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Assessing Musculoskeletal Pain Discussion Assignment

Assessing Musculoskeletal Pain Discussion AssignmentAssessing Musculoskeletal Pain Discussion AssignmentCase 3: Knee PainPhoto Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.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?Assessing Musculoskeletal Pain Discussion AssignmentWith 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?ORDER A PLAGIARISM-FREE PAPER HERE· 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 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.Assessing Musculoskeletal Pain Discussion AssignmentBy Day 3 of Week 8Post 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.Rubric Detail Select Grid View or List View to change the rubric’s layout.Name: NURS_6512_Week_8_Discussion_RubricAssessing Musculoskeletal Pain Discussion Assignment· Grid View· List View  Excellent Good Fair PoorMain Posting 45 (45%) – 50 (50%)“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Assessing Musculoskeletal Pain Discussion Assignment 40 (40%) – 44 (44%)“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style. 35 (35%) – 39 (39%)“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.Assessing Musculoskeletal Pain Discussion Assignment 0 (0%) – 34 (34%)“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.Main Post: Timeliness 10 (10%) – 10 (10%)Posts main post by Day 3. 0 (0%) – 0 (0%)Assessing Musculoskeletal Pain Discussion AssignmentN/A 0 (0%) – 0 (0%)N/A 0 (0%) – 0 (0%)Does not post main post by Day 3.First Response 17 (17%) – 18 (18%)“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Assessing Musculoskeletal Pain Discussion Assignment Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English. 15 (15%) – 16 (16%)“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed.Assessing Musculoskeletal Pain Discussion Assignment Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 13 (13%) – 14 (14%)“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. 0 (0%) – 12 (12%)“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.Second Response 16 (16%) – 17 (17%)“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.Assessing Musculoskeletal Pain Discussion Assignment 14 (14%) – 15 (15%)“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English. 12 (12%) – 13 (13%)“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited. 0 (0%) – 11 (11%)“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.Assessing Musculoskeletal Pain Discussion AssignmentParticipation 5 (5%) – 5 (5%)Meets requirements for participation by posting on three different days. 0 (0%) – 0 (0%)N/A 0 (0%) – 0 (0%)N/A 0 (0%) – 0 (0%)Does not meet requirements for participation by posting on three different days.Total Points: 100Name: NURS_6512_Week_8_Discussion_RubricThe 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.Assessing Musculoskeletal Pain Discussion AssignmentIn 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.                                      Case : Ankle PainA 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?Assessing Musculoskeletal Pain Discussion Assignment· 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?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.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.Assignment:Write an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note. 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.Assessing Musculoskeletal Pain Discussion AssignmentWk 8-Discussion Review of Case Study 1COLLAPSEPatient Information: 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?Assessing Musculoskeletal Pain Discussion AssignmentS.CC  Back painHPI: SK is a 42-year-old Caucasian male that presents with constant lower back pain for the past two months. Reports that he is experiencing intermittent radiating pain to his left leg. The leg pain reportedly episodic, and lasts for multiple hours. The pain has caused SK to have mobility issues while completing ADL’s, as well as when he is at work. Pt expresses “The pain is achy and throbs in my back. When my leg is affected it feels like a burning pain”. Pain level is 6/10. Reports that lifting heavy objects aggravates the pain. Rest alleviates the pain. Pt has been using ice on lower back to treat the pain, as well as taking Ibuprofen 800 mg PO BID for the past two weeks. Denies any other associated symptoms with back pain.Assessing Musculoskeletal Pain Discussion AssignmentCurrent Medications:Ibuprofen mg PO BID for back painAtorvastatin 20mg PO once daily for HLD Allergies: NKDA, No allergies to food or latex, No environmental allergies.PMHx: HLD dx in 2016, prescribed Atorvastatin 20 mg PO once daily. All immunizations up to date. Flu shot received within one year of visit. No Surgical history reported. No previous hospitalizations. Last annual physical was in May of this year.Soc Hx: SK is a construction worker that remains fairly active. Has been married for 3 years to wife, currently sexually active. Pt describes self as a “social drinker” and cannot recall last episode of alcohol consumption. Denies smoking or the use of any tobacco product. Denies illicit drug use. Exercises daily. Diet changes frequently and does not monitor intake. Wears seatbelt regularly driving company car and car for leisure purposes. Smoke detectors in home. Reports that his neighborhood is safe.Assessing Musculoskeletal Pain Discussion AssignmentFam Hx:Father: Alive, age 67, Hx HTNMother: Alive, age 69, Hx HTN, HLD, Mitral Valve ProlapseMaternal Grandmother: Alive, age 87, Hx HTN, HLDMaternal Grandfather: Deceased at age 89; GI Bleed.Paternal Grandmother: Deceased at age 61; MelanomaPaternal Grandfather: Deceased at age 48; Lung CAROS:GENERAL:  Denies fever, fatigue, sob, or recent illness.SKIN:  Denies pruritus, rash, or areas of hyperpigmentation.CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema. HX of HLDRESPIRATORY:  No sob, dyspnea, cough, or hemoptysis.MUSCULOSKELETAL:  Pain in lumbar region of back. Episodic pain that radiates from back down left leg impairing gait. Range of motion impaired.Assessing Musculoskeletal Pain Discussion AssignmentO.VS: BP: 145/90, RR: 16, HR: 84, T: 98.0 F, O2: 97% on RA; Ht. 5’10” wt. 220 lbs BMI: 31.75GENERAL: Pt is calm and cooperative while sitting upright on the examination table. Pt appears to be in NAD at this time. Appears to have good hygiene maintenance. Answers all questions without contradiction. Speech is clear and coherent.SKIN: No breakdown, lesions, abrasions, or rashes noted. No tenting.CARDIOVASCULAR:  S1, S2 heard with no murmur. S3 audible in mitral landmark. No edema noted in upper and lower extremities.RESPIRATORY: Respirations even and unlabored. Equal chest rise and fall. Lung sounds clear throughout anterior and posterior landmarks.MUSCULOSKELETAL:  Pain in lumbar region of back. No deformity noted throughout lumbar region. Episodic pain that radiates from back down to left leg impairing gait. Range of motion impaired when attempting hyperextension of spine. Diagnostic results: X Ray of Lumbar Spine, CT cervical and lumbar spine. MRI lumbar spine.A diagnostic test, such plain radiographs, standing anteroposterior and lateral views of the spine, bone scan, electromyography, as well as CT scan or an MRI scan, may be recommended in order to confirm the presence of the suspected cause of the patient’s pain (Dains, Baumann, & Scheibel, 2016).A.Assessing Musculoskeletal Pain Discussion Assignment1.Sciatica- Disc herniation causes nerve root irritation and produces acute lower back pain that radiates down the buttock to the below the knee. Acute lower back pain is associated with pain and burning that radiates to along the lateral thigh, leg and foot, sometimes associated with numbness alone the dermatomal areas. Pain that is sharp and burning and radiates down the lateral and posterior aspect of the leg to the lateral ankle or foot is called sciatica and is a classical symptom of nerve root irritation most often caused by disk displacement (Dains, Baumann, & Scheibel, 2016). During the physical exam, I will check the patient’s muscle strength and reflexes. For example, will ask the patient to walk on the toes or heels, rise from a squatting position and, while lying supine, and lifting the legs one at a time. Pain that results from sciatica will usually worsen during these activities. Sciatica is the primary diagnosis, based on the clinical symptoms, results of physical examinations and diagnostics.Assessing Musculoskeletal Pain Discussion Assignment2. Herniated lumbar disc-A herniated disk refers to a problem with one of the disks between the vertebrae that stack up to make the spine (Lama et al., 2014). A herniated disk can irritate nearby nerves and result in pain, numbness or weakness in an arm or leg (Lama et al., 2014). Diagnosis usually includes: CT lumbar spine, X-ray and an MRI.3. Muscle strain- Muscle strain is damage to a muscle or its attaching tendons (Benjamin, 2014). This can occur when putting extreme pressure on muscles during the course of normal daily activities, with sudden heavy lifting, during sports, or while performing work tasks (Benjamin, 2012). A physical exam is done, and possibly an X-ray to rule out other diagnosis. Resting, with the use of NSAIDs is the most common course of treatment (Benjamin, 2014)Assessing Musculoskeletal Pain Discussion Assignment.4. Lumbar Stenosis- Stenosis means the abnormal narrowing of a body channel when combined with the word spinal, it defines a narrowing of the bone channel occupied by the spinal nerves or the spinal cord, lumbar stenosis affects the lower back and cervical stenosis is in the neck. Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to osteoarthritis. Spinal stenosis is the most common cause of acute lower back pain in adults older than 50 years,   the cause of spinal stenosis in the lumbar spine is commonly associated with aging (Ullrich, 2017). The facet joints (small stabilizing joints located between and behind vertebrae) tend to get larger as they degenerate and can compress the spinal nerve roots in the lower back, often producing lumbar stenosis symptoms of pain, especially with activity (Ullrich, 2017). Pain is associated with lumbosacral radiculopathy, pain occurs with walking or standing, and relief with sitting or forward flexion of the spine most often in the lower back and the neck Dains, Baumann, & Scheibel, 2016) This condition is not a likely diagnosis based on the nature of the disease, including symptoms.Assessing Musculoskeletal Pain Discussion Assignment 5. Ankylosing Spondylitis- This is a systemic inflammatory condition of the vertebral column and the sacroiliac joints. Ankylosing Spondylitis (AS) is a kind of arthritis that affects joints such as the hips, knees, and shoulders. According to Dains, Baumann, & Scheibel, 2016, AS can lead to weak, brittle bones (osteoporosis). The classic symptom is pain and stiffness in the hips and lowers back (Dains, Baumann, & Scheibel, 2016). This condition is usually reported as chronic lower back pain, which is worse on the morning rising and lessens as the day progresses. Physical examination reveals thoracic kyphosis and rounding of the posterior thoracic spine with forwarding flexion of the head, neck and the lower back (Dains, Baumann, & Scheibel, 2016). This condition is ruled out secondary to the inflammatory nature of the disease and the signs as symptoms as presented.  ReferencesBall, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier.Assessing Musculoskeletal Pain Discussion AssignmentBenjamin, B. E. (2014). Interosseous Muscle Strains. Massage & Bodywork, 27(3), 108-111 4p. Retrieved from: http://web.b.ebscohost.com.ezp.waldenulibrary.org/ehost/detail/detail?vid=8&sid=170f1c32-41ce-459b-8d12-eca3f64ce3ab%40sessionmgr112&hid=125&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=108129119&db=rzhDains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby. Care, 63(10), 1281–1292. https://doi-org.ezp.waldenulibrary.org/10.4187/respcare.05935Lama, P., Zehra, U., Balkovec, C., Claireaux, H. A., Flower, L., Harding, I. J., &  Adams, M. A. (2014). Significance of cartilage endplate within herniated disc tissue. European Spine Journal: Official Publication Of The European Spine Society, The European Spinal Deformity Society, And The European Section Of The Cervical Spine Research Society, 23(9), 1869-1877. doi:10.1007/s00586-014-3399-3Philips, C. A. (2017). Diagnosing cirrhosis – comprehension in a nut shell. International Journal of Surgery and Medicine, Vol 3, Iss 2 (2017), (2). https://doi-org.ezp.waldenulibrary.org/10.5455/ijsm.cirrhosis-diagnoseUllrich, P. F. (2017). Lumbar Spinal Stenosis: A Definitive Guide. Retrieved from https://www.spine-health.com/conditions/spinal-stenosis/lumbar-spinal-stenosis-a-definitive-guideWeek 8: Assessment of the Musculoskeletal SystemA 46-year-old man walks into a doctor’s office complaining of tripping over doorways more frequently. He does not know why. What could be the causes of this condition?Without the ability to use the complex structure and range of movement afforded by the musculoskeletal system, many of the physical activities individuals enjoy would be curtailed. Maintaining the health of the musculoskeletal system will ensure that patients live a life of full mobility. One of the most basic steps that can be taken to preserve the health of the musculoskeletal system is to perform an assessment.Assessing Musculoskeletal Pain Discussion AssignmentThis week, you will explore how to assess the musculoskeletal system.Learning ObjectivesStudents will:Evaluate abnormal musculoskeletal findingsApply concepts, theories, and principles relating to health assessment techniques and diagnoses for the musculoskeletal systemLearning ResourcesRequired Readings (click to expand/reduce) 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.). St. Louis, MO: Elsevier Mosby.Assessing Musculoskeletal Pain Discussion AssignmentChapter 4, “Vital Signs and Pain Assessment” (Previously read in Week 6)Chapter 22, “Musculoskeletal System”This chapter describes the process of assessing the musculoskeletal system. In addition, the authors explore the anatomy and physiology of the musculoskeletal system.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.Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.Chapter 22, “Lower Extremity Limb Pain”This chapter outlines how to take a focused history and perform a physical exam to determine the cause of limb pain. It includes a discussion of the most common tests used to assess musculoskeletal disorders.Chapter 24, “Low Back Pain (Acute)”The focus of this chapter is the identification of the causes of lower back pain. It includes suggested physical exams and potential diagnoses.Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis. Chapter 2, “The Comprehensive History and Physical Exam” (“Muscle Strength Grading”) (Previously read in Weeks 1, 2, 3, 4, and 5)Chapter 3, “SOAP Notes”This section explains the procedural knowledge needed to perform musculoskeletal procedures.Note: Download this Student Checklist and Abdomen Key Points to use during your practice abdominal examination.Assessing Musculoskeletal Pain Discussion AssignmentBall, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.Katz, J. N., Lyons, N., Wolff, L. S., Silverman, J., Emrani, P., Holt, H. L., … Losina, E. (2011). Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study. BMC Musculoskeletal Disorders, 12(1), 78–85.This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.Smuck, M., Kao, M., Brar, N., Martinez-Ith, A., Choi, J., & Tomkins-Lane, C. C. (2014). Does physical activity influence the relationship between low back pain and obesity? The Spine Journal, 14(2), 209–216. doi:10.1016/j.spinee.2013.11.010Shiri, R., Solovieva, S., Husgafvel-Pursiainen, K., Telama, R., Yang, X., Viikari, J., Raitakari, O. T., & Viikari-Juntura, E. (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis & Rheumatism, 42(6), 640–650. doi:10.1016/j.semarthrit.2012.09.002Assessing Musculoskeletal Pain Discussion AssignmentDocument: Episodic/Focused SOAP Note Exemplar (Word document)Document: Episodic/Focused SOAP Note Template (Word document)Optional ResourceLeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.ORDER A PLAGIARISM-FREE PAPER HEREChapter 13, “The Spine, Pelvis, and Extremities” (pp. 585–682)In this chapter, the authors explain the physiology of the spine, pelvis, and extremities. The chapter also describes how to examine the spine, pelvis, and extremities.Required Media (click to expand/reduce) Online media for Seidel’s Guide to Physical ExaminationIn addition to this week’s resources, it is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapter 21 that relate to the assessment of the musculoskeletal system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/Assessing Musculoskeletal Pain Discussion AssignmentDiscussion: Assessing Musculoskeletal PainPhoto Credit: Getty Images/Fotosearch RFThe 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.Assessing Musculoskeletal Pain Discussion AssignmentTo 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 PainPhoto 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?Assessing Musculoskeletal Pain Discussion AssignmentCase 2: Ankle PainPhoto 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. Used with permission of University of Virginia.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?Assessing Musculoskeletal Pain Discussion AssignmentCase 3: Knee PainPhoto Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.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?Assessing Musculoskeletal Pain Discussion AssignmentWith 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 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.By Day 3 of Week 8Post 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.Assessing Musculoskeletal Pain Discussion AssignmentNote: 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 “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 Submit!Assessing Musculoskeletal Pain Discussion AssignmentRead a selection of your colleagues’ responses.By Day 6 of Week 8Respond 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.Submission and Grading InformationGrading CriteriaTo access your rubric:Week 8 Discussion RubricPost by Day 3 of Week 8 and Respond by Day 6 of Week 8To Participate in this Discussion:Week 8 DiscussionAssessing Musculoskeletal Pain Discussion AssignmentAssignment: Lab Assignment (Optional): Practice Assessment: Musculoskeletal ExaminationA description of symptoms alone is not enough to form an accurate diagnosis of musculoskeletal conditions. Before forming a diagnosis, advanced practice nurses need to perform a physical examination. Although the musculoskeletal examination is relatively simple, it still needs to be performed multiple times before it can be mastered.In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due in Week 9, it is recommended that you practice performing a musculoskeletal examination this week.Note: This is an optional practice physical assessment.  To PrepareArrange an appropriate time and setting with your volunteer “patient” to perform a musculoskeletal examination.Download and review the Musculoskeletal Checklist provided in this week’s Learning Resources as well as review the Seidel’s Guide to Physical Examination online media.The Lab AssignmentPerform the musculoskeletal examination. Be sure to cover all of the areas listed in the checklist.Assessing Musculoskeletal Pain Discussion AssignmentWhat’s Coming Up in Week 9?Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty ImagesNext week, you will examine appropriate methods for assessing the cognition and the neurologic systems during your Discussion. You also will complete the last assessment, Comprehensive (Head-to-Toe) Physical Assessment. Once again, you will conduct this assessment in the Digital Clinical Experience using the simulation tool, Shadow Health. Make sure to plan your time accordingly.Assessing Musculoskeletal Pain Discussion AssignmentWeek 9 Required MediaPhoto Credit: [fergregory]/[iStock / Getty Images Plus]/Getty ImagesNext week, you will need to view several videos and animations in the Seidel’s Guide to Physical Examination as well as other media, as required, prior to completing your Discussion. There are several videos of various lengths. Please plan ahead to ensure you have time to view these media programs to complete your Discussion on time.Next WeekTo go to the next week:Week 9Rubric DetailSelect Grid View or List View to change the rubric’s layout.Name: NURS_6512_Week_8_Discussion_RubricGrid ViewList ViewExcellent Good Fair PoorMain Posting45 (45%) – 50 (50%)“Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Assessing Musculoskeletal Pain Discussion Assignment40 (40%) – 44 (44%)“Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.Assessing Musculoskeletal Pain Discussion Assignment35 (35%) – 39 (39%)“Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.Assessing Musculoskeletal Pain Discussion Assignment0 (0%) – 34 (34%)“Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.Main Post: Timeliness10 (10%) – 10 (10%)Posts main post by Day 3.0 (0%) – 0 (0%)N/A0 (0%) – 0 (0%)N/A0 (0%) – 0 (0%)Does not post main post by Day 3.Assessing Musculoskeletal Pain Discussion AssignmentFirst Response17 (17%) – 18 (18%)“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.15 (15%) – 16 (16%)“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.13 (13%) – 14 (14%)“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.Assessing Musculoskeletal Pain Discussion Assignment0 (0%) – 12 (12%)“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.Second Response16 (16%) – 17 (17%)ORDER A PLAGIARISM-FREE PAPER HERE“Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.14 (14%) – 15 (15%)“Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.12 (12%) – 13 (13%)“Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.Assessing Musculoskeletal Pain Discussion Assignment0 (0%) – 11 (11%)“Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.Participation5 (5%) – 5 (5%)Meets requirements for participation by posting on three different days.0 (0%) – 0 (0%)N/A0 (0%) – 0 (0%)N/A0 (0%) – 0 (0%)Does not meet requirements for participation by posting on three different days.Total Points: 100Name: NURS_6512_Week_8_Discussion_RubricA.S Age 42 year-old African American maleCollapseAssessing Musculoskeletal Pain Discussion AssignmentEpisodic/Focused SOAP Note TemplatePatient Information:A.S Age 42 year-old African American maleS.CC Lower back pain for the last one monthHPI: The patient is a 42-year-old male who came to the hospital with complaints of lower back pain for the last one month. The patient reported that the pain at times radiates to his left leg. The patient also reported that the pain has been increasing if he sits for a long time. The pain is relived when he stands. The patient denies any fever or pain. He pain rating at the time of assessment was reported to be 8/10.Current Medications: The patient reported to be using acetaminophen 1 gram, TDS for the last one week, which has not been effective in relieving the pain.Assessing Musculoskeletal Pain Discussion AssignmentAllergies: The patient denied any history of food, drug, or environmental allegy.PMHx: The patient was admitted to the hospital in 2015 due to pneumonia. He also has a history of admission in 2010 due to anemia. The patient does not have any history of surgery. He also does not have any history of blood transfusion.Soc Hx: The patient is married. He works as a librarian in a community lbrary. The patient does not smoke or uses alcohol. He engages in regular physical activity, which has been limited by his condition. He reported to live in a healthy environment with enhanced access to healthy diets. He has three children who are currently in college.Fam Hx: The patient denied any history of chronic illnesses in his family. Both of his parents are alive, without any chronic illnesses.Assessing Musculoskeletal Pain Discussion AssignmentROS:GENERAL:  The patient was dressed appropriately for the occasion. There was no evidence of weight loss. The patient however had slowed movements due to lower back pain. The patient denied fever, chills, fatigue or weakness.HEENT:  Eyes:  The patient denied visual loss, blurred vision, double vision or eye drainage. Ears, Nose, Throat:  The patient denied hearing loss, sneezing, congestion, runny nose or sore throat.SKIN:  The patient denied rash or itching.CARDIOVASCULAR:  The patient denied chest pain, chest pressure or chest discomfort. palpitations or edema.RESPIRATORY:  The patient denied shortness of breath, cough or sputum.GASTROINTESTINAL:  The patient denied anorexia, nausea, vomiting or diarrhea. He also denied abdominal pain or blood.GENITOURINARY:  The patient denied burning on urination increased urinary frequency or changes in urine color and smell.Assessing Musculoskeletal Pain Discussion AssignmentNEUROLOGICAL:  The patient denied headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. He also denied any changes in bowel or bladder control.MUSCULOSKELETAL:  The patient complained of lower back pain that radiates to the right leg. The self-reported pain rating of the client was 8/10. The client reported that the pain increases with prolonged sitting or turning in bed. The patient also reported the pain to have affected his ability to walk, as he is forced to walk slowly to minimize pain. The patient reported that the pain has persisted for the last one month. The pain radiates to the left leg when he walks. He denied any numbness. The pain is relieved when he stands. Acetaminophen has been effective in the past in relieving it. However, he feels that it is not helping, as he has to depend on it to minimize pain.Assessing Musculoskeletal Pain Discussion AssignmentHEMATOLOGIC:  The patient denied anemia, bleeding or bruising.LYMPHATICS:  The patient denied enlarged nodes.PSYCHIATRIC:  The patient denied any history of depression or anxiety.ENDOCRINOLOGIC:  The patient denied reports of sweating, cold or heat intolerance. He also denied polyuria or polydipsia.ALLERGIES:  The patient denied any history of food, drug or environmental allergens.O.Assessing Musculoskeletal Pain Discussion AssignmentPhysical exam:Vitals: BP 123/76 P 70, R 20, T 98.7 F, SAT 98%, Wt 56 kg, Ht 5’9, pain 8/10General: The patient is a 42-year-old, who appears well-dressed for the occasion. He does not have any evidence of weight loss. His walking pace is reduced due to lower back pain. He is oriented, alert, and cooperative. He has slight limp due to lower back pain.HEENT: The head is normocephalic with normal distribution of hair. There is the absence of facial tenderness, with pink conjunctiva and white sclera and absence of jaundice. The pupils react to light. There is absence of eyes and ear drainage. There are absence of erythema, lesions or exudates on the pharynx and nasopharynx. The mucus membranes are moist with absence of dentures.Neck: There is the absence of swollen lymph nodes, neck rigidity, and swelling.Chest/Lungs: lungs are clear, with equal symmetry on respiration. There is absence of wheezing, stridor, or rhonchi. There is the absence of palpitations and abnormal heart sounds.Gastrointestinal: There is the absence of abdominal swelling, scars, or evident blood vessels. There is also the absence of organomegally and presence of normal bowel movements.Genitourinary: The patient denied assessment of the genitourinary system.Assessing Musculoskeletal Pain Discussion AssignmentNeurological: There is absence of numbness, paralysis, muscle weakness, loss of body balance, and urinary or bowel incontinence.Musculoskeletal: Lower back pain reported. Difficulty in movement on a wide range of motions noted. Absence of rigidity of the lower limbs. Liming on motion noted with reduced pace in walking. Patellar reflexes present with self-reported pain rated at 8/10. There is the absence of joint or muscle rigidity.Hematology: Absence of bleeding gumsLymphatic: Absence of lymphadenopathyPsychiatric: The patient is alert and oriented to place, self, others, and time. His judgment is intact. He denies any history of suicidal thoughts, plans, and attempts, delusions, illusions, and hallucinations.Assessing Musculoskeletal Pain Discussion AssignmentEndocrinology: Absence of polyuria, polydipsia and oliguriaDiagnostic results: The first diagnostic investigation that is appropriate for the patient in the case study is x-ray. X-ray of the cervical region should be performed to determine if the patient has bone misalignment, arthritis or fractures. MRI and CT scans can also be performed to determine whether there is nerve involvement and internal organs. The scans also enable the determination of issues such as disk herniation and problems with blood vessels. Electromyography may also be indicated to determine the electrical impulses that nerves produce and muscle response (Jensen et al., 2019). The test guides in the diagnosis of nerve compression due to spinal stenosis or disk herniation.Assessing Musculoskeletal Pain Discussion AssignmentA.Differential DiagnosesSciatica: The primary diagnosis for the patient in the case study is sciatica. Sciatica is a pain that develops from dick herniation or spinal stenosis that cause nerve compression. Patients experience pain at the path of the sciatic nerve that is affected to the lower limbs. The compression of the nerve results in nerve inflammation, pain, and at times numbness of the affected limb (Jensen et al., 2019). Patients with sciatic develop symptoms that include pain radiating to the affected limb, discomfort in sitting, and worsening of pain with prolonged activities such as sitting and sneezing (Maslak et al., 2020). The patient in the case study experiences the above symptoms. As a result, sciatica is the primary diagnosis that should be considered in the development of the treatment plan.Assessing Musculoskeletal Pain Discussion AssignmentSpinal claudication: Spinal claudication is the secondary diagnosis that should be considered for this patient. Spinal claudication arises from the marked narrowing of the spinal canal. The narrowing results in pressure build up on the cauda equina. The resulting symptoms that patients experience include legs and lower back discomfort when one moves or engages in exercises. Patients also experience pain, weakness, tingling, and numbness of the affected limbs. There is also the feeling of heaviness of the affected limbs (Barbaro & Midgley, 2021). The patient in the case study does not experience some of the above symptoms, hence, making spinal claudication a secondary diagnosis.Assessing Musculoskeletal Pain Discussion AssignmentPeripheral neuropathy: Peripheral neuropathy is the other secondary diagnosis that should be considered for the patient. Peripheral neuropathy arises from the systemic diseases such as metabolic syndrome, diabetes, and genetic disorders including Charcot-Marie-Tooth disease (Hicks & Selvin, 2019). Patients with infections such as leprosy, HIV and nutritional deficiencies are also predisposed to peripheral neuropathy. Patients often experience symptoms such as burning pain, tingling and numbness, and muscle weakness in the affected limb (Iqbal et al., 2018). The patient in the case study does not have any history of systemic disease, infection or nutritional deficiencies, hence, the least likely cause of the health problem.P. Assessing Musculoskeletal Pain Discussion Assignment

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