Sample Answer for NURS 6512N Discussion: Assessing Musculoskeletal Pain 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 fivepossible 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 6512N Discussion: Assessing Musculoskeletal Pain
Title: NURS 6512N Discussion: Assessing Musculoskeletal Pain
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
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.
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
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.
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:
NURS 6512N Discussion Assessing Musculoskeletal Pain
Case 1: Back Pain
Photo Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.
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?
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A Sample Answer 2 For the Assignment: NURS 6512N Discussion: Assessing Musculoskeletal Pain
Title: NURS 6512N Discussion: Assessing Musculoskeletal Pain
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.
A Sample Answer 3 For the Assignment: NURS 6512N Discussion: Assessing Musculoskeletal Pain
Title: NURS 6512N Discussion: Assessing Musculoskeletal Pain
Patient Information:
Initials, Age, Sex, Race: a 46-year-old female patient.
S.
CC (chief complaint): ‘My ankles are painful.’
HPI: The patient is a 46-year-old female that came to the department with complaints of pain in both ankles. She reports being more concerned with the right ankle. The patient notes that she was playing soccer over the weekend when she heard a ‘pop.’ She can bear weight but is uncomfortable. The patient rates her pain as 7/10, with increased intensity with weight. The patient denied any radiating pain. Rest and ibuprofen relieve the pain. She also uses cold compressions to sooth the pain.
Current Medications: The patient currently uses ibuprofen 500 mg as needed for pain.
Allergies: The patient has latex allergy. She denied any allergic reaction to drugs and environmental allergens.
PMHx: The patient’s immunization history is up-to-date. Her last tetanus immunization was 12/10/2022. She has a history of hospitalization due to pneumonia. She has no history of surgery or blood transfusion.
Soc Hx: The patient is a teacher. She is married with two children. She resides in an owned property with her family. She engages in sports activities weekly. She does not smoke or takes alcohol. She does not have any history of drug and substance use. She reports wearing a helmet and seat belts when riding and driving. Her support system includes family, friends, and church members. She is a devoted Christian.
Fam Hx: Her diseased mother died of hypertension. She was also diabetic and diagnosed at some point with anxiety disorder. Her living father has colon cancer. Her sister was diagnosed with asthma a year ago. Her paternal grandfather died of heart disease.
ROS:
GENERAL: The patient is dressed appropriately for the occasion. She is alert and oriented to self-, others, time, and place. She denies weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes: The patient denies visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat: The patient denies hearing loss, sneezing, congestion, runny nose or sore throat.
SKIN: The patient denies rash or itching.
CARDIOVASCULAR: The patient denies chest pain, chest pressure or chest discomfort. No palpitations or edema.
RESPIRATORY: The patient denies shortness of breath, cough or sputum.
GASTROINTESTINAL: The patient denies anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.
GENITOURINARY: The patient denies burning on urination, urgency and frequency. She is menopausal.
NEUROLOGICAL: The patient denies headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. She also denies change in bowel or bladder control.
MUSCULOSKELETAL: The patient reports bilateral ankle joints. The right ankle hurts the most. She reports some tenderness on the anterior aspect in the right ankle. She is weight bearing but uncomfortable.
HEMATOLOGIC: The patient denies anemia, bleeding or bruising.
LYMPHATICS: The patient denies enlarged nodes. There is no history of splenectomy.
PSYCHIATRIC: The patient denies history of depression or anxiety.
ENDOCRINOLOGIC: The patient denies reports of sweating, cold or heat intolerance. No polyuria or polydipsia.
ALLERGIES: The patient reports latex allergy. She denies food, drug, or environmental allergic reaction.
O.
Physical exam:
Vitals: Temperature: 37.6, BP 122/80, P-100, RR 22 bpm, SPO2 98%
General: The patient is well-groomed for the occasion. She is alert and oriented. She is responsive to questions and maintains normal eye contact. There is no evidence of any distress, fatigue, or weight loss.
Chest/Lungs: The chest rises symmetrically with respirations. The patient does not demonstrate nasal flaring or discharge. The nares are patent. On auscultation there are wheezes, rales, crackles, or rhonchi. The lungs are clear in all the lobes.
Heart/Peripheral Vascular: The patient does not have central or peripheral cyanosis. S1 and S2 heart sounds heard. There are no murmurs or S3 heart sounds. The peripheral pulses are adequate with capillary refill of less than 3 seconds. The extremities are warm to touch with no ulcers.
Musculoskeletal: The patient reports bilateral ankle pain. On assessment there is limited range of motion with plantar flexion, inversion and dorsiflexion. The right ankle appears edematous to the anterior aspect. There is skin discoloration over the right ankle. There is no cyanosis or tissue ischemia or bruising. There are no deformities. The patient is weight bearing with some discomfort. On palpation, the skin is warm to touch. The lateral malleolus area is tender to touch. The anterior talofibular ligament is inflamed.
Lymphatics: There is no lymphadenopathy or weight gain or loss.
Psychiatric: The patient denies any history of mental health disorders.
Diagnostic results:
One of the diagnostic investigations needed to develop an accurate diagnosis for the client is x-ray. An x-ray of the right ankle would be important to visualize the ligaments, joint, and bones. The results will determine if the problem is due to soft tissue injury, fracture, or ligament tear. The other recommended diagnostic is magnetic resonance imaging. MRI will provide detailed cross-sectional images of soft tissue involvement. A CT scan of the ankle joint may also be needed to guide in the diagnosis (Chen et al., 2019). Ultrasound may be needed to determine the functioning of the tendon or ligaments in different foot movements.
A.
Differential Diagnoses
Ankle sprain is the primary diagnosis for the patient. An ankle sprain develops when a joint is suddenly subjected to a move that strains the ligaments and tendons. It is most common in individuals that engage in activities such as sports. Patients that suffer ankle sprains often complain of symptoms that align with those seen in the patient in this case study. They include pain on weight bearing, swelling, tenderness, bruising, reduced range of motion, and popping sound during the injury (Chen et al., 2019; Delahunt & Remus, 2019).
Ankle fracture is the secondary diagnosis that should be considered for this patient. An ankle fracture develops when a bone is broken from fall, twit, or trauma. The fractures vary based on the severity of the cause. Patients that suffer ankle fractures experience symptoms that include deformity, tenderness, swelling, throbbing pain, bruising, and difficulty walking (Scheer et al., 2020). The patient in the case study is least likely to be suffering from fractured ankle since there are no evident deformities in the ankles.
The other diagnosis to be considered for the patient is tendon rupture. A rupture of the Achilles tendon may occur in cases of extreme stress and pressure to the ankle joint and tendon. The affected patients often experience symptoms such as thickened Achilles tendon, pain near the heel, pain that worsens with activity, and difficulties in flexing the affected leg. The additional symptoms include a pop sound during the time of injury and patient being unable to stand on the toes of the affected extremity (Svensson et al., 2019; Tarantino et al., 2020). Additional diagnostics will help in differentiating between ankle sprain and ruptured Achilles tendon.
This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Chen, E. T., McInnis, K. C., & Borg-Stein, J. (2019). Ankle Sprains: Evaluation, Rehabilitation, and Prevention. Current Sports Medicine Reports, 18(6), 217. https://doi.org/10.1249/JSR.0000000000000603
Delahunt, E., & Remus, A. (2019). Risk Factors for Lateral Ankle Sprains and Chronic Ankle Instability. Journal of Athletic Training, 54(6), 611–616. https://doi.org/10.4085/1062-6050-44-18
Scheer, R. C., Newman, J. M., Zhou, J. J., Oommen, A. J., Naziri, Q., Shah, N. V., Pascal, S. C., Penny, G. S., McKean, J. M., Tsai, J., & Uribe, J. A. (2020). Ankle Fracture Epidemiology in the United States: Patient-Related Trends and Mechanisms of Injury. The Journal of Foot and Ankle Surgery, 59(3), 479–483. https://doi.org/10.1053/j.jfas.2019.09.016
Svensson, R. B., Couppé, C., Agergaard, A.-S., Ohrhammar Josefsen, C., Jensen, M. H., Barfod, K. W., Nybing, J. D., Hansen, P., Krogsgaard, M., & Magnusson, S. P. (2019). Persistent functional loss following ruptured Achilles tendon is associated with reduced gastrocnemius muscle fascicle length, elongated gastrocnemius and soleus tendon, and reduced muscle cross-sectional area. TRANSLATIONAL SPORTS MEDICINE, 2(6), 316–324. https://doi.org/10.1002/tsm2.103
Tarantino, D., Palermi, S., Sirico, F., & Corrado, B. (2020). Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play. Journal of Functional Morphology and Kinesiology, 5(4), Article 4. https://doi.org/10.3390/jfmk5040095
ASSIGNMENT RUBRIC
| Performance Category | 100% or highest level of performance
100% 16 points |
Very good or high level of performance
88% 14 points |
Acceptable level of performance
81% 13 points |
Inadequate demonstration of expectations
68% 11 points |
Deficient level of performance
56% 9 points
|
Failing level
of performance 55% or less 0 points |
| Total Points Possible= 50 | 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points |
| Scholarliness
Demonstrates achievement of scholarly inquiry for professional and academic topics. |
Presentation of information was exceptional and included all of the following elements:
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Presentation of information was good, but was superficial in places and included all of the following elements:
|
Presentation of information was minimally demonstrated in all of the following elements:
|
Presentation of information is unsatisfactory in one of the following elements:
|
Presentation of information is unsatisfactory in two of the following elements:
|
Presentation of information is unsatisfactory in three or more of the following elements
|
| 16 Points | 14 Points | 13 Points | 11 Points | 9 Points | 0 Points | |
| Application of Course Knowledge
Demonstrate the ability to analyze and apply principles, knowledge and information learned in the outside readings and relate them to real-life professional situations |
Presentation of information was exceptional and included all of the following elements:
|
Presentation of information was good, but was superficial in places and included all of the following elements:
|
Presentation of information was minimally demonstrated in the all of the following elements:
|
Presentation of information is unsatisfactory in one of the following elements:
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Presentation of information is unsatisfactory in two of the following elements:
|
Presentation of information is unsatisfactory in three of the following elements
|
| 10 Points | 9 Points | 6 Points | 0 Points | |||
| Interactive Dialogue
Initial post should be a minimum of 300 words (references do not count toward word count) The peer and instructor responses must be a minimum of 150 words each (references do not count toward word count) Responses are substantive and relate to the topic. |
Demonstrated all of the following:
|
Demonstrated 3 of the following:
|
Demonstrated 2 of the following:
|
Demonstrated 1 or less of the following:
|
||
| 8 Points | 7 Points | 6 Points | 5 Points | 4 Points | 0 Points | |
| Grammar, Syntax, APA
Points deducted for improper grammar, syntax and APA style of writing. The source of information is the APA Manual 6th Edition Error is defined to be a unique APA error. Same type of error is only counted as one error. |
The following was present:
AND
AND
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
AND/OR
|
The following was present:
AND/OR
AND/OR
|
| 0 Points Deducted | 5 Points Lost | |||||
| Participation
Requirements |
Demonstrated the following:
|
Failed to demonstrate the following:
|
||||
| 0 Points Lost | 5 Points Lost | |||||
| Due Date Requirements | Demonstrated all of the following:
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |
Demonstrates one or less of the following.
A minimum of one peer and one instructor responses are to be posted within the course no later than Sunday, 11:59 pm MT. |