Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
Main Post
Purpose:
This purpose of this assignment is to review case study #3 knee pain, and use the information to evaluate, form possible diagnoses, and practice documenting in soap format. Documenting in SOAP note format allows a practitioner to assess and document that the patient was treated with a holistic approach (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
Case 3: Knee PainA 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?
Patient Information:ANW 15 1/19/04 M Caucasian
(CC): “My knees hurt, sometimes I hear a clicking sound, and they get stuck.”
History of Present Illness (HPI): Alexander (Alex) is a 15 year old Caucasian male who has come to the clinic complaining of pain in his knees. He states “sometimes it is just one knee that clicks and sometime it is both,” Alex states that his “knees get stuck or catch under the knee cap”. He rates the pain as 3/10 most days but after games the pain can be 6/10. He describes the pain as “dull and achy,” like I have done too much stuff. He states the pain started “a few weeks ago” and it was once in a while but now they hurt almost every day. He said his coach wants him to get his knees checked out before the next game.
Medications: Motrin 200mg po Nightly.
Allergies: KNA
Past Medical History (PMH): None
Past Surgical History (PSH): None Sexual/Reproductive History: Heterosexual. Identifies as male. Denies sexually active.
Personal/Social: Alexander is a sophomore He plays on the basketball, baseball, soccer, football, track and wrestling team. He also loves to swim but states they do not have a team at the school. Alex states although he loves sports he wants to become a “sports doctor” and be a sports coach in his part time. Alex is proud of his 4.2 GPA and plans to graduate 1 year early and start college. He lives with his mother, adoptive father, maternal grandmother, and older sister. Alex says he has a half-brother that is 5 that leaves in Tennessee with his biological father. He states his biological father had a baby boy that died at birth a few years ago. He reports seeing his biological father a few times in the last few years. He states he has a girlfriend is named Heather, is also a sophomore and that she is a cheerleader and also plays soccer. He reports that he and Heather are not sexual active but if they become active they will use condoms. Alex is excited to get his license soon. He reports he wears his sit belt in the car and wears all protective sport gear. Denies tobacco use, drinking, illicit drug use. Reports he tried Marijuana x1 and a beer in 2018 at a party.
Immunization History: All immunization up to date per mother. Received flu vaccine 10/2018. Verified through Florida Immunization Registry.
Family History: Mother: Hx Breast Cancer. Seasonal Allergies. Anxiety. Maternal Grandmother: Asthma Paternal Grandfather: Died in 2009 liver Cirrhosis from etoh abuse.Father: MI age 30 from cocaine abuse. Bipolar disorder. Maternal Grandmother: None Paternal Grandfather: Substance AbuseSister: 19 Asperger’s, Anxiety, Depression. Half-Brother- 5 Cerebral Palsy Half Brother-Deceased Still Born
ROS:General: Denies fatigue, weakness, fever, chills, sweat, loss of appetite, and weight loss. HEENT: Denies any wounds, lumps, or pain. Denies vision issues. Denies hearing issues. Reports a nose bleed once last year after being hit during a soccer game. Reports no issues eating, swallowing, or pain in throat. Reports he saw the dentist last week.Neurological: Denies headaches, pain, and dizziness or head injuries. Denies changes in memory. Denies numbness and tingling.Skin: Denies any wounds, rashes or moles. Reports, “I have a birth mark on my right butt check”.Cardiovascular: Denies chest pain, palpitations, and racing. No hx noted.Peripheral Vascular: No hx noted.Respiratory: Denies SOB, cough, and pain.Gastrointestinal: Denies abdominal pain, nausea, vomiting, constipation or diarrhea. Reports not troubles eating. Reports he eats “lots of pasta for energy”.Genitourinary: Denies issues including nocturia, dribbling, incontinence, discharge, or pain upon urination. Musculoskeletal: Reports knee pain bilaterally dull and achy 3/10 presently. Denies issues, running, jumping, kicking, or bending. Reports clicking sounds at times when knee is flexed and extended. Hematologic: Denies bleeding or bruising. Reports nose bled last year after being hit in a soccer game. No other hx notedLymphatics: Denies swelling and tenderness. No Hx noted.Endocrine: Denies heat or cold intolerance, excessive thirst or urination, or tremors. No hx noted.Psychiatric: Denies depression, thought of self- harm. Reports anxiety when taking Chemistry tests.Allergies: Denies.Physical Exam: BP 120/70 adult cuff/right arm/sitting, P 72 regular, RR 18 unlabored. O2 98%, T 98.6 temporal. Weight 185. Height 5 feet 11 inches. BMI 25General: Aox4, looks stated age, pleasant, well groomed, and cooperative. Makes eye contact when speaking and answering questions. No s/s of distress.HEENT: Head symmetrical No visual deformities noted. PER/EOMI. Responds to questions with no requests to repeat. Breaths through nares no s/s of congestion, or allergies. Teeth are intact, bright white, straight, and no odor from mouth present.Neurological: AOX4, No s/s of neurological deficits. Adequate recall.Neck: No visual lesions, no enlargement, no JVD. Skin/Lymph: Intact. No wounds, lesions, scars or moles noted. Tan in complex. No signs of edema or cyanosis. No nodes observed upon palpation. Chest/Pulmonary: Chest is symmetrical. CTA AP&L. Respiration even and unlabored noted at 19. No noted SOB, RR noted at 18, SPO2 98%. No use of accessory muscles noted. Heart/Vascular: S1 and S2 noted. RRR. No murmurs, rubs, or gallops noted. Less than 3 capillary refill. All Pulses 3+. HR slightly elevated along with BP indicative of pain.Abdomen: Deferred No issues noted. Genital/Rectal: Deferred no issues noted.Musculoskeletal: Ambulates on own, full weight bearing. Mild swelling, tenderness, warmth noted in bilateral knees. Pain with palpation over the tibial tuberosity. Flinches upon flexion and extension of both knee.Diagnostic Results/Manipulation Test: Negative Lachman test. Negative Homan’s sign. Negative McMurray test. Differential Diagnoses 1. Patellofemoral Pain Syndrome 2. Meniscus tear 3. Osgood Schlatter Disease 4. Osteogenic Sarcoma 5.Stress fracture
DIAGNOSIS/CLIENT PROBLEM
The most probable diagnosis for Alex is Petellofamoral pain syndrome. This syndrome is pain that is caused by overuse of the knee caps (American Academy of Orthopedic Surgeons, 2015). It is prevalent in those who play sports, especially those that involve jumping and running (Mayo Clinic, 2018). This syndrome causes pain around the knee cap, stiffness, and may also cause the popping and clicking sound that Alex describes and that is present upon evaluation (American Academy of Orthopedic Surgeons, 2015). This condition is sometimes called runner or jumper’s knee (American Academy of Orthopedic Surgeons, 2015). Alex plays multiple sports that have high impact on the knees. It is common in women and in adolescents (American Academy of Orthopedic Surgeons, 2015). Alex has the signs and symptoms of this condition, including pain upon examination. This condition would explain the pain that Alex’s is reporting in both versus an injury that would be more likely to shoe in just one knee. Another possible diagnosis for Alex is bilateral torn meniscuses. A meniscus tear is when there a tear takes place to the cartilage that is located behind the knee cap (American Academy of Orthopedic Surgeons, 2014). It is one of the most common knee injuries, especially in those that play sports (American Academy of Orthopedic Surgeons, 2014). The signs and symptoms of this condition are swelling, stiffness, clicking or popping sound, not being able to extend the knee fully, and a feeling that your knee is going to “give out” (American Academy of Orthopedic Surgeons, 2014). Alex is very active in many different sports and shows all signs and symptoms of this condition except for negative McMurray sign. McMurray test is a manipulative test is that performed to detect a tear in the meniscus (Ball et al, 2019). A palpable or audible click with this maneuver means that there is tear present in either the lateral or medial meniscus (Ball et al, 2019). It is very unlikely that Alex would have a torn meniscus in both knees at the same time Osgood Schlatter Diease is yet another possible diagnosis for Alex. This condition is a swelling and irritation of the growth plate in the legs near the shine bone (Kids Health Nemours, 2019).This condition usually takes place in children who are still growing and that have active lifestyles (Kids Health Nemours, 2019). This condition is common in those who play sports that involving running and jumping (American Academy of Orthopedic Surgeons, 2015). Alex is the correct age for the condition and is very active in the sports that cause this condition. This condition would explain the pain Alex is experiencing but not necessarily the clicking or popping sound. Although Osteogenic Sarcoma is a less likely diagnosis for Alex it may still be a possible diagnosis. Osteogenic Sarcoma is a type of cancer that forms at the ends of bones as they grow (Johns Hopkins Medicine, n.d). It affects those younger in age still growing (Johns Hopkins Medicine, n.d). Alex does fit the age range, with the most common age being 15 (Johns Hopkins Medicine, n.d). This condition would explain the pain being reported, however this condition is a very rare (Johns Hopkins Medicine, n.d). An Xray , MRI and CT will be able to establish if a tumor is present (Johns Hopkins Medicine, n.d). It would be very unlikely that this condition will present in both knees at the same time. Additionally this condition would not explain the clicking and pooping sounds present in the knees. A stress fracture or tiny break in a one is another possible diagnosis for Alex due to his increased sports activity (American Academy of Orthopedic Surgeons 2007). Stress fractures are a very common injury in those that play sports (Dains, Baumann, & Scheibel, 2019). Although the stress fracture would cause the pain is experiencing it would not explain the clicking in the knees. Additionally it is unlikely unless Alex has a previous condition such as osteoporosis that both knees would experience a fracture at the same time. An Xray of the knees will be able to establish if a fracture exists. Treatment Plan: Diagnostics Bilateral patella XRAY Bilateral MRI of patella CT Scan
MedicationTreatment RICE treatment. Mobic 7.5mg po daily. Knee stretching exercise.
Education Patient and parent on diagnosis. RICE therapy. Medications usage and side effects. Educate on stretching. Provide stretching pamphlet. Referral and follow-up.
Referral/Consultation Pediatric orthopedist Physical therapyFollow Up Planning 1 month
References
American Academy of Orthopedic Surgeons.(2014). Meniscus Tears. https://orthoinfo.aaos.org/en/diseases–conditions/meniscus-tears/American Academy of Orthopedic Surgeons. (2015). Osgood-Schlatter Disease (Knee Pain). https://orthoinfo.aaos.org/en/diseases–conditions/osgood-schlatter-disease-knee-pain/American Academy of Orthopedic Surgeons. (2015). Patellofemoral Pain Syndrome. https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/American Academy of Orthopedic Surgeons. (2007). Stress Fractures. https://orthoinfo.aaos.org/en/diseases–conditions/stress-fractures/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.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.Johns Hopkins Medicine. (n.d). Osteogenic Sarcoma. https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/pediatric_oncology/becoming_our_patient/cancer_types/osteogenic_sarcoma.htmlKids Health Nemours. (2019). Osgood Schlatter Disease. https://kidshealth.org/en/parents/osgood.htmlMayo Clinic. (2018). Patellofemoral pain syndrome. https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792
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Post Douglas 19304723
/in Uncategorized /by developerRespond on two different days who selected at least one different factor than you, in one or more of the following ways:Offer alternative diagnoses and prescription of treatment options for urinary tract infections.Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives
Main Post
Urinary tract infections (UTI) are one of the most common infections in the world, and advanced practitioners must be able to diagnose and treat the varying types of UTIs. Understanding the location of the UTI, upper or lower, the pathophysiology, and specific signs and symptoms are crucial for treatment. An advanced practitioner must also be aware of the roles that gender and age play in the development of a UTI. UTIs are common in the outpatient setting but can also happen in the hospital and can also be caused by a Foley catheter, which is considered a hospital-acquired event that the hospital will not receive reimbursement.
Pathophysiology of Lower Urinary Tract Infection
A lower urinary tract infection involves the path of least resistance or the most opportunistic point of entry for an organism, usually bacterial and involves the urethra and the bladder. An infection in the urethra or bladder (cystitis) are considered a lower urinary tract infection. The microbial spectrum of UTIs consists mainly of Escherichia coli, with occasional other species of Enterobacteriaceae such as Proteus mirabilis and Klebsiella pneumoniae and other bacteria such as Staphylococcus saprophyticus (Yamamichi, Shigemura, Kitagawa, and Fujisawa, 2018).
Pathophysiology of Upper Urinary Tract Infection
The upper urinary tract consists of the kidneys and ureters. Infection in the upper urinary tract generally affects the kidneys (pyelonephritis), which can cause fever, chills, nausea, vomiting, and other severe symptoms. It can be caused by an infection that has made its way up the urinary tract and can become a complicated infection from an obstruction, such as benign prostatic hypertrophy, and calculi.
Similarities and Differences
Although the location of the infection is different many of the signs and symptoms can present the same; fever, dysuria, frequency, or urgency may be present in both. Many lower tract UTIs may be asymptomatic, and in upper tract UTIs, the symptoms may be more severe, including nausea and vomiting, flank pain, or costovertebral angle tenderness. Finding the underlying cause and treatment is the same; antibiotics for bacterial infections and analgesics for pain control. Intravenous antibiotics are preferred for upper tract UTIs in an attempt to preserve organ damage, but mat be converted to oral after initial treatment.
Gender and Age as Factors
While common in both males and females, females are more prone to community-acquired UTIs than men, basically because of anatomical differences. Lema (2015) acknowledges that the close proximity of the vagina and urethral meatus to the anal opening, the shorter length of the female urethra, and the opportunity for trauma during intercourse allows for the opportunity for a UTI to be acquired. Although this happens across the lifespan of a woman, the peak times are from mid-teens to the early forties or the sexually active years. Young children, especially females, are a high-risk group due to not being able to clean themselves properly after using the bathroom or poor technique. Older patients are also high risk; men with prostate issues cannot empty their bladder are also at risk.
Diagnosis and Treatment
Diagnosis of a lower tract UTI can be done with the assessment of signs and symptoms and urine culture, midstream is preferred. Research by Lee (2018) acknowledges that patients with non-febrile uncomplicated UTIs, active pain control and minimal use of antibiotics should be prioritized, including uncomplicated cystitis. Pain in acute cystitis is a natural consequence of the inflammatory response, and pain-mediated urinary frequency or urgency is the chief complaint of patients. Painkillers, including nonsteroidal anti-inflammatory drugs (NSAIDs), are a good choice for managing symptoms while reducing the usage of antibiotics. Urinalysis and urine culture confirms the diagnosis of acute pyelonephritis and according to the Infectious Diseases Society of America (2019) a urine culture showing at least 10,000 colony-forming units (CFU) per mm3 and symptoms compatible with the diagnosis. Symptoms management and oral antibiotic therapy are needed, and in severe cases, hospitalization with intravenous antibiotic therapy may be required.
Conclusion
As future practitioners, understanding the pathophysiologies of an upper tract UTI and a lower tract UTI is paramount to obtaining a diagnosis. Untreated and under treated UTIs can lead to life-threatening complications. Management of the signs and symptoms is important, but the treatment of the underlying cause can stop a lower tract UTI from spreading into the upper urinary tract. Age and gender play significant roles in UTIs, women of childbearing years, and older men who have trouble emptying their bladder are at high risk. Assessment and quality interviews can assist the practitioner in prevention through education.
References
Acute pyelonephritis. (2019). Retrieved July 18, 2019, from https://www.idsociety.org/clinical-practice/patient-care/patient-care/
Lee, S. (2018). Recent advances in managing lower urinary tract infections. F1000Research, 7, 1964. https://doi-org.ezp.waldenulibrary.org/10.12688/f1000research.16245.1
Lema, V. M. (2015). Urinary Tract Infection In Young Healthy Women Following Heterosexual Anal Intercourse: Case Reports. African Journal Of Reproductive Health, 19(2), 134–139. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=mnh&AN=26506666&site=eds-live&scope=site
Yamamichi, F., Shigemura, K., Kitagawa, K., & Fujisawa, M. (2018). Comparison between non-septic and septic cases in stone-related obstructive acute pyelonephritis and risk factors for septic shock: A multi-center retrospective study. Journal Of Infection And Chemotherapy: Official Journal Of The Japan Society Of Chemotherapy, 24(11), 902–906. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jiac.2018.08.002
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Post Douglas Dq2 19273707
/in Uncategorized /by developerRespond to at least two of your colleagues who selected at least one different factor than you in one of the following ways:
Share insights on how the factor your colleague selected impacts the pathophysiology of anaphylactic shock.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Main Post
Anaphylactic Shock
Anaphylactic shock is a life-threatening medical emergency from an allergic reaction that requires immediate treatment. Rapid-onset respiratory compromise, skin/mucosal involvement, and hypotensive end-organ dysfunction are all characteristic presentations (Brasted & Ruppel, 2016). The body’s response to the allergen is to release inflammatory mediators at a local site, but ultimately, the response is systemic, which leads to an overwhelming cascade that affects the homeostasis of the body. Due to an increase in vascular permeability, fluid shift from the intravascular to extravascular space can occur within minutes, resulting in edema, respiratory arrest, and circulatory collapse (Brasted & Ruppel, 2016). The effect leads to vasodilation and consequently, intravascular volume depletion resulting in systemic hypotension; the hypoperfusion affects every end organ.
Emergency Versus Treating as an Outpatient
Hindsight is always 20/20, but, the respiratory compromise in this scenario should have led the school nurse to deem this a medical emergency. Urticaria and other skin symptoms were significantly more common in food-induced anaphylaxis (Kim, Kim, & Cho, 2018). I am not aware of emergency medicines available at the school levels, but; the girl did not have any medications specifically assigned to her. First line treatment would have been epinephrine or an Epi-pen, a device that people with known allergies carry with them or in this case; the girl would have had available for the school nurse to administer. Epinephrine is a powerful catecholamine that the body produces naturally for the “fight or flight” response. When administered in an anaphylactic shock situation, it acts on many levels to combat the allergen’s triggered processes. First, it is a potent alpha-1 adrenergic agonist, and it vasoconstricts and increases the peripheral vascular resistance. This increases blood pressure and reduces mucosal edema, especially relevant in alleviation of upper airway obstruction (Brasted & Ruppel, 2016). Epinephrine is also a powerful inotropic agent, allowing the heart to generate an increased cardiac output by strengthening the contractions of the heart. It decreases the inflammatory mediators with its beta-2 adrenergic effect, slowing the process of the allergen response. If an Epi-pen is used, the patient should still go to the emergency room for further evaluation as hypoperfusion may have damaged some organs. There is no situation that anaphylactic shock should be managed in an outpatient setting, especially with a six-year-old child.
Age and Gender’s Role in Anaphylactic Shock
Anaphylaxis does not differentiate between old and young or male and female if you have an allergy and come in contact with the allergen, you have the potential for anaphylaxis or even anaphylactic shock. However, research by Kim, Kim, and Cho (2018) acknowledged that severe symptoms were more frequent in the drug-induced anaphylaxis, and risk factors for the severe anaphylaxis were found to be age, sex, and drug-induced anaphylaxis. The results showed that older males were at more risk for severe anaphylaxis when the allergen was a drug.
Conclusion
Anaphylactic shock requires a practitioner’s immediate attention to preserve the life of the patient. All practitioners should know the early warning signs and advanced warning signs when dealing with this life-threatening situation. Understanding the factors associated with anaphylaxis can help guide preventive and management strategies both within and outside of the school setting (White, Silvia, Muniz, Herrem, & Hogue, 2017). All schools should be able to treat anaphylaxis, in the early stages and life-saving medications should be available, even if not available in the child’s medicine bin.
References
Brasted, I. D., & Ruppel, M. C. (2016). Anaphylaxis and Its Treatment. EMS World, 45(9), 31–37. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=117794702&site=eds-live&scope=site
Kim, S.-Y., Kim, M.-H., & Cho, Y.-J. (2018). Different clinical features of anaphylaxis according to cause and risk factors for severe reactions. Allergology International, 67(1), 96–102. https://doi-org.ezp.waldenulibrary.org/10.1016/j.alit.2017.05.005
White, M. V., Silvia, S., Muniz, R., Herrem, C., & Hogue, S. L. (2017). Prevalence and triggers of anaphylactic events in schools. Allergy And Asthma Proceedings, 38(4), 286–293. https://doi-org.ezp.waldenulibrary.org/10.2500/aap.2017.38.4066
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Post Douglas Dq2
/in Uncategorized /by developerRespond to at least two of your colleagues who selected at least one different factor than you in one of the following ways:
Share insights on how the factor your colleague selected impacts the pathophysiology of anaphylactic shock.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Main Post
Anaphylactic Shock
Anaphylactic shock is a life-threatening medical emergency from an allergic reaction that requires immediate treatment. Rapid-onset respiratory compromise, skin/mucosal involvement, and hypotensive end-organ dysfunction are all characteristic presentations (Brasted & Ruppel, 2016). The body’s response to the allergen is to release inflammatory mediators at a local site, but ultimately, the response is systemic, which leads to an overwhelming cascade that affects the homeostasis of the body. Due to an increase in vascular permeability, fluid shift from the intravascular to extravascular space can occur within minutes, resulting in edema, respiratory arrest, and circulatory collapse (Brasted & Ruppel, 2016). The effect leads to vasodilation and consequently, intravascular volume depletion resulting in systemic hypotension; the hypoperfusion affects every end organ.
Emergency Versus Treating as an Outpatient
Hindsight is always 20/20, but, the respiratory compromise in this scenario should have led the school nurse to deem this a medical emergency. Urticaria and other skin symptoms were significantly more common in food-induced anaphylaxis (Kim, Kim, & Cho, 2018). I am not aware of emergency medicines available at the school levels, but; the girl did not have any medications specifically assigned to her. First line treatment would have been epinephrine or an Epi-pen, a device that people with known allergies carry with them or in this case; the girl would have had available for the school nurse to administer. Epinephrine is a powerful catecholamine that the body produces naturally for the “fight or flight” response. When administered in an anaphylactic shock situation, it acts on many levels to combat the allergen’s triggered processes. First, it is a potent alpha-1 adrenergic agonist, and it vasoconstricts and increases the peripheral vascular resistance. This increases blood pressure and reduces mucosal edema, especially relevant in alleviation of upper airway obstruction (Brasted & Ruppel, 2016). Epinephrine is also a powerful inotropic agent, allowing the heart to generate an increased cardiac output by strengthening the contractions of the heart. It decreases the inflammatory mediators with its beta-2 adrenergic effect, slowing the process of the allergen response. If an Epi-pen is used, the patient should still go to the emergency room for further evaluation as hypoperfusion may have damaged some organs. There is no situation that anaphylactic shock should be managed in an outpatient setting, especially with a six-year-old child.
Age and Gender’s Role in Anaphylactic Shock
Anaphylaxis does not differentiate between old and young or male and female if you have an allergy and come in contact with the allergen, you have the potential for anaphylaxis or even anaphylactic shock. However, research by Kim, Kim, and Cho (2018) acknowledged that severe symptoms were more frequent in the drug-induced anaphylaxis, and risk factors for the severe anaphylaxis were found to be age, sex, and drug-induced anaphylaxis. The results showed that older males were at more risk for severe anaphylaxis when the allergen was a drug.
Conclusion
Anaphylactic shock requires a practitioner’s immediate attention to preserve the life of the patient. All practitioners should know the early warning signs and advanced warning signs when dealing with this life-threatening situation. Understanding the factors associated with anaphylaxis can help guide preventive and management strategies both within and outside of the school setting (White, Silvia, Muniz, Herrem, & Hogue, 2017). All schools should be able to treat anaphylaxis, in the early stages and life-saving medications should be available, even if not available in the child’s medicine bin.
References
Brasted, I. D., & Ruppel, M. C. (2016). Anaphylaxis and Its Treatment. EMS World, 45(9), 31–37. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=117794702&site=eds-live&scope=site
Kim, S.-Y., Kim, M.-H., & Cho, Y.-J. (2018). Different clinical features of anaphylaxis according to cause and risk factors for severe reactions. Allergology International, 67(1), 96–102. https://doi-org.ezp.waldenulibrary.org/10.1016/j.alit.2017.05.005
White, M. V., Silvia, S., Muniz, R., Herrem, C., & Hogue, S. L. (2017). Prevalence and triggers of anaphylactic events in schools. Allergy And Asthma Proceedings, 38(4), 286–293. https://doi-org.ezp.waldenulibrary.org/10.2500/aap.2017.38.4066
Week 5 Forum 2 Discussion Post 6501.doc (58.5 KB)
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Post Douglas
/in Uncategorized /by developerRespond on two different days who selected different factors than you, in one or more of the following ways:
Offer alternative diagnoses and prescription of treatment options for osteoarthritis and rheumatoid arthritis.
Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives.
Main Post
Rheumatoid arthritis and osteoarthritis both involve inflammation and affect the joints. Rheumatoid arthritis is a chronic systemic inflammatory disease characterized by the persistent symmetric inflammation of multiple peripheral joints (Hammer & McPhee, 2019). Osteoarthritis is characterized by local areas of loss and damage of articular cartilage, inflammation, new bone formation of joint margins, subchondral bone changes, variable degrees of mild synovitis, and thickening of the joint capsule (Huether & McCance, 2017).
Pathophysiology
Osteoarthritis is most commonly from wear and tear of the cartilage around the joint; this can be enhanced form sports or overuse at a particular occupation. Pro-inflammatory factors are released, and catabolic activation begins resulting in a net degradation of cartilage extracellular matrix (Esa et al., 2019). The cartilage becomes and may be absent over some areas, leaving the bone unprotected (Huether & McCance, 2017). Rheumatoid arthritis pathophysiology involves the destruction of the synovial linings that protect the joints; these linings provide nutrients and lubrication for the articular cartilage. Hammer and McPhee (2019) explain that enhanced pro-inflammatory cytokine production is a dominant feature of rheumatoid arthritis.
Gender and Ethnicity’s Impact
Rheumatoid arthritis is most typically a persistent, progressive disease presenting in women in the middle years of life (Hammer & McPhee, 2019). Studies have shown that hormones play a role in the development of rheumatoid arthritis, specifically when women are undergoing hormonal changes at childbirth and menopause. All these phenomena have in common an acute decline in ovarian function and/or in oestrogen bioavailability (Alpízar-Rodríguez, Pluchino, Canny, Gabay, & Finckh, 2016). The peak incidence in females coincides with menopause when the ovarian production of sex hormones drops markedly (Karsdal, Bay-Jensen, Henriksen, & Christiansen, 2012). No evidence supports that ethnicity is a factor in rheumatoid arthritis. Several studies performed, but due to their limitations and sample sizes, they could not be validated.
Although osteoarthritis incidence rates are quite similar in men and women, after age 50, women typically are more severely affected (Huether & McCance, 2017). Following the same pattern as rheumatoid arthritis with menopausal and post-menopausal women. Several experimental studies have shown that estrogens are implicated in the regulation of cartilage metabolism (Mahajan & Patni, 2018). Again for osteoarthritis, no research clearly recognized that ethnicity enhanced the disease process.
Conclusion
Both osteoarthritis and rheumatoid arthritis are the two most common forms of arthritis that affect millions of people. The symptoms can be very similar, and a thorough examination should be done to distinguish between the two. Osteoarthritis usually affects one joint, while rheumatoid arthritis affects several joints at once.
References
Alpízar-Rodríguez, D., Pluchino, N., Canny, G., Gabay, C., & Finckh, A. (2016). The role of female hormonal factors in the development of rheumatoid arthritis. Rheumatology. https://doi-org.ezp.waldenulibrary.org/10.1093/rheumatology/kew318
Esa, A., Connolly, K., Williams, R., & Archer, C. (2019). Extracellular Vesicles in the Synovial Joint: Is there a Role in the Pathophysiology of Osteoarthritis? Malaysian Orthopaedic Journal, 13(1), 1-7. https://doi-org.ezp.waldenulibrary.org/10.5704/MOJ.1903.012
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical medicine (8th ed.). New York, NY: McGraw-Hill Education.
Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.
Karsdal, M. A., Bay-Jensen, A. C., Henriksen, K., & Christiansen, C. (2012). The pathogenesis of osteoarthritis involves bone, cartilage and synovial inflammation: may estrogen be a magic bullet? Menopause International, 18(4), 139–146. https://doi-org.ezp.waldenulibrary.org/10.1258/mi.2012.012025
-org.ezp.waldenulibrary.org/10.4103/jmh.JMH_157_18doi(4), 171. https://9 Journal of Mid-life Health,, R. (2018). Menopause and Osteoarthritis: Any Association? Patni, A., & Mahajan
Week 2 Discussion 2 Post.doc (59 KB)
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Post Dq2 Allison D
/in Uncategorized /by developerRespond on two different days who selected different factors than you, in one or more of the following ways:
Offer alternative diagnoses and prescription of treatment options for osteoarthritis and rheumatoid arthritis.
Share an insight from having read your colleague’s posting, synthesizing the information to provide new perspectives.
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Arthritis
Arthritis is an inflammation of the joints. It can affect one joint or multiple joints. There are more than 100 different types of arthritis, with different causes and treatment methods. Two of the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA) (Macon, B, Guy, L. 2017).
Osteoarthritis: Osteoarthritis is the most common form of arthritis, affecting millions of people worldwide. It occurs when the protective cartilage that cushions the ends of your bones wears down over time. Osteoarthritis can occur in any joint, it mainly affects the hands, knees, hips, and spine.
Rheumatoid Arthritis: Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease characterized by the persistent symmetric inflammation of multiple peripheral joints. It is characterized by the development of a chronic inflammatory proliferation of the synovial linings of diarthrodial joints, which leads to aggressive cartilage destruction and progressive bony erosions
Pathophysiology of Osteoarthritis and Rheumatoid Arthritis
In both cases involving OA and RA, the etiology is fully not understood. The pathophysiology of OA articular cartilage is played by cell/extra-cellular matrix (ECM) interactions, which are mediated by cell surface integrins. “OA is a complex disease whose pathogenesis includes the contribution of biomechanical and metabolic factors which, altering the tissue homeostasis of articular cartilage and subchondral bone, determine the predominance of destructive over productive processes” (Lannone F, et al. 2003). In RA, damage is centered around the synovial linings of joints the synovium normally provides nutrients and lubrication to adjacent articular cartilage. RA synovium, in contrast, is markedly abnormal, with a greatly expanded lining layer (8–10 cells thick) composed of activated cells; a highly inflammatory interstitium replete with B cells, T cells, and macrophages; and vascular changes, including thrombosis and neovascularization” (Hammer, G. D., & McPhee, S. J, 2019).
Factors: Age and Genetics
Many factors can play a role in OA and RA. The causes of RA and OA still remain unclear, there is several links to genetic and environmental factors that have been identified that predispose to the development of RA and OA. Genetics is the first factor that plays a significant role in the development of RA and OA. In OA there is rare genetic defect that causes the body’s production of collagen to be disrupted, this can cause an early diagnosis. Another is an inherited trait where the bones don’t line up correctly causing wear and breakdown on the cartilage. Researchers have discovered the Gene FAAH that could be a cause of OA. With RA it can be a combination of genetics and environmental factors. “The most significant genetic risk factors for rheumatoid arthritis are variations in human leukocyte antigen (HLA) genes, especially the HLA-DRB1 gene. The proteins produced from HLA genes help the immune system distinguish the body’s own proteins from proteins made by foreign invaders (such as viruses and bacteria). Changes in other genes appear to have a smaller impact on a person’s overall risk of developing the condition” (NIH, 2019). RA affects women more than men possibly due to hormones changing in women with age.
Treatment and Diagnosis of RA and OA
Diagnosis RA in early stages can be difficult because early signs and symptoms mimic other disease. To diagnosis RA and OA, MRI or X-ray can help in diagnosis of the disease and progression. There is no blood test for OA but RA, laboratory test like ESR, or sed rate or C-reactive protein (CRP), Most of the time the levels will be elevated (Mayo Clinic, 2019), which may indicate the presence of an inflammatory process in the body. Other common blood tests look for rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies. There is a physical exam that can determine redness, swelling, and pain in the joints, and will also check for reflexes and strength. There is no cure for OA or RA, but treatment with Disease-modifying antirheumatic drugs (DMARDs) can slow the progression and with RA can sometimes put patients in remission.
References
Hammer, G. D., & McPhee, S. J. (2019). Pathophysiology of disease: An introduction to clinical
medicine (8th ed.). New York, NY: McGraw-Hill Education.
Iannone F, et al. (2003). The pathophysiology of osteoarthritis. Aging Clinical and Experimental
Research.15(5):364-72. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/14703002/?ncbi_mmode=std
Macon, B, Guy, L. (2017). Arthritis. Retrieved from https://www.healthline.com/health/arthritis
Mayo Clinic. (2019). Rheumatoid arthritis. Retrieved from https://www.mayoclinic.org/diseases-
conditions/rheumatoid-arthritis/diagnosis-treatment/drc-20353653
Mayo Clinic. (2019). Osteoarthritis. Retrieved from https://www.mayoclinic.org/diseases-
conditions/osteoarthritis/diagnosis-treatment/drc-20351930
National Institute of Health. (2019). Rheumatoid arthritis. Retrieved from
https://ghr.nlm.nih.gov/condition/rheumatoid-arthritis#resources
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Post Ericka
/in Uncategorized /by developerRespond on two different days by sharing ideas for how shortcomings discovered in their evaluations and/or their examples of incivility could have been managed more effectively.
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Workplace Assessment
Prior to taking my last position in the hospital setting, I did some research on the organization. I was leaving a hostile environment and wanted to make sure I was looking at organizations that aligned with my professional integrity, had good recommendations from staff and the patient population. Clark (2019) discusses that “in the patient care environment, uncivil encounters can provoke uncertainty and self-doubt, weaken self-confidence, and compromise critical thinking and clinical judgment skills” (p.64). At this time in my career, I needed stability and a healthy work environment that supported me both professionally and personally.
Clark Healthy Workplace Inventory Results
Based on the Clark Healthy Workplace Inventory results it appears that I made a good decision, I knew that myself within six months of starting there. Scoring an 82 out of 100 this sets my workplace in the moderately healthy category. Answering the question is my workplace civil or not? I would have to say that from administration down my organization is civil. Overall the organization is true to its proposed pillars of excellence and standards for patient care, outcomes, and employee satisfaction. No organization is perfect, but I have experienced growth and change with the organization and I feel like they are moving in the right direction. In reflecting on workplace culture Clark (2105) notes that purposeful relationships and interactions with others facilitate the success of the individual, team, and organization (p.19).
Experience
Unfortunately, I have experienced incivility in the workplace that is why I am with the organization I am with now. It was an unhealthy work environment where management was concerned, I shared the organization’s vision for patient care, but my manager did not. Often our ideas were shot down and then retaliated upon if she thought it might shade her as the manager. She was not a leader. The team I worked with was one of the only reasons I stayed as long as I did. We all experienced incivility at her hands collectively and individually. It was not something that administration was unaware of, she had multiple complaints in previous years and prior to my group, her turnover rate was high. Communication had to be both verbal and in writing so that there was no miscommunication from all parties. We all could have been secretaries in our biweekly meetings. We were to add human resources (HR) to our communication when asked to do so. We worked along with HR to address issues and work on communication as a group as well as individuals. One might ask why I stayed with them as long as I did and to be honest it was the patient population. I have since come to understand that it was not me individually or the team that was the issue, but that not all managers are leaders (Marshall and Bloom, 2017).
Clark, C. M. (2015). Conversations to inspire and promote a more civil workplace. American Nurse Today, 10(11), 18–23.
Clark, C. M. (2018). Combining cognitive rehearsal, simulation, and evidence-based scripting to address incivility. Nurse Educator.
Marshall, E., & Broome, M. (2017). Transformational leadership in nursing: From expert clinician to influential leader (2nd ed.). New York, NY: Springer.
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Post Graduation Plan 19311207
/in Uncategorized /by developerPost-Graduation Plan
In this Discussion, you complete the Post-Graduation Plan you began to develop in Weeks 6 and 7. Your Post-Graduation Plan is an opportunity to explore how you may continue to develop your professional and leadership skills, promote change in your department and organization, and stimulate progress in the nursing profession.
Your Post-Graduation Plan (geared toward the next 2–3 years) should feature two to five career and/or personal goals; goals should be specific, measurable, attainable, realistic, and timely. In your plan, outline necessary steps for achieving these goals. Also, consider how you can reflect these goals in your curriculum vitae (CV).
To prepare:
By Tomorrow Tuesday 8/6/19 before 10pm, in APA format and a minimum of 3 references, create a short summary PowerPoint with a minimum of 10 slides that features five goals and describes steps for achieving these goals.
Required Readings
Resources for the Post-Graduation Plan (also shared during Weeks 6 and 7):
Dickerson, P. S. (2010). Continuing nursing education: Enhancing professional development. The Journal of Continuing Education in Nursing, 41(3), 100–101.
This article examines current frames of reference for continuing nursing education and the work that is guiding the future.
American Association of Colleges of Nursing. (2012). Career resource center. Retrieved from http://www.aacn.nche.edu/students/career-resource-center
This website provides a battery of resources for nursing graduates seeking employment.
Robert Wood Johnson Foundation. (2010). Career tools and advice. Retrieved from http://www.newcareersinnursing.org/scholars/career-central/tools
This website supplies a variety of guides on applying for jobs.
American Nurses Association. (2012). Career & credentialing. Retrieved from http://www.nursingworld.org/MainMenuCategories/CertificationandAccreditation
This website provides links to guides on careers and credentialing. The website also highlights special membership benefits for ANA members.
Optional Resources
Bolles, R. N. (2012). What color is your parachute? 2012: A Practical Manual for Job-Hunters and Career-Changers. New York, NY: Ten Speed Press.
Isaacs, K. (2010). Surviving and thriving in the workplace: Resume tips for nurses. Ohio Nurses Review, 85(6), 5.
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Post Graduation Plan
/in Uncategorized /by developerPost-Graduation Plan
In this Discussion, you complete the Post-Graduation Plan you began to develop in Weeks 6 and 7. Your Post-Graduation Plan is an opportunity to explore how you may continue to develop your professional and leadership skills, promote change in your department and organization, and stimulate progress in the nursing profession.
Your Post-Graduation Plan (geared toward the next 2–3 years) should feature two to five career and/or personal goals; goals should be specific, measurable, attainable, realistic, and timely. In your plan, outline necessary steps for achieving these goals. Also, consider how you can reflect these goals in your curriculum vitae (CV).
To prepare:
By Tomorrow Tuesday 8/6/19 before 10pm, in APA format and a minimum of 3 references, create a short summary PowerPoint with a minimum of 10 slides that features five goals and describes steps for achieving these goals.
Required Readings
Resources for the Post-Graduation Plan (also shared during Weeks 6 and 7):
Dickerson, P. S. (2010). Continuing nursing education: Enhancing professional development. The Journal of Continuing Education in Nursing, 41(3), 100–101.
This article examines current frames of reference for continuing nursing education and the work that is guiding the future.
American Association of Colleges of Nursing. (2012). Career resource center. Retrieved from http://www.aacn.nche.edu/students/career-resource-center
This website provides a battery of resources for nursing graduates seeking employment.
Robert Wood Johnson Foundation. (2010). Career tools and advice. Retrieved from http://www.newcareersinnursing.org/scholars/career-central/tools
This website supplies a variety of guides on applying for jobs.
American Nurses Association. (2012). Career & credentialing. Retrieved from http://www.nursingworld.org/MainMenuCategories/CertificationandAccreditation
This website provides links to guides on careers and credentialing. The website also highlights special membership benefits for ANA members.
Optional Resources
Bolles, R. N. (2012). What color is your parachute? 2012: A Practical Manual for Job-Hunters and Career-Changers. New York, NY: Ten Speed Press.
Isaacs, K. (2010). Surviving and thriving in the workplace: Resume tips for nurses. Ohio Nurses Review, 85(6), 5.
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Post Holly 19388609
/in Uncategorized /by developerRespond 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.
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Purpose:
This purpose of this assignment is to review case study #3 knee pain, and use the information to evaluate, form possible diagnoses, and practice documenting in soap format. Documenting in SOAP note format allows a practitioner to assess and document that the patient was treated with a holistic approach (Ball, Dains, Flynn, Solomon, & Stewart, 2019).
Case 3: Knee PainA 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?
Patient Information:ANW 15 1/19/04 M Caucasian
(CC): “My knees hurt, sometimes I hear a clicking sound, and they get stuck.”
History of Present Illness (HPI): Alexander (Alex) is a 15 year old Caucasian male who has come to the clinic complaining of pain in his knees. He states “sometimes it is just one knee that clicks and sometime it is both,” Alex states that his “knees get stuck or catch under the knee cap”. He rates the pain as 3/10 most days but after games the pain can be 6/10. He describes the pain as “dull and achy,” like I have done too much stuff. He states the pain started “a few weeks ago” and it was once in a while but now they hurt almost every day. He said his coach wants him to get his knees checked out before the next game.
Medications: Motrin 200mg po Nightly.
Allergies: KNA
Past Medical History (PMH): None
Past Surgical History (PSH): None Sexual/Reproductive History: Heterosexual. Identifies as male. Denies sexually active.
Personal/Social: Alexander is a sophomore He plays on the basketball, baseball, soccer, football, track and wrestling team. He also loves to swim but states they do not have a team at the school. Alex states although he loves sports he wants to become a “sports doctor” and be a sports coach in his part time. Alex is proud of his 4.2 GPA and plans to graduate 1 year early and start college. He lives with his mother, adoptive father, maternal grandmother, and older sister. Alex says he has a half-brother that is 5 that leaves in Tennessee with his biological father. He states his biological father had a baby boy that died at birth a few years ago. He reports seeing his biological father a few times in the last few years. He states he has a girlfriend is named Heather, is also a sophomore and that she is a cheerleader and also plays soccer. He reports that he and Heather are not sexual active but if they become active they will use condoms. Alex is excited to get his license soon. He reports he wears his sit belt in the car and wears all protective sport gear. Denies tobacco use, drinking, illicit drug use. Reports he tried Marijuana x1 and a beer in 2018 at a party.
Immunization History: All immunization up to date per mother. Received flu vaccine 10/2018. Verified through Florida Immunization Registry.
Family History: Mother: Hx Breast Cancer. Seasonal Allergies. Anxiety. Maternal Grandmother: Asthma Paternal Grandfather: Died in 2009 liver Cirrhosis from etoh abuse.Father: MI age 30 from cocaine abuse. Bipolar disorder. Maternal Grandmother: None Paternal Grandfather: Substance AbuseSister: 19 Asperger’s, Anxiety, Depression. Half-Brother- 5 Cerebral Palsy Half Brother-Deceased Still Born
ROS:General: Denies fatigue, weakness, fever, chills, sweat, loss of appetite, and weight loss. HEENT: Denies any wounds, lumps, or pain. Denies vision issues. Denies hearing issues. Reports a nose bleed once last year after being hit during a soccer game. Reports no issues eating, swallowing, or pain in throat. Reports he saw the dentist last week.Neurological: Denies headaches, pain, and dizziness or head injuries. Denies changes in memory. Denies numbness and tingling.Skin: Denies any wounds, rashes or moles. Reports, “I have a birth mark on my right butt check”.Cardiovascular: Denies chest pain, palpitations, and racing. No hx noted.Peripheral Vascular: No hx noted.Respiratory: Denies SOB, cough, and pain.Gastrointestinal: Denies abdominal pain, nausea, vomiting, constipation or diarrhea. Reports not troubles eating. Reports he eats “lots of pasta for energy”.Genitourinary: Denies issues including nocturia, dribbling, incontinence, discharge, or pain upon urination. Musculoskeletal: Reports knee pain bilaterally dull and achy 3/10 presently. Denies issues, running, jumping, kicking, or bending. Reports clicking sounds at times when knee is flexed and extended. Hematologic: Denies bleeding or bruising. Reports nose bled last year after being hit in a soccer game. No other hx notedLymphatics: Denies swelling and tenderness. No Hx noted.Endocrine: Denies heat or cold intolerance, excessive thirst or urination, or tremors. No hx noted.Psychiatric: Denies depression, thought of self- harm. Reports anxiety when taking Chemistry tests.Allergies: Denies.Physical Exam: BP 120/70 adult cuff/right arm/sitting, P 72 regular, RR 18 unlabored. O2 98%, T 98.6 temporal. Weight 185. Height 5 feet 11 inches. BMI 25General: Aox4, looks stated age, pleasant, well groomed, and cooperative. Makes eye contact when speaking and answering questions. No s/s of distress.HEENT: Head symmetrical No visual deformities noted. PER/EOMI. Responds to questions with no requests to repeat. Breaths through nares no s/s of congestion, or allergies. Teeth are intact, bright white, straight, and no odor from mouth present.Neurological: AOX4, No s/s of neurological deficits. Adequate recall.Neck: No visual lesions, no enlargement, no JVD. Skin/Lymph: Intact. No wounds, lesions, scars or moles noted. Tan in complex. No signs of edema or cyanosis. No nodes observed upon palpation. Chest/Pulmonary: Chest is symmetrical. CTA AP&L. Respiration even and unlabored noted at 19. No noted SOB, RR noted at 18, SPO2 98%. No use of accessory muscles noted. Heart/Vascular: S1 and S2 noted. RRR. No murmurs, rubs, or gallops noted. Less than 3 capillary refill. All Pulses 3+. HR slightly elevated along with BP indicative of pain.Abdomen: Deferred No issues noted. Genital/Rectal: Deferred no issues noted.Musculoskeletal: Ambulates on own, full weight bearing. Mild swelling, tenderness, warmth noted in bilateral knees. Pain with palpation over the tibial tuberosity. Flinches upon flexion and extension of both knee.Diagnostic Results/Manipulation Test: Negative Lachman test. Negative Homan’s sign. Negative McMurray test. Differential Diagnoses 1. Patellofemoral Pain Syndrome 2. Meniscus tear 3. Osgood Schlatter Disease 4. Osteogenic Sarcoma 5.Stress fracture
DIAGNOSIS/CLIENT PROBLEM
The most probable diagnosis for Alex is Petellofamoral pain syndrome. This syndrome is pain that is caused by overuse of the knee caps (American Academy of Orthopedic Surgeons, 2015). It is prevalent in those who play sports, especially those that involve jumping and running (Mayo Clinic, 2018). This syndrome causes pain around the knee cap, stiffness, and may also cause the popping and clicking sound that Alex describes and that is present upon evaluation (American Academy of Orthopedic Surgeons, 2015). This condition is sometimes called runner or jumper’s knee (American Academy of Orthopedic Surgeons, 2015). Alex plays multiple sports that have high impact on the knees. It is common in women and in adolescents (American Academy of Orthopedic Surgeons, 2015). Alex has the signs and symptoms of this condition, including pain upon examination. This condition would explain the pain that Alex’s is reporting in both versus an injury that would be more likely to shoe in just one knee. Another possible diagnosis for Alex is bilateral torn meniscuses. A meniscus tear is when there a tear takes place to the cartilage that is located behind the knee cap (American Academy of Orthopedic Surgeons, 2014). It is one of the most common knee injuries, especially in those that play sports (American Academy of Orthopedic Surgeons, 2014). The signs and symptoms of this condition are swelling, stiffness, clicking or popping sound, not being able to extend the knee fully, and a feeling that your knee is going to “give out” (American Academy of Orthopedic Surgeons, 2014). Alex is very active in many different sports and shows all signs and symptoms of this condition except for negative McMurray sign. McMurray test is a manipulative test is that performed to detect a tear in the meniscus (Ball et al, 2019). A palpable or audible click with this maneuver means that there is tear present in either the lateral or medial meniscus (Ball et al, 2019). It is very unlikely that Alex would have a torn meniscus in both knees at the same time Osgood Schlatter Diease is yet another possible diagnosis for Alex. This condition is a swelling and irritation of the growth plate in the legs near the shine bone (Kids Health Nemours, 2019).This condition usually takes place in children who are still growing and that have active lifestyles (Kids Health Nemours, 2019). This condition is common in those who play sports that involving running and jumping (American Academy of Orthopedic Surgeons, 2015). Alex is the correct age for the condition and is very active in the sports that cause this condition. This condition would explain the pain Alex is experiencing but not necessarily the clicking or popping sound. Although Osteogenic Sarcoma is a less likely diagnosis for Alex it may still be a possible diagnosis. Osteogenic Sarcoma is a type of cancer that forms at the ends of bones as they grow (Johns Hopkins Medicine, n.d). It affects those younger in age still growing (Johns Hopkins Medicine, n.d). Alex does fit the age range, with the most common age being 15 (Johns Hopkins Medicine, n.d). This condition would explain the pain being reported, however this condition is a very rare (Johns Hopkins Medicine, n.d). An Xray , MRI and CT will be able to establish if a tumor is present (Johns Hopkins Medicine, n.d). It would be very unlikely that this condition will present in both knees at the same time. Additionally this condition would not explain the clicking and pooping sounds present in the knees. A stress fracture or tiny break in a one is another possible diagnosis for Alex due to his increased sports activity (American Academy of Orthopedic Surgeons 2007). Stress fractures are a very common injury in those that play sports (Dains, Baumann, & Scheibel, 2019). Although the stress fracture would cause the pain is experiencing it would not explain the clicking in the knees. Additionally it is unlikely unless Alex has a previous condition such as osteoporosis that both knees would experience a fracture at the same time. An Xray of the knees will be able to establish if a fracture exists. Treatment Plan: Diagnostics Bilateral patella XRAY Bilateral MRI of patella CT Scan
MedicationTreatment RICE treatment. Mobic 7.5mg po daily. Knee stretching exercise.
Education Patient and parent on diagnosis. RICE therapy. Medications usage and side effects. Educate on stretching. Provide stretching pamphlet. Referral and follow-up.
Referral/Consultation Pediatric orthopedist Physical therapyFollow Up Planning 1 month
References
American Academy of Orthopedic Surgeons.(2014). Meniscus Tears. https://orthoinfo.aaos.org/en/diseases–conditions/meniscus-tears/American Academy of Orthopedic Surgeons. (2015). Osgood-Schlatter Disease (Knee Pain). https://orthoinfo.aaos.org/en/diseases–conditions/osgood-schlatter-disease-knee-pain/American Academy of Orthopedic Surgeons. (2015). Patellofemoral Pain Syndrome. https://orthoinfo.aaos.org/en/diseases–conditions/patellofemoral-pain-syndrome/American Academy of Orthopedic Surgeons. (2007). Stress Fractures. https://orthoinfo.aaos.org/en/diseases–conditions/stress-fractures/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.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.Johns Hopkins Medicine. (n.d). Osteogenic Sarcoma. https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/pediatric_oncology/becoming_our_patient/cancer_types/osteogenic_sarcoma.htmlKids Health Nemours. (2019). Osgood Schlatter Disease. https://kidshealth.org/en/parents/osgood.htmlMayo Clinic. (2018). Patellofemoral pain syndrome. https://www.mayoclinic.org/diseases-conditions/patellofemoral-pain-syndrome/symptoms-causes/syc-20350792
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Post Instr 19464697
/in Uncategorized /by developerWhen should patients be treated indefinitely with antidepressant maintenance?
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