Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the doable situations from your colleagues’ differential diagnoses. Decide which of the situations you would reject and why. Determine the most probably situation, and justify your reasoning.
Publish 1
Sendy Jean Baptiste
Ankle ache
COLLAPSE
Prime of Type
Affected person Data:
GP 46 yo black feminine
S.
CC Ankle ache
HPI: A 46-year-old feminine studies ache in each of her ankles, however she is extra involved about her proper ankle. She was taking part in soccer over the weekend and heard a “pop.” She is in a position to bear weight, however it’s uncomfortable.
Location: each ankles
Onset: three days in the past
Character: stress, aching.
Related indicators and signs: ache,
Timing: whereas taking part in soccer over the weekend, she heard a pop.
Exacerbating/ relieving components: Acetaminophen makes the ache higher from 7/10 to four/10
Severity: four/10 ache scale
Present Drugs: Acetaminophen 650 mg OTC for the previous three days. Every day multivitamins OTC
Allergic reactions: NKA
PMHx: sprained proper ankle final July 2021, UTD on immunizations, covid vaccine #1 7/19/2021 Pfizer; Covid vaccine #2 9/01/2021 Pfizer Soc Hx: Single with three kids 2 boys (twins) 18 yo and a lady 16 yo. Highschool PE class coach. Denies smoking, drinks a glass of wine sometimes. Loves taking part in sports activities and loves to journey with household.
Fam Hx: Dad decease in a automotive accident 12 years in the past, mother has a historical past of HTN and hyperlipidemia, each paternal grandfather and paternal grandmother died of most cancers. The maternal grandmother has a historical past of hypertension and hyperlipidemia, the maternal grandfather has a historical past of CAD, rheumatoid arthritis. All of her kids are wholesome with no medical points.
GENERAL: Denies weight reduction, fever, chills, studies weak spot and fatigue.
HEENT: Eyes: Denies visible loss, blurred imaginative and prescient, double imaginative and prescient, or yellow sclerae. Ears, Nostril, Throat Denies listening to loss, sneezing, congestion, runny nostril, or sore throat.
SKIN: Denies rash or itching.
CARDIOVASCULAR: Denies chest ache, chest stress, or chest discomfort. No palpitations or edema.
RESPIRATORY: Denies shortness of breath, cough, or sputum.
GASTROINTESTINAL: Denies anorexia, nausea, vomiting, or diarrhea. No belly ache or blood.
GENITOURINARY: Denies burning on urination. Being pregnant. Final menstrual interval unknown.
NEUROLOGICAL: Denies headache, dizziness, syncope, paralysis, ataxia, numbness, or tingling within the extremities. No change in bowel or bladder management.
MUSCULOSKELETAL: Ankle ache (each), denies again ache.
HEMATOLOGIC: Denies anemia, bleeding, or bruising.
LYMPHATICS: Denies enlarged nodes. No historical past of splenectomy.
PSYCHIATRIC: Denies historical past of despair or anxiousness.
ENDOCRINOLOGIC: Denies studies of sweating, chilly, or warmth intolerance. No polyuria or polydipsia.
ALLERGIES: Denies historical past of bronchial asthma, hives, eczema, or rhinitis.
O.
VS: BP 106/82; P 64; R 18; T 96.9; 02 100% Wt 152lbs; Ht 76”
Common: Proper ankle swollen, unable to stroll straight, capillary refill inside three seconds, no irregular findings within the left ankle.
HEENT: No redness to eyes, Nostril clear, symmetric, pink/reddish mucosa. Throat pink, and moist.
SKIN: No indicators of rash
CARDIOVASCULAR: no murmurs or irregular coronary heart sounds auscultated.
RESPIRATORY: No respiratory misery, lungs are clear.
GASTROINTESTINAL: Bowel sounds normoactive, no guarding.
GENITOURINARY: Urine clear and yellow.
NEUROLOGICAL: Cranial nerves current, no sensitivity to mild.
MUSCULOSKELETAL: irregular gait famous due to proper ankle harm.
LYMPHATICS: no swelling lymph nodes palpated.
Diagnostic outcomes: X-rays. Medical doctors use X-rays to rule out a foot fracture or an ankle dislocation. X-rays also can detect arthritis of the foot and the ankle, which may trigger ache and swelling.
Anterior drawer take a look at: To evaluate for ankle instability.
Talar tilt take a look at (or inversion stress maneuver): To evaluate the integrity of the calcaneofibular ligament
Ottawa Ankle Guidelines: The Ottawa ankle guidelines are used to predict whether or not an x-ray is indicated for a affected person presenting with ankle ache. Location of the ache over the malleoli and the power to bear weight is necessary on this dedication Lau et al. (2018).
A .
Differential Diagnoses
Ankle Sprain:
In accordance to Dains, J. E., Baumann, L. C., & Scheibel, P. (2019), ankle sprain (Inversion or Eversion) The most typical mechanism of ankle harm is an inversion pressure that stresses the lateral ligamentous help of the joint. The lateral ligaments are of larger size than the medial ligaments and are extra predisposed to harm. An audible pop or tear implies a rupture or tear of the ligament. Swelling of the ankle inside minutes of harm signifies bleeding and smooth tissue trauma. Sufferers with a ligamentous harm will usually give you the option to stroll and bear weight on the injured foot though it could be uncomfortable. Study the injured joint by palpating the course and attachment factors of the ligaments and carry out joint ROM to take a look at for ligamentous integrity.
Sprains trigger minimal to reasonable ache, growing 1 to 2 days after the trauma when the inflammatory course of begins. A whole disruption that severs the sensory nerve fibers throughout the construction will trigger little ache, whereas a partial harm irritates sensory fibers, and should produce intense ache.
Achilles tendon rupture:
The Achilles tendon is a powerful fibrous twine that connects the again of the calf to the heel. Overstretching this tendon can lead to partial or full (rupture) tear. It’s typically an harm in leisure sports activities. Sufferers will report a leaping, falling, or stepping harm and listening to a pop adopted by a pointy ache within the ankle and issue ambulating. The affected person will be unable to stand on the toes with the affected limb. Ankle swelling could also be current.
Ankle harm:
In accordance to Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019), ankle accidents are outlined by the type of tissue — bone, ligament, or tendon — that is broken. The ankle is the place three bones meet — the tibia and fibula of your decrease leg with the talus of your foot. These bones are held collectively at the ankle joint by ligaments, that are robust elastic bands of connective tissue that hold the bones in place whereas permitting regular ankle movement. Tendons connect muscle groups to the bones to do the work of making the ankle and foot transfer and Help hold the joints secure.
Calcaneus Fracture: A fracture of the calcaneus, or heel bone, generally is a painful and disabling harm. This sort of fracture generally happens throughout a high-energy occasion.
Subtalar Dislocation: Subtalar dislocation is the disruption of the articulation of each the talocalcaneal and the talonavicular joints with an intact ankle joint mortis.
P.
This part will not be required for the assignments on this course (NURS 6512) however might be required for future programs.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s information to bodily examination: An interprofessional strategy (ninth ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Superior well being Assessment and scientific analysis in major care (sixth ed.). St. Louis, MO: Elsevier Mosby.
Lau, B. C., Moore, L. Okay., & Thuillier, D. U. (2018). Analysis and administration of lateral ankle ache following harm. JBJS Opinions, 6(eight), e7-e7. https://doi.org/10.2106/jbjs.rvw.17.00143
Sullivan, D. D. (2019). Information to scientific documentation (third ed.). Philadelphia, PA: F. A. Davis.
Backside of Type
Publish 2
Justin Wilt
Overview of case examine three
COLLAPSE
Prime of Type
Affected person Data:
AB, 15 yo., Caucasian male
S.
CC- “Boring ache in each knees, and generally a clicking within the knees.”
HPI: The affected person is a 15 yo Caucasian male presenting to the clinic with report of boring ache, which he studies to be a 5/10, in each knees. There may be additionally a click on in a single or each knees and a catching sensation underneath the patella. The affected person studies issue strolling and concentrating when the ache and the sounds happen. The signs normally categorical themselves after strolling lengthy distances or generally standing too lengthy earlier than sitting down, which normally happen within the daytime. The affected person takes both 650 mg Tylenol or 500 mg ibuprofen for the ache, relying on which is on the market. He feels that Tylenol and ibuprofen boring the ache however don’t completely alleviate the ache.
Present Drugs: Ibuprofen 500 mg and Tylenol 650 mg PRN.
Allergic reactions: NKA
Previous medical hx (PMH): No earlier medical historical past to report,
Previous surgical hx (PSH)- Affected person studies a historical past of torn rotator cuff.
Soc hx: Affected person doesn’t use tobacco merchandise, alcohol, or illicit medicine. He’s the beginning 140-pound wrestler on his highschool workforce. He lives together with his organic mother and father and has a youthful sister (12 yo). He sometimes works for native farmers doing jobs resembling bailing hay, mowing, and feeding livestock. He enjoys going to the native mall together with his pals to hang around and skate within the parking zone.
Immunizations- COVID vaccination (Moderna) 10.23/2021, present flu pictures.
Fam hx: Father: 38 yo with a historical past of Osgood-Schlatter illness; Mom: 36 yo with no earlier medical historical past; Sister: 12 yo with no earlier medical historical past; Maternal grandmother weight problems, HTN; Maternal grandfather HTN, weight problems, knee substitute age 58; Paternal grandmother died of most cancers age 63; Paternal grandfather HTN.
ROS:
Common: Affected person studies no fatigue, cough, fever, or chills. Denies issues sleeping. He has not had any current weight reduction or urge for food change.
HEENT: Affected person denies complications, dizziness, or confusion. Affected person denies issues listening to, tinnitus, or discharge. Affected person denies points with imaginative and prescient or itching, dryness, or ache within the eye. Affected person denies epistaxis, ache, or bother respiration by means of his nostril. Affected person denies soreness in throat, issue swallowing, or issues speaking. Affected person has no ache within the mouth, issues chewing, or modifications in style. Affected person denies neck ache, stiffness, or restricted ROM.
Cardiovascular: Denies palpitations, chest ache, SOB, or irregular heartbeat.
Respiratory: Affected person denies cough, issue respiration, SOB, or dyspnea upon exertion.
Gastrointestinal: Denies N/V. No modifications in bowel motion.
Musculoskeletal: Expresses regular ROM.
Psychiatric: Affected person has no historical past or current analysis of psychiatric issues. Denies despair, anxiousness, SI or HI.
Bodily examination:
Important Indicators:
Blood stress: 118/76
spO2: 100% room air
HR: 62 bpm
Resp. fee: 14
Temp.: 36.eight Celsius
HEENT- Affected person doesn’t have complications or altered sensorium. Eyes are clear, moist conjunctiva, no diplopia, doesn’t put on glasses. Ears equilateral, no listening to loss, tinnitus, or abnormalities. Mouth has no lesions, gum abnormalities, tooth decay, or bleeding. Throat is pink, no swelling, and no ache reported.
Respiratory- No crackles, rhonchi, or stridor heard throughout auscultation. Even, unlabored respiration.
Cardiovascular- No murmurs, rubs, gallups, or irregular coronary heart rhythm detected throughout auscultation.
Gastrointestinal- Regular bowel sounds heard in all quadrants throughout auscultation. Kidneys and spleen not palpable.
Pores and skin- No lesions, wounds, or lacerations discovered throughout Assessment. Heat, dry, and intact.
Musculoskeletal- No swelling, ache, or stiffness within the joints. Regular ROM.
Neurological- No neuropathy and neuro checks are regular. Alert and oriented X4. Speaks effectively.
Diagnostic tests- valgus and varus take a look at (medial and lateral ligament), posterior drawer take a look at (posterior essential ligament), Lachman take a look at (anterior essential ligament, anterior drawer take a look at (anterior essential ligament), pivot shift take a look at (anterior essential ligament), McMurray take a look at (menisci), arthrometric testing, x-ray, and CT scan.
A .
Meniscal injury- injury to the knee cartilage that present cushion between the tibia from the femur. Ache, swelling, and locking of the knee joint are hallmarks of this harm. Often resolved by relaxation, ice, ache relievers and generally surgical procedure (Kraus et al., 2012).
Medial collateral ligament injury- injury to the ligament find on the inside facet of the knee that normally feels like a pop. Swelling, ache, and a sense that the knee could “give manner” are hallmarks of this harm. Often resolved by relaxation, ice, compression, and elevation (RICE) (Hoetzel et al., 2014).
Anterior essential ligament injury- tissue that connects the femur to the tibia at the knee. Ache and swelling normally adopted by incapacity to transfer usually or make sudden twists or turns. If it’s a full tear surgical intervention is imminent, in any other case bodily remedy could also be an possibility (Kraus et al., 2012).
Osgood-Schlatter disease- impacts kids with progress spurts, particularly energetic kids taking part in sports activities. There may be normally a painful lump under the kneecap that normally resolves on its personal (Jones et al., 2000).
Sinding-Larsen-Johansson syndrome- swelling and irritation of the expansion plate at the underside of the knee characterised by swelling, tenderness across the kneecap, or ache that will increase with exercise or squatting. Often handled with ice, OTC treatment, or bodily remedy (Hoetzel et al., 2014).
P.
This part will not be required for the assignments on this course (NURS 6512) however might be required for future programs.
References
Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Head and neck: Key
factors. In Seidel’s information to bodily examination: An interprofessional strategy (ninth ed.).
St. Louis, MO: Elsevier Mosby.
Hoetzel, J., Preiss, A., Heitmann, M.A., & Frosch, Okay.H. (2014). Knee accidents in kids and
adolescents. European Journal of Trauma and Emergency Surgical procedure, 40(1), 23-36.
Jones, D., Louw, Q., & Grimmer, Okay., (2000). Leisure and sporting harm to the adolescent
knee and ankle: Prevalence and causes. Australian Journal of Physiotherapy, 46(three),
179-88.
Kraus, T., Svehlik, M., Singer, G., Schalamon, J., Zwick, E., & Linhart, W. (2012). The
epidemiology of knee accidents in kids and adolescents. Archives of orthopaedic and
trauma surgical procedure, 132(6), 773-779.
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On two separate days, reply to at least two of your colleagues who were given different case studies than you. Study the diseases that your colleagues’ differential diagnoses may point out. Resolve which of the situations you’d refuse and why. Decide the most probably situation and clarify your reasoning.
1st submit
Jean Baptiste Sendy
Ankle ache
COLLAPSE
Prime of the Recreation
Data for Sufferers:
GP is a 46-year-old black lady.
S.
CC Ankle ache
HPI: A 46-year-old lady complains of ache in each of her ankles, though her proper ankle is extra regarding. Over the weekend, she was taking part in soccer when she heard a “pop.” She will bear weight, though it’s inconvenient for her.
Each ankles are affected.
Onset: three days in the past
Character: stress, aching.
Related indicators and signs
Backside of Type
