this context include blood pressure, respiration, heart rate, temperature, pulse oximetry, weight, and height.
Neurological: The key metrics to be assessed here entail clearness of speech, vision changes, patient alertness, judgment, and facial drooping.
Lungs/Chest: Examine tachypnea, clearness of bilateral breath sounds, and whether the lungs expand symmetrically.
Skin: Explore the skin paleness, ashen, or cyanosis. Also, look for tainting, tears, and whether the skin is dry/warm.
Musculoskeletal: Examine the evidence of trauma in the affected area, radiation of lower back pain, and the relationship between pain and flexion, twisting, and extension. It is also imperative to assess whether there is reduced mobility due to pain.
Abdomen: Examine key characteristics such as softness, tenderness, presence of bowel sound, and activeness in all four quadrants.
Peripheral vascular/Heart: Here, we shall look at whether the heart rate rhythm is regular, the rate at which capillary refill in all extremities, whether S1 and S2 sounds are heard, and finally, the palpable and strength of peripheral pulses.
Diagnostic Tests:
Assess inflammations makers or infections through blood count.
Check erythrocyte sedimentation rate
Perform HLA-B27 to examine the white blood cells.
Perform MRI of the lumbar spine.
Perform Computerized Tomography (CT) cervical spine.
Perform an X-Ray of the lumbar spine.
Assessment
Differential Diagnosis:
Lumbar Spinal Stenosis (LSS) is the narrowing of the spinal canal and imposes pressure on the nerve extending from the spinal cord to the muscles (AANS, 2022). It can either be due to congenital abnormalities, primary or acquired, secondary. It is often attributed to degenerative changes in older persons. Degenerative LSS can involve lateral recess, central canal, foramina, or a combination of these locations. Neurogenic claudication is the primary symptom of LSSS and refers to leg symptoms holding the groin, buttock, and anterior thigh. Leg symptoms can comprise heaviness, fatigue, and paresthesia. The symptoms are usually symmetrical, bilateral, or unilateral.
Lumbar Disc Herniation (LDH): It is often referenced in the context of low back pain. The Intervertebral disc comprises the outer Annulus Fibrosus (AF) and inner Nucleus Pulposus (NP). The NP comprises type II collagen, which makes up to 20% of its overall dry weight. It is maintained in the center of the disc by AF, whose concentric type 1 fiber makes up 70% of its dry components. The narrowing of the thecal sac’s space in LDH can be due to extrusion of NP through AF, protrusion of disc through AF, but maintaining continuity with disc space. However, there can also be a complete loss of continuity with the disc space or sequestration of a free fragment. LDH’s common signs and symptoms include sensory abnormalities and radicular pain (Al Qaraghli & De Jesus, 2021). Its predisposing factors include Axial Overloading and dehydration, while 75% is hereditary.
Sciatica: Entails the pain radiating through the sciatic nerve’s path. Sciatica, also known as radiculopathy, is primarily caused by undue pressing on the sciatic nerve. The pressing typically travels via the buttocks and extends to the back of the leg. Persons with sciatica often feel burning low back pain or shock-like impact combined with the pain through the buttocks and down the leg (Ropper & Zafonte, 2015).
Ankylosing Spondylitis (AS): It is a rare lifelong condition deemed a form of arthritis that induces stiffness and pain in the spine. It is also called Bechterew disease and originates from the lower back, and consequently, damage joins in other body parts or extends to the neck. It dominantly leads to inflammation between vertebrae and is more severe in men. Though its cause is unclear, it could be due to genetic and environmental factors (MedlinePlus, 2020).
Lumbar Strain/Sprain (LSS): Occurs when muscle fibers are torn or abnormally stretched. The separation of ligaments from their attachment could be due to gradual overuse or sudden injury. In other words, the lumbar spine relies on soft tissues/lower back muscles to support body weight and is readily torn by excessive stress. The most dominant symptom includes sudden lower back pain (Pilitsis, 2020).
Plan
There are five differential diagnoses for the patient in this context. The next step entails tailoring the effective and appropriate treatment to guarantee quick recovery and sustainable living. Suppose there is a need to treat sciatica; it can be intervened with anti-inflammatories such as narcotics, anti-seizure medication, muscle relaxants, and tricyclic antidepressants. Surgery is an option if there are no improvements after 6-8 weeks (Jensen et al., 2019).
References:
Aish, M. A., Abu-Jamie, T. N., & Abu-Naser, S. S. (2021). Lower Back Pain Expert System
Using CLIPS. http://dspace.alazhar.edu.ps/xmlui/handle/123456789/2724
American Association of Neurological Surgeons (AANS), (2022). Lumbar Spinal Stenosis.
https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Lumbar-Spinal-Stenosis
Al Qaraghli, M. I., & De Jesus, O. (2021). Lumbar Disc Herniation. In StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560878/
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2014). Seidel’s
Guide to Physical Examination-E-Book. Elsevier Health Sciences.
Jensen, R. K., Kongsted, A., Kjaer, P., & Koes, B. (2019). Diagnosis and treatment of
sciatica. Bmj, 367. doi: https://doi.org/10.1136/bmj.l6273
Pilitsis, J.G, (2020). Low back strain and sprain. American Association of Neurological
Surgeonans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Low-Back-Strain-and-Sprain#:
Ropper, A. H., & Zafonte, R. D. (2015). Sciatica. New England Journal of
Medicine, 372(13), 1240-1248. DOI: 10.1056/NEJMra1410151
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A Sample Answer 5 For the Assignment: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
Title: NURS 6512 Discussion Assessing Musculoskeletal Pain PEER POSTS
S.
CC: “Ankle Pain”
HPI: The patient is a 46-year-old woman experiencing pain in both ankles, although the right one feels more severe. The agony started over the weekend when she was playing soccer and heard a sound in her ankles, which might have been because of joint dislocation during the game. The ankle pain is due to the rapture of the Achilles tendon at the back of the leg. The aching is around the ankle region and it is accompanied by discomfort, despite her manageable weight. The patient has tried using analgesics to relieve the pain.
Medication: Analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain (Foster et al., 2018).
PMH: Manageable weight and positive for avulsion fracture and joint inflammation.
FH: The patient is married to a 55-year-old African American man, whose mother died from arthritis. No history of cardiovascular diseases. The patient lacks a family history of stroke, respiratory disorders, and cardiac illnesses.
SH: Negative for substance use, does not consume alcohol, previously engaged in different physical activities, and has been married for eighteen years.
Allergies: Cold environment, proteins, and animal furs, such as cats’ and dogs’.
Immunization: A double dose of the COVID-19 vaccine.
ROS
General: The patient records mild chills, headache, and fever. No breathing difficulties. Mild joint pain and general body discomfort.
Respiratory: The breathing pathways are clear, no shortness of breath, and no inflammation in the lungs.
Blood cell count: The patient has a healthy blood count, strong red blood cells, and an efficient supply of oxygen to the brain and other body tissues.
Arthritis: The patient has joint pains, mild friction at the ankle, redness of the ankle bone, ruptured Achilles tendon, swollen muscles, and damaged and deformed joints.
Diabetic ulcers: No diabetic wound, the patient reports mild venous, and arterial ulcers.
Obesity: The patient reports a manageable weight, enjoys healthy sleeping patterns, no sleep apnea, and no reported varicose veins and gallstones.
O.
VS: BP 185/104; P 95; R 24; T 97.0; 02 95% Wt 230lbs; Ht 69
General: The patient is in mild pain, uncomfortable, and strains to walk due to agony.
Respiration: The patient breathes eighteen times per minute
Heartbeat is normal
No recorded chest pains
No dyspnea, tachypnea, hypopnea, and hyperpnea
Blood cell count: The hemoglobin count is 15.2 g/dL, white blood cells are 4.7 billion cells per liter, and platelets are 214 billion per liter.
Arthritis: The patient records sufficient synovial fluids, inflammation of the ankle bone, and ruptured Achilles tendon.
Diabetic wound: No cuts on the dermis.
Obesity: Weight is 230lbs and height is 69
Differential diagnoses:
Chest pain: Ruptured tendons lead to the damaging of veins and arteries, resulting in excessive pain (Liu et al., 2020). The rationale for chest pain assessment is to identify damage to the tendons and blood vessels, which leads to excessive agony.
Abdominal pain: The musculoskeletal system consists of the entire bones, and damage to the abdomen can affect the limbs, leading to ankle pain (Dains et al., 2018)
Mobility assessment: Patients with affected legs experience pain in the limb, back, and lower abdomen. Assessment of mobility is important to identify the affected musculoskeletal region impacting the limbs (Ball et al., 2019).
Back pain: The back hosts the spinal cord that anchors the skeletal system. Examining the causes of back pain helps note the damage to the spine, which may affect other anchoring organs (Sullivan, 2019).
Arthritis: Friction in the joints causes pain (Hicks et al., 2020). Testing for arthritis helps identify the underlying causes of joint and ankle ache in the limbs.
References
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.). Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2018). Advanced health assessment and clinical diagnosis in primary care (5th ed.). Elsevier Mosby.
Foster, N. E., Anema, J. R., Cherkin, D., Chou, R., Cohen, S. P., Gross, D. P., Ferreira, P. H., Fritz, J. M., Koes, B. W., Peul, W., Turner, J. A., Maher, C. G., Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G., Underwood, M., van Tulder, M., . . . Woolf, A. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions. The Lancet, 391(10137), 2368–2383. https://doi.org/10.1016/s0140-6736(18)30489-6
Hicks, C., Levinger, P., Menant, J. C., Lord, S. R., Sachdev, P. S., Brodaty, H., & Sturnieks, D. L. (2020). Reduced strength, poor balance and concern about falls mediate the relationship between knee pain and fall risk in older people. BMC Geriatrics, 20(94). https://doi.org/10.1186/s12877-020-1487-2
Liu, H., Zhang, J., Yu, J., Li, D., Jia, Y., Cheng, Y., Zhang, Q., Liao, X., Liu, Y., Wu, J., Zeng, Z., Cao, Y., Zeng, R., Wan, Z., & Gao, Y. (2020). Prognostic value of serum albumin-to-creatinine ratio in patients with acute myocardial infarction: Results from the retrospective evaluation of acute chest pain study. Medicine, 99(35). https://dx.doi.org/10.1097%2FMD.0000000000022049
Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). F. A. Davis.
Grading Rubric Guidelines
| Performance Category | 10 | 9 | 8 | 4 | 0 |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic decisions. |
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| Performance Category | 10 | 9 | 8 | 4 | 0 |
| Application of Course Knowledge –
Demonstrate the ability to analyze, synthesize, and/or apply principles and concepts learned in the course lesson and outside readings and relate them to real-life professional situations |
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| Performance Category | 5 | 4 | 3 | 2 | 0 |
| Interactive Dialogue
Replies to each graded thread topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week, and posts a minimum of two times in each graded thread, on separate days. (5 points possible per graded thread) |
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Summarizes what was learned from the lesson, readings, and other student posts for the week. |
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| Minus 1 Point | Minus 2 Point | Minus 3 Point | Minus 4 Point | Minus 5 Point | |
| Grammar, Syntax, APA
Note: if there are only a few errors in these criteria, please note this for the student in as an area for improvement. If the student does not make the needed corrections in upcoming weeks, then points should be deducted. Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition |
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| 0 points lost | -5 points lost | ||||
| Total Participation Requirements
per discussion thread |
The student answers the threaded discussion question or topic on one day and posts a second response on another day. | The student does not meet the minimum requirement of two postings on two different days | |||
| Early Participation Requirement
per discussion thread |
The student must provide a substantive answer to the graded discussion question(s) or topic(s), posted by the course instructor (not a response to a peer), by Wednesday, 11:59 p.m. MT of each week. | The student does not meet the requirement of a substantive response to the stated question or topic by Wednesday at 11:59 pm MT. |