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NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper

NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperDiscussion: Assessing Musculoskeletal PainA 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.This week, you will explore how to assess the musculoskeletal system.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperLearning ObjectivesStudents will:Evaluate abnormal musculoskeletal findingsApply concepts, theories, and principles relating to health assessment techniques and diagnoses for the musculoskeletal systemEvaluate musculoskeletal X-Ray imagingLearning 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.ORDER A PLAGIARISM-FREE PAPER HEREChapter 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)NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper. 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperChapter 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.Ball, 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper 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.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)30489-6Hicks, 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(1), 94. https://doi.org/10.1186/s12877-020-1487-2Document: 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. (2020). DeGowin’s diagnostic examination (11th ed.). New York, NY: McGraw Hill Medical.Chapter 13, “The Spine, Pelvis, and Extremities”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)NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperDiscussion: Assessing Musculoskeletal Pain Photo 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperIn 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 6512 Week 8: Assessment of the Musculoskeletal System PaperCase 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?NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperCase 2: Ankle Pain 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. 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?NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperCase 3: Knee Pain 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. Used with permission of University of Virginia.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperA 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?NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperIdentify 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.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 “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!NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperRead 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. Rubric Detail Select Grid View or List View to change the rubric’s layout.ContentName: NURS_6512_Week_8_Discussion_RubricNURS 6512 Week 8: Assessment of the Musculoskeletal System PaperGrid ViewList ViewExcellentGoodFairPoorMain PostingNURS 6512 Week 8: Assessment of the Musculoskeletal System PaperPoints Range: 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperPoints Range: 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.Points Range: 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.Points Range: 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperMain Post: TimelinessPoints Range: 10 (10%) – 10 (10%)Posts main post by Day 3.Points Range: 0 (0%) – 0 (0%)N/APoints Range: 0 (0%) – 0 (0%)N/APoints Range: 0 (0%) – 0 (0%)Does not post main post by Day 3.First ResponsePoints Range: 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. NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper 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.Points Range: 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperPoints Range: 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.Points Range: 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 ResponsePoints Range: 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperNURS 6512 Week 8: Assessment of the Musculoskeletal System PaperPoints Range: 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.Points Range: 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperPoints Range: 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperParticipationPoints Range: 5 (5%) – 5 (5%)Meets requirements for participation by posting on three different days.Points Range: 0 (0%) – 0 (0%)N/APoints Range: 0 (0%) – 0 (0%)N/APoints Range: 0 (0%) – 0 (0%)Does not meet requirements for participation by posting on three different days. Total Points: 100Name: NURS_6512_Week_8_Discussion_RubricEpisodic/Focused SOAP Note- Case Study 2- Ankle PainPatient Information: C.S2. is a 46-year-old, African American Female. NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperSubjective data:CC: Right Ankle painHPI: C.S2 is a 46-year-old African American female patient who presents today with bilateral ankle pain, but states her right ankle is the one that concerns her for today’s visit. The patient states that she was playing soccer over the weekend (3 days ago) and heard a “pop” in her ankle. The patient states she is able to bear weight, but it is very uncomfortable for her. The patient states that her ankle pain is a sore, shooting pain that she describes as a 5 on the scale of 0-10. Patient states she has not had any other signs or symptoms other than the pain and. Trouble bearing weight. The patient state she feels like the pain may be getting slightly better but is concerned and wanted to have it checked out. The patient states that she has put ice on the ankle with slight relief, and walking exacerbates the pain.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperCurrent Medications: C.S. is currently taking ibuprofen 400mg as needed for minor aches and pains. Patient states she hasn’t taken any in two days. Patient also takes Lisinopril 20mg PO daily for blood pressure that is controlled. Patient started this medication 2 years ago. Patient denies taking any other over the counter medications or supplements. Pt denies illicit drug use.Allergies: peanuts: anaphylaxisLatex: Swelling and itchingPMHx:  Patient C.S2 Has a previous diagnosis of hypertension-stage 2 diagnosed 2 years ago. Patient takes her Lisinopril 20g PO daily as prescribed and checks her blood pressures about twice a week, and follows up with her provider for checkups every 6 months. Patient states she has had an allergy to peanuts since she was a little girl and hasn’t eaten them since that episode. Patient denies any other health issues. Patient denies any surgical history.Immunization History: NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperTdap 10/2019Influenza vaccine this seasonCOVID vaccination 12/2021, 01/2022Soc Hx:Sexually active with male partner, Husband of 12 years. Condom contraceptives.Pt denies tobacco use past or present. Pt denies vaping.Pt admits drinking 2-3 alcoholic beverages per week, normally on the weekend, Wine.Pt denies use of marijuana, cocaine, heroin, or other illicit drugs.Pt states she was playing soccer and running for exercise about twice a week for the past 5 years.Pt states she tries to limit her sodium intake, but does eat steaks and burgers every once in a while. Pt states she has a “cheat day” about once a week.Pt does consume caffeine via one or two cups of coffee a day.Pt consumes at least four glasses of water a day, sometimes more.Pt works a full-time job, 40 hrs. per week, as a dental hygienist but states her job isn’t stressful.Pt lives with her husband. No children.Pt states she has adequate access to healthcare, has insurance, and is able to afford tests and medications that may be ordered for her.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperFam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.Father: hypertension, hyperlipidemia, obesity, living age 75.Mother: Type 2 diabetes, hypertension, living, age 72.Sister: hypertension, living, age 48Maternal grandmother: died of breast cancer at age 65Maternal grandfather: died of heart attack at age 54Paternal grandmother: died of pneumonia age 78Paternal grandfather: died of prostate cancer at 85ROS:GENERAL: Patient states she has a headache every now and then, nothing of concern for her. Patient states she has the weakness and pain in both ankles, but more in the right ankle.  No weight loss, no fever, denies chills, denies fatigue.HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.SKIN:  Pt denies any concerns with her skin. NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperCARDIOVASCULAR:  Denies chest pain, chest pressure or chest discomfort. No palpitations or edema. Patient states she has not had any abnormal bleeding. Patient states she exercises and has a normal heart rate on her watch when doing so.RESPIRATORY:  No shortness of breath, cough or sputum.GASTROINTESTINAL:  Patient has normal bowel movements with no assistance from medications.  No nausea, vomiting or diarrhea. No abdominal pain or blood.GENITOURINARY: Patient denies burning during urination. Patient has had 2 miscarriages with no term pregnancy. Last menstrual period,04/02/22, lasted 5 days.NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.MUSCULOSKELETAL:  No back pain, or stiffness. Patient states ankles are sore with the right ankle being more painful to bear weight. Patient states there is weakness and ROM is decreased on the right ankle. Patient states was swollen on day of injury, but denies any swelling after.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperPSYCHIATRIC:  No history of depression or anxiety. Patient denies any thoughts of hurting herself or others.Objective data.Physical exam:Vital signs:Weight 135lbsHeight 5’6’’BP: 132/88 left arm, 130/86 right arm sitting on side of the bed.HR 65, 02 99%, R 18, temp 98.8 oral General: Patient appears comfortable sitting on the examination table. Patients manner is appropriate and patient is A&O x3. Patient is able to perform all ROM activites, but grimacing is noted when moving the Right foot.Respiratory: Lung sounds are normal and auscultated in all lobes. No shortness of breath noted. Respiration rate of 18 noted.Musculoskeletal: tenderness and guarding noted during assessing the right ankle. Patient began to grimace as she performed the ROM exercises of the right ankle.  Right Lower leg slightly edematous with +1 edema  and right side has limited ROM.Skin: No rash, discoloration or open wounds noted.Diagnostic results:Xray performed with no significant findings.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperA.Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.Sprained ankle. Ankle Sprains are injuries that often happen to people who are athletic. Sprains occur among patients of any age and activity levels, but most often to patients who participate in athletics (OrthoInfo, 2021). Ankle sprains happen when strong ligaments that are meant to support the ankle stretch beyond their limits and begin to tear (OrthoInfo, 2021). There is often a “popping’ sound associated with a sprained ankle. There is a varying severity of ankle sprains which is determined by the number of ligaments that are torn. Sprained ankles can heal on their own with ice, elevation, and over -the-counter medication, but can remain sore and swollen for weeks. If the ankle remains swollen and painful for several weeks with the inability to bear weight, the patient may have a severe ankle sprain or even a fracture. Symptoms of an ankle sprain consist of pain, swelling, bruising, tenderness to touch, and sometimes instability of the ankle (OrthoInfo, 2021).NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperTendinopathy. Tendinopathy is a painful condition that occurs in and around the tendons as they are overused (Andres & Murrell, 2008). Tendonitis has often been used for pain in and around tendons, but this implies that the pain is associated to inflammation and that may not always be the case. Studies suggest that tendinopathy is an overuse of the tendons leading to inadequate tendon repair that predisposes the tendon to microtears and degeneration (BMJ, 2022). Treatments for tendinopathy include activity modifications, rest, ice, stretching and strengthening which is best lead by a physical therapist so the patient isn’t causing more damage (BMJ, 2022). If the patient doesn’t notice a difference or pain relief with these measures, then surgical intervention may be needed. For athletes experiencing tendinopathy, they normally experience this pain in the Achilles or patellar tendons (BMJ, 2022). Tendionopathy can be further investigated with ultasound or MRI if the X-ray is inconclusive.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperAchilles tendinitis. The Achilles tendon is the largest tendon in the body and it runs down the back of the lower leg and attaches to the heal. Achilles Tendinitis occurs when the large tendon becomes irritated, inflamed, and painful (OrthoInfo, 2021). The Achilles tendon connects the calf muscles to the heel and is used during walking, running, jumping, and helping you to stand on your toes (OrthoInfo, 2021). This large tendon is used to the stresses of running and jumping, but is also prone to tendinitis when overused. Tendinopathy is when the tendon has developed some microscopic degeneration because of damage over time, however, tendinitis and tendinosis is from inflammation. Achilles tendinitis is normally the result of repetitive stress to the tendon when people push their bodies to do to much too quickily (OrthoInfo, 2021)NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper.Patients should be sure to stretch before exercise or exertion because tight calf muscles is one of the many causes of Achilles tendinitis. Patients may experience pain and stiffness in the morning, pain that worsens with activity, severe pain the day after exercising, thickening of the tendon, bone spur formation, swelling that is spresent all the time, swelling that worsens with activity, pain on the back of the heel  (OrthoInfo, 2021). X-ray, MRI, and ultrasound are good tests to order for this patient. Treatment for achilles tendonitis includes rest, ice, NSAIDs, physical therapy, night splinting, and cortisone injections. There are surgical treatments if the pain doesn’t resolve.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperThis section is not required for the assignments in this course (NURS 6512) but will be required for future courses.ReferencesAndres, B. M., & Murrell, G. A. (2008, July 30). Treatment of Tendinopathy: What Works, What Does Not and What is on the Horizon. Retrieved from NCBI: National Center for Biotechnology Information: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505250/Ball, J. D. (2019). Seidel’s guide to physical examination: An interprofessional approach (Vol. 9th edition). St. Louis, MO: Elsevier Mosby.BMJ. (2022, March 22). Tendinopathy. Retrieved from BMJ Best Practice: https://bestpractice.bmj.com/topics/en-us/582OrthoInfo. (2021). Achilles Tendinitis. Retrieved from OrthoInfo: https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis/OrthoInfo. (2021). Sprained Ankle. Retrieved from OrthoInfo: American Academy of Orthopaedic Surgeons: https://orthoinfo.aaos.org/en/diseases–conditions/sprained-ankle/NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperRE: Review of Case Study 2Soccer is a hard sport to play and of course with twisting and quickly starting and stopping some injuries may occur.  The ligaments are what holds our ankle bones together and when stretched beyond what they are able this can cause the sprains, strains and tears to this fibourous tissue (Holm, 2017). In soccer, it is very common to injure the ankle multiple times, there is research on techniques using myofascial to help strengthen the ankle, make it more flxible and stable after injury in hopes of preventing more sprains during the sport Allois, et al., 2021). I found that interesting using myfascial technique on an ankle. NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperAllois, R., Niglia, A., Pernice, A., & Cuesta-Barriuso, R. (2021). Fascial therapy, strength exercises and taping in soccer players with recurrent ankle sprains: A randomized controlled trial. Journal of Bodywork & Movement Therapies, 27, 256–264. https://doi.org/10.1016/j.jbmt.2021.03.022Holm, R. P. (2017). The Story of a Badly Sprained Ankle. South Dakota Medicine: The Journal of the South Dakota State Medical Association, 70(5), 235. RE: Review of Case Study 2I support your differential diagnosis of a sprained ankle. An ankle sprain happens when the foot twists, rolls, or turns over its normal range of motion, which leads to a ligament being forced to stretch out of its capacity. With a sprain, popping sounds might be heard with pain and swelling. Your patient stated that her right ankle was swollen on the day of injury, but the swelling subsided afterward. This description fits with grade 1 sprain ankle with minimal impairment caused by microscopic tearing of collagen fibers (Uconn.edu, n.d.). The provider can test the Anterior Drawer sign to check ATFL rupture, forced inversion test to check the CFL rupture, assess the Osteochondral direct of Talar Dome, assess 5th Metatarsal base Fracture, assess Tibio-Fibular syndesmosis damage, external rotation test, and squeeze test (Stanford.edu, n.d.).NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperI object differential diagnosis of Achilles tendinopathy. Achilles tendinopathy is caused by a sudden increase in exercise amount and intensity, tight calf muscles, and Haglund’s deformity. Symptoms include pain and stiffness along the Achilles tendon in the morning, pain on the tendon or back of the heel worsening with activity, Severe pain the day after training, etc. (AAOS, n.d.). However, the patient in this case study had an onset of pain while playing soccer, and the popping sound was from the heart, which means that the patient’s condition is originated from trauma on her right foot. We do not have pain location, and the provider needs to investigate the exact pain location and pain character. A thorough physical exam to determine which part of the ligament or bone is affected will also be essential for objective assessment together with labs and imaging tests to make more accurate differential diagnoses. Playing soccer might provoke hidden Achilles Tendinitis, but I do not find any signs and symptoms of the patient that align with Achilles Tendinopathy. I do not see pain location in the case study, therefore, I would go for further exam such as Achilles Tendon Palpation (Stanford.edu, n.d.), X ray, MRI, and ultrasound.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperThe providerThank you for sharing your post. ReferencesUCONN.edu. (n.d.). Foot & Ankle. From https://health.uconn.edu/orthopedics-sports-medicine/conditions-and-treatments/where-does-it-hurt/foot-and-ankle/sprained-ankle/ Standford.edu. (n.d.). Approach to the exam of the ankle and foot. Retrieved on April 23rd, 2022. From https://stanfordmedicine25.stanford.edu/the25/Ankleandfootexam.html AAOS. (n.d.). Achilles Tendinitis. Retrieved on April 23rd, 2022, from https://orthoinfo.aaos.org/en/diseases–conditions/achilles-tendinitis/ RE: Review of Case Study 2I completely agree with the differential diagnosis of an acute sprained ankle. This patient was playing soccer and heard a “pop” sound this leads to the prognosis of some acute trauma. Depending on the meninism of injury anterior the acute sprain could either occur at the talofibular ligament (ATFL) or the calcaneofibular ligament (CFL) and This diagnosis can be confirmed by an Xray (Melanson & Shuman,2021).Achilles tendinitis is the least likely diagnosis as it is an inflammation of the Achilles tendon and would not “pop” if it became inflamed (Medina Pabón,2021). This diagnosis is relevant as it is caused mostly in sports (nearly 80%) (Medina Pabón,2021) to diagnose the severity of Achilles tendinitis an Xray and ultrasound can be used to confirm the diagnosis (Medina Pabón,2021)NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperReferencesMedina Pabón MA, Naqvi U. Achilles Tendonitis. [Updated 2021 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538149/Melanson SW, Shuman VL. Acute Ankle Sprain. [Updated 2021 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459212/ RE: Review of Case Study 2, Reply #2Review of Case Study 2-Reply #2 to Brittany GarrisonThank you for your post. You provided three differential diagnosis and a I agree that a sprained ankle would be the primary diagnosis for the patient in this case study. This patient presented with bilateral ankle pain, however more concerned about her right ankle that she hurt playing soccer. She can bear weight but is uncomfortable and upon injury, heard a “popping” sound. In the assessment you provided patient was experiencing tenderness and guarding to right ankle, 1+edema, and grimacing when performing ROM. Ice assists with pain, while walking aggravates the ankle.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperThese signs and symptoms are congruent with a right ankle sprain.  More diagnostic tests would need to be performed. An Xray was performed, ruling out a fracture. Ligaments are not able to be seen on an Xray, therefore will not be able to show a sprained ankle.With a rupture or tear of an ankle ligament, a “pop” may be heard, usually implying an ankle sprain. Soft tissue trauma is indicated if swelling of ankle occurs and patient will have discomfort but normally be able to bear weight on injured area (Dain’s, Baumann, & Scheibel, 2019).I would disagree with the diagnosis of Achilles tendinitis because the patient doesn’t report tightness or tenderness with palpation over Achilles. ROM was decreased, however with this diagnosis ROM with dorsiflexion would be decreased the most with crepitus over Achilles and calf muscle weakness (Dain’s, Baumann, & Scheibel, 2019). Also, with tendonitis a “popping” sound is normally not heard. However, if the Achilles tendon ruptures this can occur.Tendinopathy I would also disagree with due to this being defined as more of a chronic issue unless a tear or rupture of the tendon occurs. I do agree many athletes are prone tendinopathy, however the patient in the case study has an acute injury.  An ultrasound scan or MRI can be used to determine tendinopathy. Morning stiffness and stiffness after inactivity is a common symptom, absent in the case study. Proximal tenderness insertion, greatest at 2-6 cm. is normally present. This test is called the Royal London Hospital Test and would be a good tool to use to make a differentiation. (Maffuli, Longo, Kadakia, & Spiezia, 2020).NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperReferencesDains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.Maffulli, N., Longo, U. G., Kadakia, A., & Spiezia, F. (2020). Achilles tendinopathy. Foot and Ankle surgery, 26(3), 240-249. RE: Review of Case Study 2NURS-6512 Wk 8 Discussion Response #224 April 2022Thank you for your insightful post on case study #2.  Given the information provided, peroneal tendon injury would have been an appropriate differential diagnosis to include.  This usually occurs when the tendon tears upon rapid dorsiflexion of an inverted foot.  This specific ankle trauma is commonly seen in young, athletic populations of people.  Patients often relay a “pop” is heard or felt (Walt & Massey, 2020).NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperA diagnosis can be concluded by inspecting the area during a physical examination.  Tenderness and swelling are noted posterior to the lateral malleolus.  Confirmation is final after x-ray imaging, computed tomography (CT), and magnetic resonance imaging (MRI).  Treatment is usually non-operative with a specialized boot that is worn in lieu of full weight bearing  (Steffes, 2021).ReferencesSteffes, M. (2021, December 20). Peroneal tendon tears and instability. www.orthobullets.com. https://www.orthobullets.com/foot-and-ankle/7023/peroneal-tendon-tears-and-instabilityWalt, J., & Massey, P. (2020, June 26). Peroneal tendon syndromes. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK544354/  RE: Review of Case Study 2Based on your interview and assessment I agree with your primary differential diagnosis of a sprained ankle. After researching about ankle sprains, I found that there are grades of ankle sprain severity. I would put this patients’ sprained ankle at a grade 2 as evidenced by the pain with weight bearing and walking, loss of range of motion, and erythema. A grade 2 indicates a partial tear in the ligament and recovery time is 3 to 6 weeks. The most common type of ankle sprain is an inversion injury, or lateral ankle sprain in which the foot rolls inward, damaging the ligaments of the outer ankle (Harvard Health Publishing, 2021)NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper. When assessing this patient, I would reference the Ottawa Ankle Rules. In cases of acute ankle injury, the Ottawa Ankle Rules help identify the characteristics of patients needing an ankle radiograph series (Ball et al., 2019). This rule is highly effective for detecting an ankle fracture.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.Harvard Health Publishing. (2021, June 21). Recovering from an ankle sprain.health.harvard.edu. Retrieved April 24, 2022, from https://www.health.harvard.edu/pain/recovering-from-an-ankle-sprainReview of Case Study 3 Patient Information:15-year-old male, African AmericanS.CC (chief complaint)NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper “pain on my knees.”HPI:Fifteen years old, a male African American patient was brought to the clinic for pain in his knees. The pain is dull on both knees. Sometimes one or both knees click, and there is a catching sensation under the patella. The pain started about two weeks ago; the pain is rated as six on a 0-10 pain scale. The pain worsens when he runs or jumps and gets better with rest and an ice pad. Associated signs and symptoms include swelling of the knees. Clicking sound present on knees.Current Medications:Tylenol 500 mg, PO, Q4 hours PRN, for headacheAllergies: No allergy to food,No allergy to medication,No allergy to animals.No allergy to environmental factors such as pollens.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperPMH:He was fully vaccinated, including flu shot and covid vaccines with 1st and second shots. The patient had a frequent upper respiratory infection in his childhood but got better five years ago—no past surgical history.Soc Hx:The patient is in the 10th grade, attending Walden High School. He likes playing basketball with his friends every evening after school, usually 1-2 hours a day.  He lives with his father, mother, and little sister in a single-family house in a safe neighborhood. His house has smoke detectors, and he uses seat belts. The patient has health insurance through his father’s work and goes to his pediatrician annually.  The patient never smoked and never used illicit drugs. The patient tried alcohol a year ago due to peer pressure but stopped after the first try. The family has a sound support system and strong bonding. The patient goes to church every Sunday and likes to go on mission trips during school breaks.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperFam Hx:Father: Age 47, has HTNMother: Age 45, Hx of AsthmaSister: Age 12, has AsthmaMaternal grandfather: passed away by old age, diet at 83 years of age, had asthma, HTN.Maternal grandmother: died from a car accident at the age of 49. Had DM2.Paternal grandfather: age 75, had HTN, stroke three years agoPaternal grandmother: age 74, has Asthma, Osteoporosis, and Osteoarthritis.Aunt: HTN, hypothyroidismUncle: No medical historyROS:GENERAL:  No recent weight loss or weight gain. She denied fever, chills, weakness, or fatigue. Appears healthy, strong, and well-kempt.CARDIOVASCULAR:  Denied any chest pain, tightness, or chest discomfort. No palpitations or edema.RESPIRATORY:  No shortness of breath, difficulty breathing, cough, or sputum.NEUROLOGICAL:  No headache, no weakness, dizziness, syncope, paralysis, ataxia, numbness, or tingling in the extremities. No change in bowel or bladder control.MUSCULOSKELETAL:  Positive knee pain on both knees, rated as five on a 0-10 pain scale; the pain gets worse with running and jumping when he plays basketball, knees get swollen. The pain gets better with an ice pad and rest. This B/L knee pain started two weeks ago and did not get better. Clicking sound on both knees,NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperO.Physical exam:Vital signs: BP 120/80, HR 58, RR 16, Temp 97.8F, spO2 99% with Room Air. HT 6”, WT 170LBs, BMI 23.1General: The patient appears healthy, strong, and fit. Walks carefully due to recent B/L knee pain, dressed clean and well-kempt, body posture straight, gait a bit weak and unstable. Body odor and breath odor without any strong odor. The patient is calm and cooperative, follows simple directions, and answers questions appropriately without difficulty. Positive facial grimace intermittently due to knee pain but tries to keep his facial expression regular. Overall, he is in good health except for the new onset of knee pain.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperRespiratory: breathing nonlabored, no dyspnea, lungs clear in all lung fields, no adventitious sounds in lung fieldsCardiovascular: audible with S1& S2, rhythm regular, no murmurs, positive pulses on carotid, jugular vein. No JVD.Musculoskeletal: Pain in the front of both knees. Kneecaps tender to the touch, positive +1 edema on B/L knees. The positive clicking sound of the kneecap. Positive ROM on all extremities without limitation except limited ROM on knees due to pain. No muscle weakness in other parts of the body.Neurological: Positive Deep tendon reflexes, cranial nerves intact, motor and sensory function, found normal, pupillary response positiveSkin: warm, pink, dry, no redness. Positive +1 edema on both front of the knees.Diagnostic resultsBlood test: unremarkableX rays: soft tissue swelling and inflammation noted in Patellofemoral PainMRI: Soft tissue tearing inside the knee joint found.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperA.Differential DiagnosesRunner’s knee (Patellofemoral Pain Syndrome) 2. Jumper’s knee (Patellar Tendonitis) 3. Osgood Schlatter Disease 4. Bursitis 5. OsteoarthritisRunner’s knee, Patellofemoral pain syndrome is the presumptive primary diagnosis for this patient considering his signs and symptoms of knee pain when running and jumping. The condition is caused by kneecap too high in the knee joint, weak thigh muscle, tight hamstrings, tight Achilles tendons, poor foot support, walking or running with the feet rolling i. In contrast, the thigh muscles pull the kneecap outward, excessive training or overuse, or injury. The patient’s condition might be because of excessive training or overuse of knee joints (Hopkinsmedicine.org, n.d.) because he likes playing basketball every day, which involves strenuous running and jumping. Clicking the knee sound might have resulted from excessive use of the knee joint when exercising.NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper Jumper’s knee, Patella Tendonitis, is caused by inflammation of the patellar tendon, which is caused by overuse of knee joints such as jumping on hard surfaces. The condition is usually sports-related by leg muscle contracting and hitting the ground. The condition has pain, tenderness around the patellar tendon, swelling, pain with jumping, running, or walking, and tenderness behind the lower part of kneecaps (Johns Hopkins Medicine.org. n.d.). Osgood Schlatter Disease, same as osteochondrosis, is a possible differential diagnosis for the patient for the pain of anterior knee pain in the immature athletic population. The condition brings pain and tenderness to the patellar tendon insertion site at the tibial tuberosity without a traumatic event to the knees—activities like jumping and sprinting cause the condition. The condition is common in people who play sports such as basketball, volleyball, sprinters, gymnastics, and football, resulting in microvascular tears, fractures, and inflammation (Smith& Varacallo, 2022).NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper Prepatellar Bursitis is the possible diagnosis for its knee pain, swelling on the front of the kneecap, tenderness, and warmth to the touch, which aligns with the patient’s symptoms. Prepatellar bursitis is usually due to constant kneeling and pressure on the knees; sports-related direct blows or falls on the knee with football, wrestling, or basketball can cause this condition. Rheumatoid arthritis, gout, or bacterial infection can cause the condition too. X-rays, CT, MRI, or aspiration are used (American Academy of Orthopedic Surgeons, 2022).  Osteoarthritis has signs and symptoms of pain, aching, stiffness, decreased range of motion, flexibility, and swelling. The condition has risk factors such as joint injury or overuse, older age, women over the age of 50 have a higher rate of developing the condition, obesity, family history of OA, and race (CDC, 2020).NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperReferencesAmerican Academy of Orthopaedic Surgeons. (2022). Prepatellar (Kneecap) Bursitis. From   https://orthoinfo.aaos.org/en/diseases–conditions/prepatellar-kneecap-bursitisCDC.gov. (2020). What is osteoarthritis? From             https://www.cdc.gov/arthritis/basics/osteoarthritis.htmJohn’s Hopkins Medicine.org. (n.d.). Patellofemoral pain syndrome (Runner’s knee). Retrieved        on April 20th, 2022, From https://www.hopkinsmedicine.org/health/conditions-and-    diseases/patellofemoral-pain-syndrome-runners-         knee#:~:text=Runner’s%20knee%20is%20dull%20pain,until%20the%20pain%20goes%2      0away.John’s Hopkins Medicine. Org. (n.d.). Patellar Tendonitis (Jumper’s knee). Retrieved on April           20th 2022, From https://www.hopkinsmedicine.org/health/conditions-and-                 diseases/patellar-tendonitis-jumpers- knee#:~:text=Jumper’s%20knee%2C%20also%20known%20as,to%20tears%20in%20yo       ur%20tendon.Smith JM, Varacallo. (2022). Osgood Schlatter Disease. In: Stat Pearls, Treasure Island, https://www.ncbi.nlm.nih.gov/books/NBK441995/RE: Case StudyThank you for asking me for specific maneuvers I can use for a patient with a complaint of knee pain. First, the provider inspects and then palpates to find any visual abnormality such as redness, shape, skin change, warmth, tenderness, edema, or any abnormal sensation.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperAuscultation is used to detect any popping, grinding, or clicking sound with Active ROM and Passive ROM. The knee ligaments can be tested with the Valgus and varus test to check medical and lateral collateral ligaments. The patient lies down, and the provider puts one hand on the patient’s knee joint and the other hand on the patient’s ankle and moves the leg side to side. The posterior drawer test is used to check the posterior cruciate ligament. The patient lies down with the knee bent at a 90-degree angle with the foot flat on the table. And the provider will put hands around the top of the leg below the knee and push straight back on the patient’s leg. The Lachman, anterior drawer, and pivot shift tests check the anterior cruciate ligament (ACL). A McMurray test checks for any problem with menisci. In this test, the provider pushes the patient’s legs up while holding the knee and the bottom of the foot while turning the leg and pressing on the knee to see any presence of pain, sound, clicking feeling to find out any menisci damage. Arthrometric testing can be used to measure looseness of the knee in case the patient’s pain is too severe, or the patient’s size makes a physical exam unable. The sensor pads are put on the patient’s knee cap and the small bump on the tibial tubercle in this test. The provider will measure pressure while pulling or pushing on the pressure handle. Arthrometric testing is suitable for this 15 year old patient due to his pain of his knees.NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper If the knee is red, hot, or swollen, arthrocentesis can relieve pain and pressure, check infection or any presence of blood in the joint fluid, which suggests a tear in a ligament or cartilage, and check the presence of fats which might indicate the presence of broken bone. Local anesthetic, general, or spinal anesthesia can be considered to reduce pain for arthrocentesis (Kaiserpermante.org, 2017). This patient did not show any signs of redness and warmth, I would hold on with arthrocentesis for now.NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper  References Kariswerpermante.org. (2017). Physical examination of the knee, Exam overview. From https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=hw28334Assignment: 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.NURS 6512 Week 8: Assessment of the Musculoskeletal System PaperIn 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 a 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 AssignmentComplete the following in Shadow Health:Musculoskeletal (Practice)NURS 6512 Week 8: Assessment of the Musculoskeletal System Paper

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