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

 

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APA format 3 references please use 2 from discussion references and 1 from walden university library and 1 and half pages  Due 9/28/19 at 10 am EST

 

Hybrid learning environments are gradually infiltrating face-to-face teaching environments. Wolpert-Gowron states it plainly, “It is not a question of if; it is a question of how” (2011, para. 3). Blending online and face-to-face content can satisfy the need for flexibility and self-direction, yet also includes the facilitative relationship of the student and instructor (Bradshaw & Hultquist, 2017). The two modalities, if carefully structured, can complement each other.

            In the associate degree nursing skills laboratory environment, students show up for a six-hour block of didactic and hand-on learning. The students are often fatigued by the need to be active learners for that amount of time. Indeed, the design of the nursing laboratory is intended to emphasize the application of skills rather than acquiring new knowledge. This environment seems ideal for blended classroom methods. Bradshaw and Hultquist (2017) warn that adequate planning is essential for blended classrooms to be successful. In particular, there is a tendency to expect more work from the students compared with traditional face-to-face learning. In my view, blended environments demand that the instructor be well prepared and very clear with their expectations with the students.  The increased work needed by the instructor has been a barrier to implementing blended classroom methods in my institution.

            The nursing skills laboratory is where students accomplish psychomotor learning of their nursing skills. The way instructors teach in this environment is not guided by evidence because there is not much research on the topic. Staykova, Stewart, and Staykov (2017) compared traditional methods (PowerPoint lecture, hands-on practice with checklists, and quizzes) against innovative methods in the nursing skills laboratory environment.  The innovative strategies included the use of admission tickets (ATs) to class. ATs require home pre-learning to include online or textbook reading and a brief online assignment.  Staykova, Stewart, and Staykov (2017) found that active learning is achieved through a combination of traditional and innovative approaches.  The use of ATs is particularly intriguing to me in order to make sure all learners arrive with the same necessary information and to help create an engaged learning environment when they are present in class. I hope to use this blended teaching strategy in the future.

References

Bradshaw, M. J., & Hultquist, B. L.  (2017). Innovative teaching strategies in nursing and

            related health professions (7th ed.). Burlington, MA: Jones and Bartlett.

Educause Learning Initiative. (2012). Things you should know about flipped classrooms.

 Retrieved from https://library.educause.edu/-/media/files/library/2012/2/eli7081-pdf.pdf

Staykova, M. P., Stewart, D. V., & Staykov, D. I. (2017). Back to the Basics and Beyond:

Comparing Traditional and Innovative Strategies for Teaching in Nursing Skills Laboratories. Teaching and Learning in Nursing, 12(2), 152–157. https://doi-org.ezp.waldenulibrary.org/10.1016/j.teln.2016.12.001

Wolpert-Gawron, H. (2011, April 28). Blended learning combining face-to-face and online

education. Retrieved January 21, 2015 from https://www.edutopia.org/blog/blended-online-learning-heather-wolpert-gawron

 

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APA format 1 page 3 references one from the discussion below 1 from walden university library.  Due 10/4/2019 ASAP

 

Lesson Title: Medication Administration Checkoff

The selected video demonstrates how to correctly administer medication using the 5 Medication Rights.

Intended Audience: Pre-licensure nursing students

Objectives:

• The student will demonstrate how to successfully administer medications at the bedside.
• The student will educate the patient about their medications.
• The student will explain safety precautions to patient.
• The student will document medications given on MAR
• The student will re-assess patient after medication administration

A key strategy in nursing education is to help students connect class time with clinical time (Bristol, n.d.). A significant aspect of this is bringing clinical to class. The video mentioned above, can be used to prepare the learners for the on-site clinical lab as students are able to view the video as many times as needed to familiarize themselves with the content presented. The visual and auditory nature of videos appeals to a wide audience and allows each user to process information in a way that’s natural to them (Next Thought Studios, n.d.). As students review medication administration in their textbooks, they can view the video as a visual to see how to correctly perform a med pass. When the students arrive to class, they are prepared for the skill review and check off. This concept mirrors the flipped classroom approach. “Students gain first-exposure learning prior to class and focus on the processing part of learning in class” (Andrew, n.d.).

When the students arrive to class, the instructor would do a brief overview of the lesson and state the objectives. The students will be given an opportunity to asks any questions they may have about the video or textbook content. They will then role play giving medications at bedside. During checkoffs with the instructors, the students will demonstrate how to correctly give medications as well as explain the rationale about each step during the role playing. The instructor could also have the students record their own video administering medications in class as a way to evaluate the students.

Overall, the referenced video is a good video to use to demonstrate how to correctly administer medications.

Andrew, S. (n.d.). The flipped classroom: preparing students for in-class learning with online activities. Retrieved from https://americanenglish.state.gov/files/ae/resource_files/2.2_presentation_slides_-_final_for_ae_website_-_.pdf

Bristol, T. (n.d.). Help student learn how to learn with clinical skills videos. Retrieved from https://evolve.elsevier.com/education/nursetim/videos-help-students-learn-how-to-learn-with-clinical-skills/

Next Thought Studios. (n.d.). Why videos are important in education. Retrieved from https://www.nextthoughtstudios.com/video-production-blog/2017/1/31/why-videos-are-important-in-education

Nurse Buff Nursing Humor & Lifestyle Blog. (2019). Medication administration checkoff. Retrieved from https://www.nursebuff.com/nursing-skills-video/

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APA format, 3 references 1 from walden university library, 1 and half pages long 

 

Initial Post Week 8

Teamwork is important as it can help inspire innovation and creativity (Chiang, Chapman, & Elder, 2011). Some of the benefits include creativity, learning, blending strengths, trust, conflict resolution skills, ownership and risk-taking (Mattson, 2015). Luckily the group I am a part of has been amazing to work with. Everyone is professional, contributes, and communicates appropriately.  Of course, this isn’t always the case. Teamwork isn’t always positive and can come with its barriers which can include meaning, time, work culture, equality, and conflicting views (Chiang, Chapman, & Elder, 2011). Group projects in the online setting can be even harder as most times your group members live quite far away and the only way to contact them is through phone and video chats and email. “It was hypothesized that groups receiving more support from the facilitator, getting more acquainted with teammates, building more trust, having clearer communication among teammates, and involving better organization practices would have greater satisfaction with online collaboration experiences” (Tseng, Ku, Wang, & Sun, 2009, para 31). We have tried to make time by scheduling meetings when it works for the most amount of people and doing it via video chat so that we can all see each and bounce ideas off of each other (Chiang, Chapman, & Elder, 2011). We have made the due dates far enough in advance that everyone has plenty of time to work around their schedules to get the work done. We have split up the work fairly so that no one feels like they have more to do than anyone else.

One of the barriers that we have had to overcome is time (Chiang, Chapman, & Elder, 2011). Everyone has busy lives, children, shift work, families, friends, and school. Sometimes it is hard to find the time to all get together for meetings or to find time to get all of the work done. Strategies that Chiang, Chapman, & Elder (2011) recommend include agendas/readings handed out early so people have enough time to review before meeting and to try and schedule meetings at convenient and acceptable times to people’s schedule (Chiang, Chapman & Elder, 2011). When working together to develop curriculum it is important to make sure everyone involved has a chance to give their input no matter how busy each other’s schedule is. Another interesting barrier I read about which I feel applies to all groups in this class in unfamiliarity of team members. Since we don’t know each other well, we don’t know all of each other’s strengths. Creating smaller teams is a strategy to overcome this barrier (Kalisch & Begeny, 2005). This is beneficial for a nurse educator as when providing group education sessions the educator will know to create smaller group sizes.

https://www.researchgate.net/profile/Beatrice_Kalisch/publication/7424821_Improving_Nursing_Unit_Teamwork/links/5ac319d00f7e9bfc045f3f7d/Improving-Nursing-Unit-Teamwork.pdf

Thanks, Hope

References

Chiang, C-K., Chapman, H., & Elder, R. (2011). Overcoming challenges to collaboration: Nurse educators’ experiences in curriculum change. Journal of Nursing Education, 50(1), 27–33. Retrieved from the Walden Library databases.

Kalisch, B.J., & Begeny, S.M. (2005). Improving nursing unit teamwork.  Journal of Nursing  Administration, 35(12), 550-556. Retrieved from             https://www.researchgate.net/profile/Beatrice_Kalisch/publication/7424821_Improving Nursing_Unit_Teamwork/links/5ac319d00f7e9bfc045f3f7d/Improving-Nursing-Unit- Teamwork.pdf

Mattson, D. (2015). 6 benefits of teamwork in the workplace. Retrieved from https://www.sandler.com/blog/6-benefits-of-teamwork-in-the-workplace

Tseng, H., Ku, H.Y., Wang, C.H. & Sun, L. (2009). Key factors in online collaboration and their relationship to teamwork satisfaction. Quareterly Review of Distance Education, 2, 195. Retrieved from Walden Library Databases.

 

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APA 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

 

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