wordpress-seo domain was triggered too early. This is usually an indicator for some code in the plugin or theme running too early. Translations should be loaded at the init action or later. Please see Debugging in WordPress for more information. (This message was added in version 6.7.0.) in /home/intelligentwr/nursingassignmentcrackers/wp-includes/functions.php on line 6114Patient Information:<\/strong><\/p>\n Initials: C.A, Age: 46 years, Sex: Female, Race: African American<\/p>\n S.<\/u><\/strong><\/p>\n CC (chief complaint): <\/strong>Bilateral ankle pain<\/p>\n HPI<\/strong>: C. A is a 46 is African American aged 46 years old. She presents with complaints of pain in her bilateral ankle, especially on the right side. She claims to have heard a “pop” while playing soccer over the weekend. She can tolerate weight, but it is painful. Her major worry is her right ankle.<\/p>\n Location: Bilateral ankle<\/p>\n Onset: Abrupt<\/p>\n Character: Sharp but not radiating pain<\/p>\n Associated signs and symptoms: Ankle enlargement and inadequate right ankle movement.<\/p>\n Timing: The pain has lasted for two days. It is irregular with each episode taking about 15-20 minutes.<\/p>\n Exacerbating\/ relieving factors: Pain is intensified by walking, tolerating weight, or sitting. Pain is momentarily eased by cold compresses.<\/p>\n Severity: Pain is worse on the right ankle at about 5\/10 compared to the left ankle which is about 2\/10.<\/p>\n Current Medications<\/strong>: None<\/p>\n Allergies: <\/strong>No identified drug and food allergies<\/p>\n Past Medical History<\/strong>: No history of chronic medical conditions, blood transfusion, or previous surgeries. Flu vaccine: December 2020<\/p>\n Social History<\/strong>: She is a professional teacher and the team’s soccer captain. She likes playing soccer on weekends. She does not take alcohol, smoke tobacco, or use illicit drugs.<\/p>\n Family History<\/strong>: Her parents are all alive. Her mother is diabetic but effectively managed by metformin. She is not living with her husband because they separated two years ago. She has a 20-year-old college-going daughter.<\/p>\n ROS<\/strong>:<\/p>\n GENERAL: \u00a0No fever, chills, night sweats, or changes in weight<\/p>\n HEENT:\u00a0 Eyes:\u00a0 Refutes loss of vision, blurred vision, or yellow sclera. Ears, Nose, and Throat: Refutes ear discharges, hearing loss, dysphagia, nasal congestion, or sore throat.<\/p>\n SKIN:\u00a0 Reports no rash, itching, or skin discoloration.<\/p>\n CARDIOVASCULAR: No paroxysmal nocturnal dyspnea, palpitation, chest pain, or orthopnea.<\/p>\n RESPIRATORY: \u00a0No cough, shortness of breath, sputum, or difficulty in breathing. GASTROINTESTINAL: No alteration in changes in abdominal distention, or bowel routines.<\/p>\n GENITOURINARY: \u00a0Refutes hematuria, frequency, or dysuria. The last menstrual period was on 07\/09 \/2022.<\/p>\n NEUROLOGICAL: \u00a0Denies convulsion, headache, syncope, or alterations in the functions of bowel and bladder.<\/p>\n HEMATOLOGIC: \u00a0No anemia, bruising, or bleeding.<\/p>\n LYMPHATICS: \u00a0 No record of splenectomy. No lymphadenopathy.<\/p>\n PSYCHIATRIC: \u00a0Refutes anxiety, depression, hallucinations, or delusions.<\/p>\n ENDOCRINOLOGIC: \u00a0No cold, polydipsia, polyuria, and heat intolerance.<\/p>\n ALLERGIES: No history of asthma, eczema, or hives.<\/p>\n O.<\/u><\/strong><\/p>\n Physical exam<\/strong><\/p>\n Vital Signs: <\/strong>P 78 RR 19 Temp 98.4 F, BP 123\/74 mmHg, Weight 128 lbs., Height 5′ 5″<\/p>\n General: <\/strong>A middle-aged female adult of African American origin. She has a minor discomfort. She is oriented and alert.<\/p>\n Respiratory: <\/strong>Vesicular breath sounds in entire lung zones, a symmetric chest that budges with respiration. No crackles or wheezing.<\/p>\n Cardiovascular: <\/strong>No murmurs. PMI in the fifth intercostal space, normoactive precordium, midclavicular line. S1 and S2 detected. Ecchymosis measuring 2 cm by 2 cm was noted around the lateral malleolus. Tenderness of the lateral malleolus was observed, particularly above the anterior talofibular ligament. Restricted range of motion of the right ankle, especially on plantar flexion, inversion, and dorsiflexion. Bilateral skin intact. No noted erythema or edema on the left ankle. The usual range of motion was noted on the left ankle. Noted bilateral constructive dorsalis pedis. Bilateral intact sensation, No noted deformity, crepitus, or bony tenderness.<\/p>\n Neurological: <\/strong>GCS 15\/15, oriented to person, place, and time. Cranial nerves are intact, sensation in every dermatome is intact, and typical bulk, typical tone, and reflexes in all joints. Regular functions of bladder and bowel.<\/p>\n Diagnostic results<\/strong>:<\/p>\n The prone anterior drawer test<\/strong>: This test evaluates the reliability of the ankle\u2019s lateral ligamentous complex. The test is crucial for the patient\u2019s case.<\/p>\n Talar tilt test:<\/strong> This test focuses on the calcaneofibular ligament. The patient suffered pain around the ligament area.<\/p>\n Eversion test<\/strong>: This test is conducted to assess the reliability of the deltoid ligament. It is negative in the patient’s case.<\/p>\n Imaging<\/strong>: Based on the Ottawa Ankle rules, conducting a series of X-rays is crucial is necessary where the pain is noted in the malleolar area alongside any of the following signs; tenderness above the posterior periphery of the distal 6 cm or medial malleolus’ tip, tenderness above the posterior periphery of the distal 6 cm or lateral malleolus’ tip, and incapacity to tolerate weight shortly following an injury (Murphy et al., 2020). The patient, C.A, met the Ottawa rules. As a result, a right lateral X-ray was conducted, which indicated swelling in the soft tissue. There is a need for an MRI of the ankle or more perspectives to effectively describe the ligaments involved.<\/p>\n A<\/u><\/strong>.<\/u><\/p>\n Differential Diagnoses <\/strong><\/p>\n Lateral Ankle Sprain: <\/strong>This pain is a frequent injury associated with sports. It occurs majorly with the ankle inversion and entails the lateral ligamentous complex, which comprises the calcaneofibular and posterior talofibular ligament, and anterior talofibular ligament that are damaged in reducing order (Martin et al., 2021). Patients with this condition often have a hematoma, tenderness above the sprained ligament, inadequate range of motion, and soft tissue swelling. These characteristics are common with the patient in this case. The “pop” sound she reported is an indication of a clear ligament tear.\u00a0 As such, lateral ankle sprain is the primary diagnosis in this patient.<\/p>\n Ankle Fracture<\/strong>: This condition characterizes one or more ankle joint bones including the tibia, talus, and fibular. It presents as a cute immediate pain, tenderness, incapacity to tolerate weight, limited movement, pain, skin abnormalities, and swelling (McKeown et al., 2020). It is not the major diagnosis since ankle fractures are normally high-energy injuries but the patient can tolerate the weight.<\/p>\n \u00a0Syndesmotic Ankle Injury: <\/strong>This condition is also called a high ankle sprain. It characterizes an injury to a minimum of one of the ligaments that encompass the distal tibiofibular syndesmosis (Raheman et al., 2022). It is also attributed to injuries associated with sports with an abrupt twisting force. It leads to more proximal pain above the ankle.<\/p>\n Anterior Impingement: <\/strong>This condition connotes strapped structures down the tibiotalar joint\u2019s anterior margin in terminal dorsiflexion (Chen et al., 2019). It often characterizes ankle pain and restricted movement. It is also linked to considerable abnormalities in the osseous and soft tissues.<\/p>\n Achilles Tendinitis:<\/strong> This condition characterizes Achilles tendon inflammation. It manifests with swelling, pain, and erythema at the point of tendon placement into the calcaneus. It also manifested in incapability to move and tightness (Lee & Lee, 2018). In the case at hand, the patient reported pain and tenderness in the ankle\u2019s lateral area. However, in Achilles tendinitis, the pain should manifest in the posterior area of the ankle.<\/p>\n This section is needless in this course. However, it will be necessary for future courses.<\/p>\n Chen, L., Wang, X., Huang, J., Zhang, C., Wang, C., Geng, X., & Ma, X. (2019). Outcome comparison between functional ankle instability cases with and without anterior ankle impingement: a retrospective cohort study. The Journal of Foot and Ankle Surgery<\/em>, 58<\/em>(1), 52-56. https:\/\/doi.org\/10.1053\/j.jfas.2018.07.015<\/p>\n Lee, Y. K., & Lee, M. (2018). Treatment of infected Achilles tendinitis and overlying soft tissue defect using an anterolateral thigh free flap in an elderly patient: A case report. Medicine<\/em>, 97<\/em>(35). Doi:\u00a010.1097\/MD.0000000000011995<\/p>\n Martin, R. L., Davenport, T. E., Fraser, J. J., Sawdon-Bea, J., Carcia, C. R., Carroll, L. A., … & Carreira, D. (2021). Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Journal of Orthopaedic & Sports Physical Therapy<\/em>, 51<\/em>(4), CPG1-CPG80. https:\/\/www.jospt.org\/doi\/10.2519\/jospt.2021.0302<\/p>\n McKeown, R., Kearney, R. S., Liew, Z. H., & Ellard, D. R. (2020). Patient experiences of an ankle fracture and the most important factors in their recovery: a qualitative interview study. BMJ open<\/em>, 10<\/em>(2), e033539. http:\/\/dx.doi.org\/10.1136\/bmjopen-2019-033539<\/p>\n Murphy, J., Weiner, D. A., Kotler, J., McCormick, B., Johnson, D., Wisbeck, J., & Milzman, D. (2020). Utility of Ottawa ankle rules in an aging population: evidence for addition of an age criterion. The Journal of Foot and Ankle Surgery<\/em>, 59<\/em>(2), 286-290. https:\/\/doi.org\/10.1053\/j.jfas.2019.04.017<\/p>\n Raheman, F. J., Rojoa, D. M., Hallet, C., Yaghmour, K. M., Jeyaparam, S., Ahluwalia, R. S., & Mangwani, J. (2022). Can weightbearing cone-beam CT reliably differentiate between stable and unstable syndesmotic ankle injuries? A systematic review and meta-analysis. Clinical Orthopaedics and Related Research\u00ae<\/em>, 10-1097. Doi: 10.1097\/CORR.0000000000002171<\/p>\n <\/p>\n 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.<\/p>\n In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.<\/p>\n 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.<\/a> Used with permission of University of Virginia.<\/p>\n 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?<\/p>\n Photo Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http:\/\/www.med-ed.virginia.edu\/courses\/rad\/ext\/8ankle\/01anatomy.html.<\/a> Used with permission of University of Virginia.<\/p>\n 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?<\/p>\n Photo Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http:\/\/www.med-ed.virginia.edu\/courses\/rad\/ext\/7knee\/01anatomy.html.<\/a> Used with permission of University of Virginia.<\/p>\n 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?<\/p>\n Note:<\/em><\/strong> Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.<\/em><\/p>\n Post<\/strong>\u00a0an 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.<\/p>\n Note:<\/em><\/strong>\u00a0For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues\u2019 postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on\u00a0Submit!<\/strong><\/em><\/p>\n Read<\/strong>\u00a0a selection of your colleagues’ responses.<\/p>\n Respond<\/strong>\u00a0to\u00a0at least two<\/strong>\u00a0of your colleagues on\u00a02<\/strong>\u00a0different days<\/strong> 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.<\/p>\n\n
References<\/h2>\n
Sample Answer for NURS 6512 Discussion: Assessing Musculoskeletal Pain Included After Question<\/strong><\/em><\/span><\/h2>\n
To prepare:<\/strong><\/h2>\n
\n
Case 1: Back Pain<\/strong><\/h2>\n
Case 2:<\/strong>\u00a0Ankle Pain<\/h2>\n
Case 3:<\/strong>\u00a0Knee Pain<\/h2>\n
With regard to the case study you were assigned:<\/h2>\n
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By Day 3 of Week 8<\/strong><\/h2>\n
By Day 6 of Week 8<\/strong><\/h2>\n