APA format 3 peer references and response needs to agree or disagree with differential diagnosis and explain why
Week 9: Review of case study 1
Patient Initials: _AS__ Age: __20___ Gender: __M_
SUBJECTIVE DATA:
Chief Complaint (CC): an Unbearable headache
History of Present Illness (HPI): 20-year-old Caucasian male presented with a chief complaint of intermittent headaches. The patient reports that a headache is so bad and unrelenting that he feels it in his eyes with great intensity, nose, cheekbones, and jaw. The patient states “The headache ache comes and goes.” The patient reported that his headache started two days ago and had increased in severity of a 10/10 on the pain scale as the pressure in the eyes creating the sensitivity to light, the feeling of having toothache makes it too hard to bear. While the patient was not able to pinpoint when his headache started, he reports that he was so overwhelmed with school and work over the past couple of weeks, it may have precipitated the headache. The patient reporting taking Tylenol which is ineffective; he has tried to get more sleep and use dimmed lights while awake. He states, “while the sleeping for a longer time helps a little, the headaches return as the day progress and gradually gets worse with each passing minute. The only thing that stops the headache is passing time.”.
Medications: Tylenol 650 mg every 4 to 6 hours.
Allergies: Ibuprofen- angioedema
Past Medical History (PMH): Mumps -resolved
Past Surgical History (PSH): Appendectomy at age 16 due to a ruptured appendix.
Sexual/Reproductive History: Not sexually active.
Personal/Social History: Reports going to church on Saturdays (worship sunset to sunset), Saturday after sabbath worship; sometimes going bowling or roller skating and socializes with peers from church or school. Denies tobacco use, alcohol use, and drug use. Patient reports at least three mornings per week approximately one hour of exercise at the work gym.
Immunization History: reports immunization up to date and will get his annual flu shot at work October 25, 2018.
Significant Family History: grandfather died one year ago (72) from heart failure. Grandmother 68 alive and living with hypertension.
Lifestyle: Patient is newly as a mental health counselor at a hospital psychiatric unit. He just started studying law part-time at the local university; current course is online. He currently lives alone in a two-bedroom apartment, as parents live in another country. His support system is his family who is a phone call away, and his best friend who lives 20 minutes away from his home. He does not drink, smoke or do drugs. He attends church on Saturday. Socializes with church friends and or best friend after sunset some Saturday at the local bowling alley, skating rink, or “hang out” at a local diner. Currently is not involved in a relationship and is not sexually active.
Review of Systems:
General: Patient reports having an “unbearable headache” Patient is unaware of any changes in weight, eating preference or activities; however, reports a decrease in appetite.
HEENT: “except for the increasing headache no problem.”, reports wearing shades due to an increased sensitivity to lights; no hearing impairment; reports stuffy nose in the morning in the morning but no runny nose; denies difficulty chewing or swallowing, pain or discomfort.
Neck: Endorses stiffness, reports “may be due to tension.”
Respiratory: denies any respiratory distress
Cardiovascular: denies palpitation, denies heart problems
Gastrointestinal: Reports decreased appetite, some nausea, no vomiting no change in bowel pattern noted.
Genitourinary: No change in urinary function
Musculoskeletal: Denies problem with range of motion, walking or gait.
Psychiatric: Denies having any psychiatric history
Neurological: Reports feeling less alert, unfocused at times.
Skin: Denies any dermatological problems
OBJECTIVE DATA:
Physical Exam:
Vital signs: temp: 98.4, b/p 130/74, RR 18, pulse 88, SPO2 100% ht. 5’7” weight 140 BMI 21.9.
General: Patient is an alert and oriented *4, 20-year-old Caucasian male who appears to be in good health. He is appropriately groomed, no odor and looks clean. Erect posture, steady gait. Facial expression looks strained and sad; mood appears dysphoric. He is speaking English fluently and clearly. Voice is low and calm. Speech appear slowed and forced. The patient was able to count from 1-20 backward and repeat a series of words without hesitation. Reports having a headache for a long time, “maybe age 11, really not sure, but they weren’t this awful or frequent.”. For the past four months he has been having headaches for at least four days straight per month; but, this latest bout of headaches has been the worst experienced. He denies any head injury or trauma, and chronic illnesses. Patient report at its worst the pain is 10/10, and at its best, it is 7/10. He also states, “while I take Tylenol, I don’t think it effective; I think time passing makes it goes away, the problem is times seem to go too slow.”.
HEENT: head is symmetrical and normocephalic, no depression, swelling but reported tenderness. Denies head injury or trauma. No facial drooping, Patient endorses headache that is currently a 7/10. Reports pain is to present at forehead bilateral, temporal artery has no bruit, patient reports feeling like a “pressured weight” on his head. Patient does report some pulsating pain with movement. He also endorses feeling the pain behind the eyes, nose, cheekbones and jaw. His forehead is creased. Eyes are symmetrical. Left eye appears glossy, no crusting, no nicking of arteries, optic disc is reddish orange, no microaneurysm, neovascularization. Patient states, “pain can be felt in the eyes and vision in the left eyes sometimes vision seems blurred or doubled and funny”. On evaluation the patient can read clearly at 20/20 on the Snellen eye chart. Pupils are equal, rounded, reactive to light and accommodation. Peripheral vision is intact. No excess blinking, denies pain on examination. No wax in the ear, symmetrical, clean, no difficulty hearing bilaterally during whisper, Weber and Rinne test, no infection or lesion noted, the handle of malleus, light reflex, and the umbo is visualized as the membrane is pearly gray. Nose is midline, no stuffiness, no redness, no drainage noted. Lips are pink and moist, no cavities noted, reports last dental exam and cleaning was September 2018. Tongue is light pink and moist, no problem with swallowing, hard and soft palate gag reflex. Tongue is flexible and resistant to force. Salivary glands are functional. No pain reported on examination.
Neck: Good range of motion, lymph nodes are not palpable; however, tension can be felt in the neck, appears as if the patient has difficulty relaxing. The trachea is midline; thyroid is non-palpable.
Chest: No wheezing, rhonchi, or rales
Lungs: clear in all four quadrants
Heart: no murmurs or abnormal heart sound
Abdomen: flat and no tender, bowel sounds present in all four quadrants, no reports of difficulty in bowel movement or change in the pattern
Musculoskeletal: range of motion is good, no curvature noted. No swelling, redness or tenderness. Some stiffness in the neck but not related to the range of motion but to the patient not being able to relax/ patient is tense. No difficulty in standing, walking in a straight line, stopping or turning suddenly. Balance and gait are exceptional. Patient report having frequent muscle contraction.
Psychiatric: While presently dysphoric, no indication of depression on assessment, the patient appears future-oriented. Denies suicidal and homicidal ideation as well as auditory and visual hallucination. Headache complaint does not appear somatic.
Neurological: Cranial nerve assessment finds all nerve intact with no impairment. The patient is alert and oriented to person, place, time and situation. He can do serial addition and multiplication; repeat a series of words after having a different line of conversation. Count from 1-20 backward. No numbness or tingling in fingers, toes, or face. Muscle strength is (5) good as there is active motion against full resistance, reflex is 2+ normal. Patient can recognize writing on skin, interpret hard and soft with eyes closed. While no sensory issue is present patient reports based on the increased level of activity on the unit at the increase stimuli has been affecting his concentration; he feels overstimulated believes he cannot process new information right now, only wanting to concentrate on one task at a time. He also reiterates that bright light bothers his eyes and the combination with the increased stimulants makes the headache worst. Patient reports feeling less alert and unfocused; however, while this may occur, this neurological exam does not correlate.
24 Hour diet and activity recall: – woke 5:30 or work 8-hour work day which begins at 7 am. 10 am, Breakfast 2 boiled eggs, a slice of toast with a slice of cheese, a bowl of cereal and a glass of coffee. Lunch, chicken Caesar salad. No dinner, went straight at 4pm home after work headache was too intense. Slept for 3 hours, headache was still present but less intense, spent 4 hours on school work then went back to sleep, slept until 5:30 am, then got ready for work. Reports drinking on average four to five glasses of water per day. Patient does not cook, will sometimes eat frozen tv dinners or ramen noodles; sometimes snacks heavily, his favorite snacks are chocolate ice-cream, eclairs, Cheetos and Doritos.
Diagnostic test MRI, and or CT-scan, and complete blood count to rule out inflammation.
ASSESSMENT:
Tension Headache- Per Dains, Baumann & Scheibel, (2016) Tension headache is the most common type of headache in adults, and the pain is bilateral, and last for hours to days, and it can form a cycle that may last for months. The text also notes that factors such as stress, hunger and depression can trigger this headache. Based on information gained from AS, stress is likely a contributing factor to AS headaches. However, results from imaging and testing are needed to determine his type of headache. In a randomized clinical study conducted by Omidi, & Zargar, (2015) they found that the use of psychotherapy dubbed mindfulness-based stress reduction was helpful in reducing pain and stress and would be a useful tool in relieving the tension headache.
Migraine- Per Dains, Baumann & Scheibel, (2016) migraine without aura is seen in 20% of the population, has a unilateral throbbing pain with symptoms of nausea and photophobia. According to Tai, Yap, & Goh, (2018) dietary intake can trigger migraine headaches. They conducted a study that found that coffee, chocolate and monosodium rich foods such as broth, flavored snacks, frozen foods, and pasta sauce can trigger a migraine. It is clear from AS description he is experiencing throbbing pain and is experiencing nausea and photophobia, however, he does states that his headache is bilateral. Hence a leaning towards mixed headache diagnosis. However, this differential diagnosis cannot be ruled out as the patient may also have a migraine with aura as well. In any event, diet change and food choices must be discussed with the patient has some of AS choices is likely a trigger to his headache.
Mixed headache- According to Dains, Baumann, & Scheibel, (2016) is a combination of tension and migraine whereby the effect is a combination of throbbing, tightness, pressure and constant pain is felt. Based on AS description this may be what he is experiencing, therefore, this is an important differential diagnosis Krøll, Hammarlund, Westergaard, Nielsen, Sloth, Jensen, & Gard, (2017) performed a study on mixed headaches; the writers noted that while this type of headache is common, very little study is done, so there are not many tailored interventions exist to help the patient. Therefore, more studies are needed to help understand mixed headaches and proper medication modalities, and alternative remedies, to help alleviate and manage the pain.
Conclusion
Per Dain, Baumann, & Scheibel, “headache and nausea are associated with head trauma, stroke, and tumor.” While this may true in many cases, headaches do not seem to have a definitive cause and appear to be puzzling as some headaches have no underlying factors and give no warning. As always pain is what the patient says, so determinants are based mostly on the information provided by the patient. Therefore, asking the right questions is very important. Diagnostic tests, lab test, and physical assessment is done to ensure patient body systems; neurological functionalities are not affected as headaches could be secondary, as a result of many other medical issues; such as sinusitis, meningitis, optic neuritis, or a tumor.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Krøll, L. S., Hammarlund, C. S., Westergaard, M. L., Nielsen, T., Sloth, L. B., Jensen, R. H., & Gard, G. (2017). Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain. The Journal of Headache and Pain, 18(1), 46.
Omidi, A., & Zargar, F. (2015). Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache. Journal of Research in Medical Sciences, 20(11), 1058–1063
Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
Tai MLS, Yap JF, & Goh CB. (2018). Dietary trigger factors of migraine and tension-type headache in a South East Asian country. Journal of Pain Research, Vol Volume 11, Pp 1255-1261 (2018), 1255
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response For Below Discussion Post
/in Uncategorized /by developerAPA format 3 peer review references due 10/13/18 at 2pm EST
Patient Initials: __JH_____ Age: __60_____ Gender: ____M___
Subjective Data:
Chief Complaint: Case #3 “I have a cough that’s getting worse.” (Laureate Education, 2012).
HPI: Mr. Hendricks is a 60 year-year old Caucasian male who presents today complaining of a cough that is progressively getting worse; more frequent over the past three days. He states that his cough is accompanied by expectoration of thick green secretions accompanied by some blood at times. He has associated symptoms of shortness of breath that is aggravated when walking and nothing seems to help. Patient also states that he had difficulty trying to fall asleep last night because he felt like he was getting a fever and had intermittent chills and sweats and took Tylenol. He states “I have never felt like this before and would like to know what’s going.”
Medications: over the counter Tylenol 650mg po at nights.
Allergies: No known drug or food allergies. No seasonal allergies.
Past Medical History: No medical history provided.
Past Surgical History: No surgical history provided.
Immunization history: Up to date with immunizations. Influenza shot received September 2018. Pneumococcal vaccine received October 2018.
Personal/Social History: Patient denies smoking, drinks wine socially, exercise with brisk walking three times weekly and tries to eat a balanced diet. He has a master’s degree in finance and works as an accountant at an accounting firm. He is a safe driver who drives to work daily and always wears seatbelt. He lives with his wife who is a homemaker who helps baby sit twin granddaughters. Patient denies history of recent travel to foreign country within the three months.
Review of Systems
General: productive cough with green phlegm and blood at times; shortness of breath, chills, night sweats, fever and restlessness.
HEENT: Patient denies head or nasal congestion, headache, nasal discharge, dizziness, vertigo. Patient states productive cough with green-colored sometimes bloody phlegm.
Cardiovascular: Patient denies palpations. Has some chest tightness.
Respiratory: Patient states that he has SOB that worsens with walking. Has productive cough with green-colored sputum and occasional hemoptysis. Patient states that he hears whistling noises when he breathes.
Objective Data:
Physical exam:
General: Mr. Hendricks is a 60 year old Caucasian male and a good historian who is relatively healthy and has good hygiene. Alert and oriented x 3, looks age appropriate with normal facial expression and appropriate behavior. He coughed a few times during exam and appears to be in some respiratory distress with shortness of breath.
Vital signs: Ht. 5’9”, Wt. 210 lbs; BMI= 30, blood pressure 128/70, pulse of 82, respirations of 20 and labored, temperature of 100.9 and O2 saturation on room air of 89%.
HEENT: No headache or head masses. No lesions. Wears glasses. Pupils equal and reactive to light; ears symmetrical, no tenderness or discharge. No frontal or maxillary sinus tenderness. No discharge from nose and mucosa pink and moist. Wears partial upper dentures. Throat appears red. Good hygiene.
Neck: No masses, full range of motion. Thyroid size normal.
Integumentary: Warm and most
Respiratory: Thorax symmetrical with diminished breath sounds. B/L rales and expiratory wheezes throughout. Wet productive cough.
Cardiovascular: regular heart rate with good S1 and S2 heart sounds. No S3, S4 or murmur.
Gastrointestinal: abdomen protuberant. Normoactive bowel sounds in all four quadrants.
Peripheral vascular: No peripheral edema. 2+ dorsalis pedis pulses palpated bilaterally.
ASSESSMENT:
Lab Tests and Results:
Diagnostics:
Differential Diagnoses:
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to
physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Centers for Disease Control and Prevention (2017a). Asthma. Retrieved October 9, 2018 from:
https://www.cdc.gov/asthma/
Centers for Disease Control and Prevention (2017b). Bronchitis. Retrieved October 9, 2018
from: https://www.cdc.gov/antibiotic-use/community/for-patients/common-illnesses/bronchitis.html
Healthline.com (2018). COPD Exacerbation. Retrieved October 9, 2018 from:
https://www.healthline.com/health/copd/exacerbation-symptoms-and-warning-signs
Laureate Education. (Producer). (2012). Advanced health assessment and diagnostic reasoning.
Baltimore, MD: Author.
Mayo Clinic (2018). Pneumonia. Retrieved October 9, 2018 from:
https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204
Mount Sinai (2018). What is Bronchiectasis? Retrieved October 9, 2018 from:
http://nationaljewish.mountsinai.org/conditions-we-treat/bronchiectasis-and-ntm/
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response For Below Discussion
/in Uncategorized /by developerAPA format 3 peer references and response needs to agree or disagree with differential diagnosis and explain why
Week 9: Review of case study 1
Patient Initials: _AS__ Age: __20___ Gender: __M_
SUBJECTIVE DATA:
Chief Complaint (CC): an Unbearable headache
History of Present Illness (HPI): 20-year-old Caucasian male presented with a chief complaint of intermittent headaches. The patient reports that a headache is so bad and unrelenting that he feels it in his eyes with great intensity, nose, cheekbones, and jaw. The patient states “The headache ache comes and goes.” The patient reported that his headache started two days ago and had increased in severity of a 10/10 on the pain scale as the pressure in the eyes creating the sensitivity to light, the feeling of having toothache makes it too hard to bear. While the patient was not able to pinpoint when his headache started, he reports that he was so overwhelmed with school and work over the past couple of weeks, it may have precipitated the headache. The patient reporting taking Tylenol which is ineffective; he has tried to get more sleep and use dimmed lights while awake. He states, “while the sleeping for a longer time helps a little, the headaches return as the day progress and gradually gets worse with each passing minute. The only thing that stops the headache is passing time.”.
Medications: Tylenol 650 mg every 4 to 6 hours.
Allergies: Ibuprofen- angioedema
Past Medical History (PMH): Mumps -resolved
Past Surgical History (PSH): Appendectomy at age 16 due to a ruptured appendix.
Sexual/Reproductive History: Not sexually active.
Personal/Social History: Reports going to church on Saturdays (worship sunset to sunset), Saturday after sabbath worship; sometimes going bowling or roller skating and socializes with peers from church or school. Denies tobacco use, alcohol use, and drug use. Patient reports at least three mornings per week approximately one hour of exercise at the work gym.
Immunization History: reports immunization up to date and will get his annual flu shot at work October 25, 2018.
Significant Family History: grandfather died one year ago (72) from heart failure. Grandmother 68 alive and living with hypertension.
Lifestyle: Patient is newly as a mental health counselor at a hospital psychiatric unit. He just started studying law part-time at the local university; current course is online. He currently lives alone in a two-bedroom apartment, as parents live in another country. His support system is his family who is a phone call away, and his best friend who lives 20 minutes away from his home. He does not drink, smoke or do drugs. He attends church on Saturday. Socializes with church friends and or best friend after sunset some Saturday at the local bowling alley, skating rink, or “hang out” at a local diner. Currently is not involved in a relationship and is not sexually active.
Review of Systems:
General: Patient reports having an “unbearable headache” Patient is unaware of any changes in weight, eating preference or activities; however, reports a decrease in appetite.
HEENT: “except for the increasing headache no problem.”, reports wearing shades due to an increased sensitivity to lights; no hearing impairment; reports stuffy nose in the morning in the morning but no runny nose; denies difficulty chewing or swallowing, pain or discomfort.
Neck: Endorses stiffness, reports “may be due to tension.”
Respiratory: denies any respiratory distress
Cardiovascular: denies palpitation, denies heart problems
Gastrointestinal: Reports decreased appetite, some nausea, no vomiting no change in bowel pattern noted.
Genitourinary: No change in urinary function
Musculoskeletal: Denies problem with range of motion, walking or gait.
Psychiatric: Denies having any psychiatric history
Neurological: Reports feeling less alert, unfocused at times.
Skin: Denies any dermatological problems
OBJECTIVE DATA:
Physical Exam:
Vital signs: temp: 98.4, b/p 130/74, RR 18, pulse 88, SPO2 100% ht. 5’7” weight 140 BMI 21.9.
General: Patient is an alert and oriented *4, 20-year-old Caucasian male who appears to be in good health. He is appropriately groomed, no odor and looks clean. Erect posture, steady gait. Facial expression looks strained and sad; mood appears dysphoric. He is speaking English fluently and clearly. Voice is low and calm. Speech appear slowed and forced. The patient was able to count from 1-20 backward and repeat a series of words without hesitation. Reports having a headache for a long time, “maybe age 11, really not sure, but they weren’t this awful or frequent.”. For the past four months he has been having headaches for at least four days straight per month; but, this latest bout of headaches has been the worst experienced. He denies any head injury or trauma, and chronic illnesses. Patient report at its worst the pain is 10/10, and at its best, it is 7/10. He also states, “while I take Tylenol, I don’t think it effective; I think time passing makes it goes away, the problem is times seem to go too slow.”.
HEENT: head is symmetrical and normocephalic, no depression, swelling but reported tenderness. Denies head injury or trauma. No facial drooping, Patient endorses headache that is currently a 7/10. Reports pain is to present at forehead bilateral, temporal artery has no bruit, patient reports feeling like a “pressured weight” on his head. Patient does report some pulsating pain with movement. He also endorses feeling the pain behind the eyes, nose, cheekbones and jaw. His forehead is creased. Eyes are symmetrical. Left eye appears glossy, no crusting, no nicking of arteries, optic disc is reddish orange, no microaneurysm, neovascularization. Patient states, “pain can be felt in the eyes and vision in the left eyes sometimes vision seems blurred or doubled and funny”. On evaluation the patient can read clearly at 20/20 on the Snellen eye chart. Pupils are equal, rounded, reactive to light and accommodation. Peripheral vision is intact. No excess blinking, denies pain on examination. No wax in the ear, symmetrical, clean, no difficulty hearing bilaterally during whisper, Weber and Rinne test, no infection or lesion noted, the handle of malleus, light reflex, and the umbo is visualized as the membrane is pearly gray. Nose is midline, no stuffiness, no redness, no drainage noted. Lips are pink and moist, no cavities noted, reports last dental exam and cleaning was September 2018. Tongue is light pink and moist, no problem with swallowing, hard and soft palate gag reflex. Tongue is flexible and resistant to force. Salivary glands are functional. No pain reported on examination.
Neck: Good range of motion, lymph nodes are not palpable; however, tension can be felt in the neck, appears as if the patient has difficulty relaxing. The trachea is midline; thyroid is non-palpable.
Chest: No wheezing, rhonchi, or rales
Lungs: clear in all four quadrants
Heart: no murmurs or abnormal heart sound
Abdomen: flat and no tender, bowel sounds present in all four quadrants, no reports of difficulty in bowel movement or change in the pattern
Musculoskeletal: range of motion is good, no curvature noted. No swelling, redness or tenderness. Some stiffness in the neck but not related to the range of motion but to the patient not being able to relax/ patient is tense. No difficulty in standing, walking in a straight line, stopping or turning suddenly. Balance and gait are exceptional. Patient report having frequent muscle contraction.
Psychiatric: While presently dysphoric, no indication of depression on assessment, the patient appears future-oriented. Denies suicidal and homicidal ideation as well as auditory and visual hallucination. Headache complaint does not appear somatic.
Neurological: Cranial nerve assessment finds all nerve intact with no impairment. The patient is alert and oriented to person, place, time and situation. He can do serial addition and multiplication; repeat a series of words after having a different line of conversation. Count from 1-20 backward. No numbness or tingling in fingers, toes, or face. Muscle strength is (5) good as there is active motion against full resistance, reflex is 2+ normal. Patient can recognize writing on skin, interpret hard and soft with eyes closed. While no sensory issue is present patient reports based on the increased level of activity on the unit at the increase stimuli has been affecting his concentration; he feels overstimulated believes he cannot process new information right now, only wanting to concentrate on one task at a time. He also reiterates that bright light bothers his eyes and the combination with the increased stimulants makes the headache worst. Patient reports feeling less alert and unfocused; however, while this may occur, this neurological exam does not correlate.
24 Hour diet and activity recall: – woke 5:30 or work 8-hour work day which begins at 7 am. 10 am, Breakfast 2 boiled eggs, a slice of toast with a slice of cheese, a bowl of cereal and a glass of coffee. Lunch, chicken Caesar salad. No dinner, went straight at 4pm home after work headache was too intense. Slept for 3 hours, headache was still present but less intense, spent 4 hours on school work then went back to sleep, slept until 5:30 am, then got ready for work. Reports drinking on average four to five glasses of water per day. Patient does not cook, will sometimes eat frozen tv dinners or ramen noodles; sometimes snacks heavily, his favorite snacks are chocolate ice-cream, eclairs, Cheetos and Doritos.
Diagnostic test MRI, and or CT-scan, and complete blood count to rule out inflammation.
ASSESSMENT:
Tension Headache- Per Dains, Baumann & Scheibel, (2016) Tension headache is the most common type of headache in adults, and the pain is bilateral, and last for hours to days, and it can form a cycle that may last for months. The text also notes that factors such as stress, hunger and depression can trigger this headache. Based on information gained from AS, stress is likely a contributing factor to AS headaches. However, results from imaging and testing are needed to determine his type of headache. In a randomized clinical study conducted by Omidi, & Zargar, (2015) they found that the use of psychotherapy dubbed mindfulness-based stress reduction was helpful in reducing pain and stress and would be a useful tool in relieving the tension headache.
Migraine- Per Dains, Baumann & Scheibel, (2016) migraine without aura is seen in 20% of the population, has a unilateral throbbing pain with symptoms of nausea and photophobia. According to Tai, Yap, & Goh, (2018) dietary intake can trigger migraine headaches. They conducted a study that found that coffee, chocolate and monosodium rich foods such as broth, flavored snacks, frozen foods, and pasta sauce can trigger a migraine. It is clear from AS description he is experiencing throbbing pain and is experiencing nausea and photophobia, however, he does states that his headache is bilateral. Hence a leaning towards mixed headache diagnosis. However, this differential diagnosis cannot be ruled out as the patient may also have a migraine with aura as well. In any event, diet change and food choices must be discussed with the patient has some of AS choices is likely a trigger to his headache.
Mixed headache- According to Dains, Baumann, & Scheibel, (2016) is a combination of tension and migraine whereby the effect is a combination of throbbing, tightness, pressure and constant pain is felt. Based on AS description this may be what he is experiencing, therefore, this is an important differential diagnosis Krøll, Hammarlund, Westergaard, Nielsen, Sloth, Jensen, & Gard, (2017) performed a study on mixed headaches; the writers noted that while this type of headache is common, very little study is done, so there are not many tailored interventions exist to help the patient. Therefore, more studies are needed to help understand mixed headaches and proper medication modalities, and alternative remedies, to help alleviate and manage the pain.
Conclusion
Per Dain, Baumann, & Scheibel, “headache and nausea are associated with head trauma, stroke, and tumor.” While this may true in many cases, headaches do not seem to have a definitive cause and appear to be puzzling as some headaches have no underlying factors and give no warning. As always pain is what the patient says, so determinants are based mostly on the information provided by the patient. Therefore, asking the right questions is very important. Diagnostic tests, lab test, and physical assessment is done to ensure patient body systems; neurological functionalities are not affected as headaches could be secondary, as a result of many other medical issues; such as sinusitis, meningitis, optic neuritis, or a tumor.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Krøll, L. S., Hammarlund, C. S., Westergaard, M. L., Nielsen, T., Sloth, L. B., Jensen, R. H., & Gard, G. (2017). Level of physical activity, well-being, stress and self-rated health in persons with migraine and co-existing tension-type headache and neck pain. The Journal of Headache and Pain, 18(1), 46.
Omidi, A., & Zargar, F. (2015). Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache. Journal of Research in Medical Sciences, 20(11), 1058–1063
Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
Tai MLS, Yap JF, & Goh CB. (2018). Dietary trigger factors of migraine and tension-type headache in a South East Asian country. Journal of Pain Research, Vol Volume 11, Pp 1255-1261 (2018), 1255
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response For Below Discusssion Post
/in Uncategorized /by developerAPA format 3 references 1 from walden library, 1 page long
Learning activity for Scenario Two
Learning needs
In this scenario, type I and type II diabetic patients will need education on the benefit and use of an insulin pump. When compared to insulin injections, a pump more closely mimics the bodies pancreas in supplying a continuous infusion of insulin (Reece & Hamby Williams, 2014).
Learning objectives
The learning objectives are defined as “specific, measurable, achievable, realistic and timebound” (McKimm & Swanwick, 2009, p. 409). When developing objectives for educating patients on insulin pump use, it is important to address adjustment of pump setting, counting carbohydrates, ability to troubleshoot pump, and recognition of complications, such as diabetic ketoacidosis (Reece & Hamby Williams, 2014).
Learner centered activity
Being that the audience for this course will be already diagnosed diabetics with a basic understanding of the disease and treatment, it would be appropriate to adapt a learner centered course with unstructured learning experiences. Once acquiring the knowledge of how the pump is set up and attached, patients would follow an unstructured learning experience and be asked to “apply their previous experiences …to a situation of their choice” (Billings & Halstead, 2016, p. 164). This type of learning motivates learners to retain knowledge, promotes critical thinking, and apply the information to real life scenarios (Billings & Halstead, 2016).
Measuring learning objectives
One method to measure if the learning outcomes are met, is to provide a post class survey to participants. This patient feedback would provide the information needed to determine if learning objectives were met. The survery would specifically ask if patients felt comfortable managing their insulin pump, if their questions were answered, and if they have the tools needed to improve their glycemic control (Reece & Hamby Williams, 2014).
References
Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). St. Louis, MO: Elsevier.
Reece, S. W., & Hamby Williams, C. L. (2014). Insulin Pump Class: Back to the Basics of Pump Therapy. Diabetes spectrum : a publication of the American Diabetes Association, 27(2), 135–140. doi:10.2337/diaspect.27.2.135
McKimm, J., & Swanwick, T. (2009). Setting learning objectives. British Journal of Hospital Medicine, 70(7), 406–409.
REPLY QUOTE EMAIL AUTHOR
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response For Below Discusssion
/in Uncategorized /by developerAPA format for SOAP NOTE 3 peer review articles 1 and half pages long please follow below instructions
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
case Study #3 Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked
S
Cc: “Earache right ear”
HPI: Patient is an 11-year-old Caucasian boy who was brought in by his grandmother after complaining about having a mild earache for the past two days. Patient states that the pain is worse when he falls asleep and that it has become harder for him to hear, grandmother believes that he feels warm but has not taken his temperature
Medications: Patient does not take any medications
PMH: No significant illnesses, shots are up to date
FH: No history of previous ear concerns no family history of ear disease. During the school year, patient lives at home with his mother, father and he does not have pets. Patient is staying with grandmother and grandfather most of summer
SH: Student in public school and is currently on summer break, has been spending a lot of time this summer in the pool per his grandmother that he is spending the summer with.
ROS: general: negative for chills fever currently
EENT: complains of mild right ear pain and mild hearing loss, denies tinnitus, denies pain in throat, or eye pain
O
VS: T 100.8, P 94, R 18, BP 98/64
General: Patient appears to be in mild pain, holding head to right side slightly
HEENT: right tympanic membrane obscured, ear canal is read and has a musty odor from ear canal with small amount of watery drainage, head is normocephalic without signs of trauma, no nasal drainage, PEARL, no complaints of sore throat, no redness in throat
SKIN: Warm and dry, good skin turgor, prominent tan
NECK: No lymph node edema or signs of pain on palpation
NEUROLOGICAL: No complaints of headache or dizziness
Diagnostic results. WBC slightly elevated, low grade temp
A
Differential Diagnoses:
1) Acute Otitis Externa
2) Acute Otitis Media
3) Pharyngitis
Primary diagnoses/presumptive diagnoses: Acute otitis media
P – not indicated per template
Assessing for a possible ear infection would require additional information from the patient in addition to a physical assessment of the ear and the patient. Obtaining background information including recent travel, activities, family history, trauma, history of previous illnesses and treatments that have been used for treatment that were successful or not successful.
Diagnostic studies used to diagnose the specific pathogen would include obtaining a culture of purulent drainage, simple otoscopy was mostly used for diagnosing AOM (D’silva, 2013) or a more invasive way of evaluating white blood cell elevation is by completing a CBC which is not used as often as visual inspection of the ear canal. White blood cell count (WBC), a classical inflammation marker, is also used in many scoring systems during routine daily clinical practice (Kutlucan et al., n.d.). Using data from a CBC can also provide information about the patient’s overall health.
Otitis externa
Acute otitis externa is the most common infection of the external auditory canal (Demirel et al., 2018). Ball describes (2015) symptoms of otitis externa as having watery to purulent and thick drainage mixed with pus with a musty odor and usually occurs after swimming.
Acute otitis media
Acute otitis media is one of the most frequent bacterial infections in children, and one of the primary reasons for the prescription of antibiotics by pediatricians (Intakorn, n.d.). Otitis media can have an abrupt onset with fever, feeling of a blockage, and interferes with sleep. The middle ear fills with pus causing conductive hearing loss (Ball).
Acute pharyngitis:
Acute respiratory infections are one of the most common diseases, accounting for one of the main causes of patient visits to community health centers and hospitals (Yuniar, 2017). Ball (2015) describes a patient with acute pharyngitis as having a sore throat with deferred pain in ears and dysphagia with fever, malaise, fetid breath, abdominal pain and headache.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., Stewart, R. W. (2015). Seidel’s guide to
physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Demirel, H., Arlı, C., Özgür, T., İnci, M., & Dokuyucu, R. (2018). The Role of Topical
Thymoquinone in the Treatment of Acute Otitis Externa; an Experimental Study in
Rats. Journal of International Advanced Otology, 14(2), 285–289. https://doi-
org.ezp.waldenulibrary.org/10.5152/iao.2017.4213
D’silva, L., Parikh, R., Nanivadekar, A., & Joglekar, S. (2013). A Questionnaire-Based Survey
of Indian ENT Surgeons to Estimate Clinic Prevalence of Acute Otitis Media, Diagnostic
Practices, and Management Strategies. Indian Journal of Otolaryngology & Head & Neck
Surgery, 65, 575–581. https://doi-org.ezp.waldenulibrary.org/10.1007/s12070-012-0545-2
Intakorn, P., Sonsuwan, N., Noknu, S., Moungthong, G., Pircon, J.-Y., Liu, Y., … Hausdorff, W.
P. (n.d.). Haemophilus influenzae type b as an important cause of culture-positive acute
otitis media in young children in Thailand: a tympanocentesis-based, multi-center, cross-
sectional study. BMC PEDIATRICS, 14. https://doi-org.ezp.waldenulibrary.org
/10.1186/1471-2431-2431-14-157
Kutlucan, L., Kutlucan, A., Basaran, B., Dagli, M., Basturk, A., Kozanhan, B., … Kos, M. (n.d.).
The predictive effect of initial complete blood count of intensive care unit patients on
mortality, length of hospitalization, and nosocomial infections. EUROPEAN REVIEW
FOR MEDICAL AND PHARMACOLOGICAL SCIENCES, 20(8), 1467–1473.
Retrieved from
https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=t
rue&db=edswsc&AN=000380260000006&site=eds-live&scope=site
Yuniar, C. T., Anggadiredja, K., & Islamiyah, A. N. (2017). Evaluation of Rational Drug Use for
Acute Pharyngitis Associated with the Incidence and Prevalence of the Disease at Two
Community Health Centers in Indonesia. Scientia Pharmaceutica, 85(2), 1–10.
https://doi-org.ezp.waldenulibrary.org/10.3390/scipharm85020022
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response For Below Post 19225811
/in Uncategorized /by developerAPA format 1 page with 3 references one from the reference at end of post.
Due 5/11/19 1200 EST
When looking to establish an evaluation model, it is necessary to look at the curriculum design and analyze its effectiveness (Billings & Halstead, 2016). Our team selected both formative and summative models of evaluation. Formative evaluation occurs during the individual sessions, allowing the educator and learner to give feedback on the curriculum as it is presented (Klenowski, 2010). The summative evaluation looks at our program as a whole, and looks at adherence of program mission, vision and philosophy.
The two curriculum components to include in the evaluation model are those of organization and goals. Our curriculum sessions are organized in logical order; we establish a simple to complex model of learning. When evaluating our sessions, we would look at “increasing depth and complexity to determine whether the sequencing was useful to learning and progressed to the desired (program) outcomes” (Billings & Halstead, 2016, p. 475). In addition, with a summative model, evaluating if the program goals have been met at the conclusion of the program will look at the effectiveness of the curriculum (Klenkowski, 2010).
As a Community Health Accreditation Partner (CHAP), our facility meets the requirements for accreditation, specifically adequate management of pain (CHAP, 2017). The program we have developed will cover the educational needs of the family and caregivers, as well as provide hospice nurses with the necessary tools to implement and evaluate the management of pain in the home.
References
Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed.). St. Louis, MO: Elsevier.
Community Health Accreditation Partner. (2017). Standards of excellence: Hospice. Retrieved from https://education.chaplinq.org/chap-standards-of-excellence
Klenowski, V. (2010). Curriculum Evaluation: Approaches and Methodologies. Elsevier, Inc. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=edsgvr&AN=edsgcl.1504700072&site=eds-live&scope=site
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response For The Below Case Study Discussion
/in Uncategorized /by developerAPA format 3 peer references and discussion needs to be related to what is posted as response to the persons diagnosis
Patient Initials: RF Age: 15 Gender: M
SUBJECTIVE DATA:
Chief Complaint (CC): A dull pain in both knees with occasional clicking in one or both knees and the sensation of the patella catching.
History of Present Illness (HPI): RF is a 15-year-old male who reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. He states that the pain has been on and off for the last four months and initially only present after intense activity but has gotten worse since starting track this summer and seems to be present more often than before.
The patient states that the clicking comes and goes and isn’t always present in both knees at the same time. The catching sensation under the patella is more pronounced since he started doing the long jump in track. The patient states that he is able to bear weight as the pain is a dull ache. Icing his knees after sports and taking ibuprofen help to reduce the pain and swelling but both occur more frequently now making it difficult to participate in sports. The patient feels that he may be overdoing it with all of the sports he participates in and is worried about not being able to play soccer if it continues to get worse. The patient rates the pain 7/10 after intense activity.
Medications: Ibuprofen 200 mg oral tab, two tabs every 6 hours as needed for pain.
Allergies: No known drug, food, or environmental allergies.
Past Medical History (PMH): None
Past Surgical History (PSH): None
Sexual/Reproductive History: Patient is not sexually active at this time.
Personal/Social History: Patient denies smoking, alcohol use, and illicit drug use. The patient is very active with sports playing soccer, basketball, baseball, and track. He states that he tries to eat well mainly because of sports but doesn’t always make the best choices for snacks. He tries to avoid soda most of the time and reports drinking a lot of water.
Immunization History: Immunizations are up to date. Gets influenza vaccine annually.
Significant Family History:
Paternal grandfather has hypertension, and father has borderline hypertension. Maternal grandfather has type II diabetes.
Lifestyle: RF is a freshman in high school who lives with both of his parents and older sister. RF plays soccer, basketball, baseball and participates in track for high school. RF also plays club soccer playing and traveling most of the year. RF is a good student, athletic, and enjoys being active. He also participates in winter sports and skis during winter break. RF works part-time as a referee during the summers due to his commitment to school and sports.
Review of Systems:
General: No recent weight gain or loss of significance. Patient denies fatigue, fever, or chills.
HEENT: No headaches or dizziness. No changes in vision. He does not wear glasses, and his last eye exam was just under a year ago. Denies eye drainage, pain, or double vision. No changes in hearing. Has had no recent ear infections, tinnitus or ringing in the ears. Denies sinus infections, congestion, and epistaxis. He reports his sense of small is intact. Last dental exam was four months ago for regular cleaning. Denies bleeding gums or a toothache. Denies dysphagia or throat pain.
Neck: No history of trauma, denies recent injury or pain. He denies neck stiffness.
Breasts: Denies any breast changes. Denies history rashes. Denies history of masses or pain.
Respiratory: Denies a cough, hemoptysis, and sputum production. Patient denies any shortness of breath with resting or with exertion. Patient reports no pain with inspiration or expiration.
Cardiovascular/Peripheral Vascular: No history of murmur or chest palpitations. No edema or claudication. Denies chest pain. No history of arrhythmias.
Gastrointestinal: Denies nausea or vomiting. Patient reports no abdominal pain, diarrhea, or constipation. Last bowel movement was this morning. Denies rectal pain or bleeding. Denies changes in bowel habits. Denies history of dyspepsia.
Genitourinary: Denies changes in urinary pattern. No incontinence, no history of STDs or HPV, the patient is heterosexual and not sexually active. Denies hematuria. Denies urgency, frequency, and dysuria.
Musculoskeletal: No limitation in range of motion for all limbs though patient reports difficulty moving knees after excessive strain from sports. No history of trauma or fractures. Patient reports dull pain in both knees. The patient states occasional swelling in knee joints after participating in sports. Patient reports clicking in one knee and sometimes both. The patient states that the pain is worse after participating in the long jump or running long distances. Patient denies history or presence of misalignment of either knee.
Psychiatric: Denies suicidal or homicidal history. No mental health history. Denies anxiety and depression.
Neurological: No dizziness. No problems with coordination. Denies falls or seizures. Denies numbness or tingling. Denies changes in memory or thinking patterns.
Skin: No history of skin cancer. Denies any new rashes or sores. Patient reports many blisters from sports which are treated with Neosporin, band-aids, and NewSkin spray. Denies eczema and psoriasis. Denies itching or swelling.
Hematologic: No bleeding disorders or history of blood transfusion. Denies excessive bruising.
Endocrine: Patient reports no endocrine symptoms. Denies polyuria, polydipsia. Patient denies no intolerance to heat or cold.
Allergic/Immunologic: Denies environmental, food, or drug allergies. No known immune deficiencies.
OBJECTIVE DATA:
Physical Exam:
Vital signs: B/P 118/74; P 65 and regular; T 98.6; RR 16; O2 100% on room air; Wt: 125 lbs.; Ht: 5’7”; BMI 19.1
General: RF is a well-developed, well-nourished Caucasian teenage male who appears to be in no apparent distress.
HEENT: Head: Skull is normocephalic, atraumatic. No masses or lesions.
Eyes: PERRLA, +direct and consensual pupil response. EOM intact, 20/20 vision bilaterally without correction. Fundoscopic exam normal, vessels intact, the optic disc with clear margins.
Ears: Bilateral external ears no lesions, masses, drainage or tenderness. Tympanic membranes intact, pearly gray, no bulging, no erythema, and landmarks appreciated bilaterally. Hearing intact bilaterally.
Nose: No nasal flaring, no discharge, no obstruction, septum not deviated. Turbinates pink and moist. No polyps or lesions bilaterally. Nares patent with no edema or erythema.
Throat: Oropharynx clear and mucosa moist. No erythema or exudate. Uvula midline, palate rises symmetrically.
Mouth: No lesions, no thrush. Moist mucous membranes. Healthy dentition present. Tongue midline.
Neck: Supple, non-tender. Full range of motion. Trachea midline. No masses. Thyroid and lymph nodes not palpable.
Chest/Lungs: Thorax non-tender with symmetric expansion. Respiration regular and unlabored, without a cough. Tactile fremitus equal bilaterally and greater in upper lung fields. Breath sounds clear with adventitious sounds. All lung fields with resonant percussion tones.
Heart: Regular rate and rhythm; normal S1, S2; no murmurs, rubs, or gallops. Apical pulse not visible. Apical pulse was barely palpable. JVP appears to be approximately less than 6 cm with HOB elevated to 45 degrees. No carotid bruits or JVD appreciated.
Peripheral Vascular: Pulses 2+ bilateral pedal and 2+ radial bilaterally. No pedal edema. Popliteal pulses 2+ bilaterally.
Abdomen: Abdomen round, soft, and non-tender without rash, palpable mass or organomegaly. Active bowel sounds. Tympany over most quadrants with areas of dullness noted upon percussion. No abdominal bruits.
Genital/Rectal: Adequate tone, no masses noted, eternal genitalia intact.
Musculoskeletal: Normal passive and active ROM in upper and lower extremities. No focal joint inflammation or abnormalities appreciated in upper extremities. + tenderness to palpation at the inferior pole of the patella bilaterally. + Q angle greater than 10 degrees bilaterally. Clicking present with movement in right knee. Normal alignment of the knees bilaterally. All upper and lower extremity joints without effusions or erythema. Spine without tenderness and range of motion is full. Greater tenderness was noted in knees bilaterally when extended, and quadriceps are relaxed. Normal muscle strength present against resistance.
Neurological: CN ll-Xll grossly intact. Awake, alert, and oriented to person, place and time. The patient can move all limbs on command and spontaneously.
Skin: Warm, moist, and intact. Skin is pale. + edema right knee. No peripheral cyanosis. No clubbing. No rashes or bruises present.
ASSESSMENT:
Lab Tests and Results:
CBC- Normal
Erythrocyte sedimentation rate (ESR) – Normal
Diagnostic test:
Passive extension-flexion sign- positive- which is tenderness on palpation of the tendon at the inferior pole of the patella.
McMurray test- Negative for locking during joint movement.
X-ray- negative
MRI- Showed high signal intensity within the proximal posterior central aspect of the tendon at its origin.
Differential Diagnosis:
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Huether, S. E., & McCance, K. L. (2017). Disorder of the joints. In alterations of musculoskeletal function (6th ed., pp. 991-1038).
Rath, E., Schwarzkopf, R., & Richmond, J. (2010). Clinical signs and anatomical correlation of
patellar tendinitis. Indian Journal of Orthopaedics, 44(4), 435-437 3p. doi:10.4103/0019-
5413.6931
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response To Below Discussion 18955787
/in Uncategorized /by developerAPA format 2pages with 3 peer review references Due Friday 8/31/2018 at 7pm EST Will pay 15 dollars
Collecting Comprehensive Health Assessment
The United states census Bureau’s 2009 data revealed that 37% of individuals age 65 and older have disabilities. This includes adults with disabilities who developed in old age and those who lived with disability from birth or have acquired disability in younger or middle years (Hahn, Aronow, Rosario, & Guenther, 2013). According to Ball, Dains, Flynn, Solomon & Stewart, 2014 the primary objective of the clinician when conducting an interview and physical assessment on a patient, is to discover the details about a patient’s concern, explore expectations, identify underlying worries, and believing them which optimizes your ability to help them. It is important to adapt to the needs of all patients of any age with disabling physical or emotional states (Ball et al., 2015).
Selected Patient for Face-to-Face Interview and Assessment
As a clinician building a health history on a 76-year-old Black/African American male with disabilities living in an urban setting. It is important to be sensitive to cultural differences that may exist between you and the patient that can help avoid miscommunication. To build health history based on ethnicity and to avoid stereotype, when necessary clinicians should modify their habits to foster effective communication, because your first meeting with the patient set the tone for success. Also, the clinician should be honest, flexible and have a desire to help (Ball et al, 2015). When you first enter the patient’s, space be respectful by greeting the patient, introduce yourself and state the reason for your visit. Acquire written or verbal consent from the patient to collect health history and to conduct an interview. If possible conduct the interview in an uncluttered quiet area. Have the patients’ health record available and utilize all healthcare professionals involved in this patient’s care. Because the patient may lack the ability to give accurate history, having a family member present with the patient’s permission during the interview helps the patient to be more comfortable to provide needed information (Ball et al., 2015). It is important to sit in front of the patient at eye level, speak slowly, clearly and enunciate each word in the patients view for patients with hearing and visual disability (Ball et al., 2015). To conduct the interview, it is important to have written open-ended questions that are short, uncomplicated and pertinent to the patient to avoid overwhelming and confusion. History on the elderly can be more complex so guiding techniques can be used to obtain important information (Kahn et al., 2013).
Health Related Risk
Frailty is increasingly common among our aging population. Assessing level of frailty is very important, because it has a significant impact on individuals and society with increased risk of dependency, disability, hospitalization, institutional placement, and mortality (Harttgen, Kowal, Strulik, Chatterji, & Vollmer 2013). Frailty is characterized by weakness weight loss and low activity. It is considered an at-risk state caused by age –associated accumulation of deficits (Ball et al., 2015). Functional impairment must be assessed.
Functional Mobility Assessment Screening Tool
Functional assessment must be address for the disabled patient by assessing their health risk. Assessing the patient’s ability to perform activities of daily living (ADL), and cognitive, psychological social and sexual limitation should be completed on all older adults or a disabled patient (Ball et al., 2015). Does the patient has difficulty walking standard distance (0 feet or 2 to 3 blocks), difficulty climbing stairs (up and down), difficulty holding and opening small objects, needs assistance with house-keeping, shopping, money management, meal preparation and assistant eating. Interviewer must keep in mind that the patients will hide or overstate their abilities (Ball et al., 2015).
Conclusion
To build a health history as it relates to ethnicity, information about personal and social history is important to address cultural background, practices, home environment as a youth, education, occupation, current health habits, health coverage and concern about healthcare cost should be collected to avoid the stereotype as they influence the health problem on the patient’s life (Ball et al., 2015). Understanding a person’s life and daily routine can help you to understand how your patient’s lifestyle might affects his healthcare. Also understanding an older patient usual level of functioning and knowing about any recent significant changes are important to providing appropriate healthcare (Paula, Krzysztof, & Ewa, 2018).
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to
physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response To Below Discussion 18955817
/in Uncategorized /by developerAPA format 1 page 3 References (peer review) and for Nursing MSN class
Building a Health History
As a nurse practitioner, it is important to understand that many considerations have been considered when assessing patients as no two individuals are the same. Therefore, consideration should be given to the differences in the patient. These differences are not limited to race, culture, age, gender, and socio-economic background. Per Donnelly & Martin (2016) in obtaining a proper assessment of a patient leads to proper treatment of the patient.
Considering Each Case History
In building a health history, consideration should be like each of the demographic population. Different interviewing and assessment techniques that will allow them to be comfortable and willing to share the necessary information that will build their health history. For instance, when assessing a seventy-six-year-old black male with disabilities living in an urban setting, these factors should be noted, age, demographic, cognitive awareness, and lifestyle, the same can be said for all the other case history. The seventy-six-year-old male will require the nurse practitioner to be focused on then when speaking. They should speak slowly and with clarity, and properly pronouncing words, as the patient may have a problem processing conversation quickly. According to Ball, Dains, Flynn, Solomon & Stewart (2015), the adolescent boy may need time to open, so the interview and assessment process should not be rushed. The fifty-five-year-old Asian female living in a high-density poverty complex will need to be addressed with respect. The nurse practitioner should understand that the pre-school age white female living in a rural community may need communication through play to alleviate their fears. The sixteen-year-old teenager living in an inner-city neighborhood will need reassurance and non-judgmental evaluation. Understanding age, gender, ethnicity, and environment will allow the practitioner to know how to approach each patient case.
Risk assessment Instruments
There are many risk assessment instruments that can be used for screening. These are important in building the foundational health history as it can show the progression of patient development as well as decline. In the evaluation of the patient who is seventy-six-year-old male is, a fall risk assessment would be appropriate, questions regarding last fall if any, and type of medications. An STD screening would be appropriate for the adolescent Hispanic/ Latino boy asking a question regarding sexual activity and how many sexual partners. A TB and pneumonia screening should be done for the Asian female asking question relating to exposure and symptoms. For the pre-school age white female would benefit from a developmental screening, parents involvement is usually necessary as answers to the question relating to achievement of the milestone is gained through them; and, the pregnant sixteen-year-old could do a prenatal and nutrition screening, questions relating to nutrition, supplements, feelings regarding pregnancy.
Pregnant at Sixteen in the Inner-city
According to According to Ball, Dains, Flynn, Solomon & Stewart (2015), using effective tools is helpful in gaining the most information necessary information to build not only a positive relationship; but, also necessary heal history. One of the screening that could be used for the 16-year-old white pregnant teenager living in an inner-city neighborhood would be HEEADSSS (home environment, education, eating, activities, drugs, sexuality, suicide/depression, safety from injury and violence). This instrument is appropriate for this patient for many reasons, given that at this age and stage of development and background patient may be having an identity crisis, unsure about her pregnancy, and uncertain home environment as well as any or all the other issues in the screen tool. The risk assessment instrument could include an HIV risk assessment as at this teenager was likely engaging in an unprotected sexual activity. As there may be limited knowledge about the potential father, doing an HIV risk assessment can help to protect the fetus from possible infection. Proper screening is important as highlighted by Duberstein and Jerant (2014) journal article regarding suicide prevention; whereby the lack of proper screening as let to a steady incline of suicide rates.
Five Targeted Questions
Asking targeted question will allow the provider the capability to expand the interaction, promoting follow-up questions and gaining more information.
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Donnelly, M., & Martin, D. (2016). History taking and physical assessment in holistic palliative care. British Journal of Nursing, 25(22), 1250.
Duberstein, P., & Jerant, A. (2014). Suicide Prevention in Primary Care: Optimistic Humanism Imagined and Engineered. JGIM: Journal of General Internal Medicine, 29(6), 827. doi:10.1007/s11606-014-2839-4
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response To Below Discussion 18962067
/in Uncategorized /by developerAPA format 1 and half pages long MSN degree 3 peer review references
Week 2-Main Post-Jamie Michalski
Diversity and Health Assessments
Caring for patients in healthcare today, providers will encounter many different patient populations that come from a diverse set of cultures, lifestyles, and backgrounds that have beliefs and practices regarding health and illness which may be different from the provider. Providers must first examine their own beliefs, values, and culture for self-awareness and to examine for potential bias. Approaching individuals from a variety of cultures and backgrounds also requires flexibility and the ability to adapt the health history and physical exam to the patients’ needs or culture. Having an understanding of the patient’s beliefs, lifestyle, culture, and background and how they impact the patient is necessary for providers to provide culturally competent care.
The patient selected for this discussion is MR, a 23-year-old male patient, complaining of anxiety.
Identifying Information: MR is a 23-year-old Native American male seen in the office on September 5, 2018. The history is obtained from both a written questionnaire filled out before the visit and from the patient, and he is considered a reliable historian.
Chief Complaint–“I’ve been anxious lately and used both pot and alcohol to help me feel better” and is concerned about “not getting into heaven.”
History of Present Illness: a 23-year-old male patient that uses both marijuana and alcohol for anxiety symptoms. MR describes the anxiety as starting when he lost his job one month ago. MR describes the anxiety occurring on 4-5 days during the week, and MR describes it as a “feeling of fear about providing for my family,” and on 4-6 days/per week he uses alcohol and smoking “pot” to “feel better.”
Current Medications-None
Family History- Diabetes-Father, Hypertension-Mother, and Alcoholism-Father.
Social History-smokes marijuana –per patient written questionnaire: typical amount described as 1 “joint”; with use of 6-7 times per month. Drinks alcohol, described as beer; amount varies from 36-64 ounces 3-6 times per week. Occasional use of liquor; the typical amount is 3-8 ounces per week usually with beer. Smokes cigarettes with a six pack year history.
Questions to ask MR:
Native American patients may have a lower socioeconomic status with the median annual household income is $ 37,353 for Native American households compared to $ 56,565 for non-Hispanic whites (US Department of Health and Human Services [HHS], Office of Minority Health [OMH], 2018). Patients with lower socioeconomic status may not seek medical care due to lack of insurance, ability to pay insurance premiums, have transportation issues, not fill prescription medications, or take prescribed medications sparingly with the belief to “make the medication last longer.”
Native American patients’ spirituality is also a cultural factor that requires cultural competence for the practitioner to understand how the patients’ spiritual practices influence his care and how the provider can assist the patient. The practitioner must have an understanding of the relationship between spiritual beliefs and health practices and how beliefs relate to illness, health, family, symbols, and taboos (Sullivan, 2012). The patient’s spiritual belief may include that mental health issues are viewed as spiritual punishment that is unable to be healed.
Native American patients have twice the rate of diabetes than non-Hispanic white patients (HHS, OMH, 2018). The influence of both smoking cigarettes, marijuana and a family history of diabetes and hypertension concerns for the development of diabetes and hypertension in the future.
The Native American culture has undergone a significant shift in the past 30 years. Nearly 60% of Native Americans now live in major metropolitan areas, and 22% still live on reservations (HHS, OMH, 2018). This shift from reservations to metropolitan areas has changed the Native American lifestyle and culture which strives to find harmony and live with nature (Ball, Dains, Flynn, Solomon & Stewart, 2015). Native Americans have higher rates of alcoholism, and chronic liver disease either from alcoholism, obesity, and exposure to hepatitis B and C virus is the leading cause of death (HHS, OMH, 2018).
References
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.) St. Louis, MO: Elsevier Mosby
Sullivan, D. D. (2012). Guide to clinical documentation (2nd ed.). Philadelphia, PA: F. A. Davis.
US Department of Health and Human Services, Offices of Minority Health. (2018). Profile: American Indian/Alaskan Native Profile. Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=62
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"
Need Response To Below Discussion 19014077
/in Uncategorized /by developerAPA format 3 peer review references Response needs to be why you disagree or agree with diffential diagnosis and why
Patient Information:
TB, 20-year-old, Male, Caucasian
S.
CC Intermittent headaches.
HPI: T.B. is a 20-year-old Caucasian male who presents with intermittent, diffuse headaches. His headaches have been occurring every week or so since Spring, 2018. These headaches last for 2 to 3 days and occur over entire head but is worse above the eyes and radiates the nose, cheekbones, and jaw. The pain is described as a pressure that is intense above the eyes. There are no associated signs or symptoms, other than mild relief when enters a dark room. T.B has not discovered a condition that makes headaches occur or worsen. Currently, the pain is rated as 7/10 pain scale.
Current Medications: Intermittent Acetaminophen Extra Strength 2 several times a day with headaches
Allergies: None is known to date.
PMHx: Reports has received all recommended immunizations and last tetanus is in 2016. Appendectomy at age 15.
Soc Hx: Patient is a part-time student at local community college and works part-time as a Barista. He denies tobacco or recreational drug use, no alcohol use since 2017 in high school. He reports recently beginning to vape. He lives with a roommate in an apartment and reports has been more active as walks 3 miles daily to work and school.
Fam Hx: Mother is living and in good health. Father has not been in the patient’s life since infancy. Sister was diagnosed with epilepsy several years ago. Patient reports no known family history of cancer or neurological issues
ROS:
GENERAL: Patient reports no weight loss or fever
HEENT: Eyes: Patient reports no visual changes
Ears, Nose, Throat: Patient reports no hearing loss, congestion, runny nose or sore throat.
SKIN: Patient reports no rash or itching.
CARDIOVASCULAR: Patient reports no chest pain, chest pressure or chest discomfort.
RESPIRATORY: Patient reports no shortness of breath, cough or sputum.
NEUROLOGICAL: Patient reports no dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities.
LYMPHATICS: Patient denies knowledge of enlarged nodes. No history of splenectomy.
PSYCHIATRIC: No history of depression or anxiety reported.
ENDOCRINOLOGIC: No reports of sweating, cold or heat intolerance. No polyuria or polydipsia reported.
ALLERGIES: No history of asthma, hives, eczema or rhinitis reported.
O.
Physical exam:
Diagnostic results: MRI should be considered to determine if there is a demyelinating disease or tumor triggering pain. There is no actual diagnostic tool for trigeminal neuralgia temporal, but other causes should be ruled out (Ball, Dains, Flynn, Solomon, & Stewart, 2015).
CT Scan could be ordered if felt to be sinusitis that does not respond to conservative or antibiotic treatment can lead to rare but dangerous sphenoid sinusitis affecting nerves (Velayudhan, Chaudhry, Smoker, Shinder, & Reede, 2017). CT scan is preferred over MRI for sinusitis diagnosis.
A dental referral would be recommended if another diagnosis is ruled out or pain has oral pain or sign of dental inflammation.
Additional questions for the patient would be
Do you associate the pain with a specific event or timing?
How long have you experienced this pain?
Is the pain increasing, decreasing, or staying the same?
What makes the pain better?
Have you experienced similar pain before?
Do you have pain with chewing?
Do you grind your teeth?
Do you have nasal or postnasal drainage?
Do you have a fever?
A. Headache with facial pain
Differential Diagnosis:
Trigeminal neuralgia temporal: The trigeminal nerve sends impulses to the upper, middle, and lower portions of the face. In this case, more than one nerve branch may be irritated and sending signals of pain to the upper head and the middle including the nose, cheekbones, and jaw. It is possible for this pain to be bilateral (National Institute of Neurological Disorders and Stroke, n.d). Some possible triggers of trigeminal pressure might be pressure from blood vessels or rarely a tumor. Another trigger could be demyelination, such as Multiple Sclerosis (MS). Ball, Dains, Flynn, Solomon, & Stewart (2015) report this condition occurs in older patients. An MRI should be considered to determine if another diagnosis such as MS is triggering the pain.
Headache due to reaction from electric cigarette/Vaping. Cai & Wang (2017) shared the strong evidence of neurological effects from e-cigarette solvents and flavor additives. The substances produced from vaping are acrolein, glycerol, propylene oxide, ethyl, ethyl matol, and methol which are toxic and related to neurological issues. Li, Zhan, Wang, Leischow, and Zeng (2016) reported severe headaches occurred after e-cigarette use due to high nicotine and propylene glycol. Fruit flavors also contributed
Sinusitis: The frontal sinuses lie above the eyes which could contribute to the primary site of pain. The maxillary sinus could be inflamed causing the upper jaw, teeth, nose and cheek pain. One concern is sinusitis typically has postnasal discharge (Ball, Dains, Flynn, Solomon, & Stewart, 2015)
Tension-type headache (TTH): A primary symptom of TTH is a hatband pain distribution (Ball, Dains, Flynn, Solomon, Stewart (2015). Although rare, Wagner and Moreira Filho (2018) studied a TTH combined with temporomandibular junction sleep bruxism occurs during periods of anxiety. This combined scenario could reflect the upper eye and jaw, cheek pain.
Dental Caries or Malocclusion: Ball, Dains, Flynn, Solomon, and Stewart (2015) reports dental disease is a primary source of pain in the jaw, but also could cause pain at top of the head. In our patient’s case, the pain starts below the forehead and radiates lower making this diagnosis less likely.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Hua Cai, & Chen Wang. (2017). Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns. Redox Biology 3(C) 402-406 https://doi-org.ezp.waldenulibrary.org/10.1016/j.redox.2017.05.013
Li, Q., Zhan, Y., Wang, L., Leischow, S. J., & Zeng, D. D. (2016). Analysis of symptoms and their potential associations with e-liquids’ components: a social media study. BMC public health, 16, 674. doi:10.1186/s12889-016-3326-0
National Institute of Neurological Disorders and Stroke. (n.d). Trigeminal neuralgia fact sheet. Retrieved from https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Trigeminal-Neuralgia-Fact-Sheet
Velayudhan, V., Chaudhry, Z. A., Smoker, W. R. K., Shinder, R., & Reede, D. L. (2017). Imaging of intracranial and orbital complications of sinusitis and atypical sinus infection: What the radiologist needs to know. Current Problems in Diagnostic Radiology, 46(6), 441–451. https://doi-org.ezp.waldenulibrary.org/10.1067/j.cpradiol.2017.01.006
Wagner, B. de A., & Moreira Filho, P. F. (2018). Painful temporomandibular disorder, sleep bruxism, anxiety symptoms and subjective sleep quality among military firefighters with frequent episodic tension-type headache. Arquivos De Neuro-Psiquiatria, 76(6), 387–392. https://doi-org.ezp.waldenulibrary.org/10.1590/0004-282X20180043
"Looking for a Similar Assignment? Get Expert Help at an Amazing Discount!"