NURS 6512 A 42-year-old Male Lower Back Pain

NURS 6512 A 42-year-old Male Lower Back Pain

NURS 6512 A 42-year-old Male Lower Back Pain

 

Patient Information:

A.S Age 42-year-old African American male

S.

CC Lower back pain for the last one month

HPI: The patient is a 42-year-old male who came to the hospital with complaints of lower back pain for the last one month. The patient reported that the pain at times radiates to his left leg. The patient also reported that the pain has been increasing if he sits for a long time. The pain is relived when he stands. The patient denies any fever or pain. He pains rating at the time of assessment was reported to be 8/10.

Current Medications: The patient reported to be using acetaminophen 1 gram, TDS for the last one week, which has not been effective in relieving the pain.

Allergies: The patient denied any history of food, drug, or environmental allergy.

PMHx: The patient was admitted to the hospital in 2015 due to pneumonia. He also has a history of admission in 2010 due to anemia. The patient does not have any history of surgery. He also does not have any history of blood transfusion.

Soc Hx: The patient is married. He works as a librarian in a community library. The patient does not smoke or uses alcohol. He engages in regular physical activity, which has been limited by his condition. He reported to live in a healthy environment with enhanced access to healthy diets. He has three children who are currently in college.

Fam Hx: The patient denied any history of chronic illnesses in his family. Both of his parents are alive, without any chronic illnesses.

ROS:

GENERAL:  The patient was dressed appropriately for the occasion. There was no evidence of weight loss. The patient however had slowed movements due to lower back pain. The patient denied fever, chills, fatigue or weakness.

HEENT:  Eyes:  The patient denied visual loss, blurred vision, double vision or eye drainage. Ears, Nose, Throat:  The patient denied hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN:  The patient denied rash or itching.

CARDIOVASCULAR:  The patient denied chest pain, chest pressure or chest discomfort. palpitations or edema.

RESPIRATORY:  The patient denied shortness of breath, cough or sputum.

GASTROINTESTINAL:  The patient denied anorexia, nausea, vomiting or diarrhea. He also denied abdominal pain or blood.

GENITOURINARY:  The patient denied burning on urination increased urinary frequency or changes in urine color and smell.

NEUROLOGICAL:  The patient denied headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. He also denied any changes in bowel or bladder control.

MUSCULOSKELETAL:  The patient complained of lower back pain that radiates to the right leg. The self-reported pain rating of the client was 8/10. The client reported that the pain increases with prolonged sitting or turning in bed. The patient also reported the pain to have affected his ability to walk, as he is forced to walk slowly to minimize pain. The patient reported that the pain has persisted for the last one month. The pain radiates to the left leg when he walks. He denied any numbness. The pain is relieved when he stands. Acetaminophen has been effective in the past in relieving it. However, he feels that it is not helping, as he has to depend on it to minimize pain.

HEMATOLOGIC:  The patient denied anemia, bleeding or bruising.

LYMPHATICS:  The patient denied enlarged nodes.

PSYCHIATRIC:  The patient denied any history of depression or anxiety.

ENDOCRINOLOGIC:  The patient denied reports of sweating, cold or heat intolerance. He also denied polyuria or polydipsia.

ALLERGIES:  The patient denied any history of food, drug or environmental allergens.

O.

Physical exam:

Vitals: BP 123/76 P 70, R 20, T 98.7 F, SAT 98%, Wt. 56 kg, Ht. 5’9, pain 8/10

General: The patient is a 42-year-old, who appears well-dressed for the occasion. He does not have any evidence of weight loss. His walking pace is reduced due to lower back pain. He is oriented, alert, and cooperative. He has slight limp due to lower back pain.

HEENT: The head is normocephalic with normal distribution of hair. There is the absence of facial tenderness, with pink conjunctiva and white sclera and absence of jaundice. The pupils react to light. There is absence of eyes and ear drainage. There are absence of erythema, lesions or exudates on the pharynx and nasopharynx. The mucus membranes are moist with absence of dentures.

Neck: There is the absence of swollen lymph nodes, neck rigidity, and swelling.

Chest/Lungs: lungs are clear, with equal symmetry on respiration. There is absence of wheezing, stridor, or rhonchi. There is the absence of palpitations and abnormal heart sounds.

Gastrointestinal: There is the absence of abdominal swelling, scars, or evident blood vessels. There is also the absence of organomegaly and presence of normal bowel movements.

Genitourinary: The patient denied assessment of the genitourinary system.

Neurological: There is absence of numbness, paralysis, muscle weakness, loss of body balance, and urinary or bowel incontinence.

Musculoskeletal: Lower back pain reported. Difficulty in movement on a wide range of motions noted. Absence of rigidity of the lower limbs. Liming on motion noted with reduced pace in walking. Patellar reflexes present with self-reported pain rated at 8/10. There is the absence of joint or muscle rigidity.

Hematology: Absence of bleeding gums

Lymphatic: Absence of lymphadenopathy

Psychiatric: The patient is alert and oriented to place, self, others, and time. His judgment is intact. He denies any history of suicidal thoughts, plans, and attempts, delusions, illusions, and hallucinations.

Endocrinology: Absence of polyuria, polydipsia and oliguria

Diagnostic results: The first diagnostic investigation that is appropriate for the patient in the case study is x-ray. X-ray of the cervical region should be performed to determine if the patient has bone misalignment, arthritis or fractures. MRI and CT scans can also be performed to determine whether there is nerve involvement and internal organs. The scans also enable the determination of issues such as disk herniation and problems with blood vessels. Electromyography may also be indicated to determine the electrical impulses that nerves produce and muscle response (Jensen et al., 2019). The test guides in the diagnosis of nerve compression due to spinal stenosis or disk herniation.

A.

Differential Diagnoses

Sciatica: The primary diagnosis for the patient in the case study is sciatica. Sciatica is a pain that develops from dick herniation or spinal stenosis that cause nerve compression. Patients experience pain at the path of the sciatic nerve that is affected to the lower limbs. The compression of the nerve results in nerve inflammation, pain, and at times numbness of the affected limb (Jensen et al., 2019). Patients with sciatic develop symptoms that include pain radiating to the affected limb, discomfort in sitting, and worsening of pain with prolonged activities such as sitting and sneezing (Maslak et al., 2020). The patient in the case study experiences the above symptoms. As a result, sciatica is the primary diagnosis that should be considered in the development of the treatment plan.

Spinal claudication: Spinal claudication is the secondary diagnosis that should be considered for this patient. Spinal claudication arises from the marked narrowing of the spinal canal. The narrowing results in pressure build up on the cauda equina. The resulting symptoms that patients experience include legs and lower back discomfort when one moves or engages in exercises. Patients also experience pain, weakness, tingling, and numbness of the affected limbs. There is also the feeling of heaviness of the affected limbs (Barbaro & Midgley, 2021). The patient in the case study does not experience some of the above symptoms, hence, making spinal claudication a secondary diagnosis.

Peripheral neuropathy: Peripheral neuropathy is the other secondary diagnosis that should be considered for the patient.

Peripheral neuropathy arises from the systemic diseases such as metabolic syndrome, diabetes, and genetic disorders including Charcot-Marie-Tooth disease (Hicks & Selvin, 2019). Patients with infections such as leprosy, HIV and nutritional deficiencies are also predisposed to peripheral neuropathy. Patients often experience symptoms such as burning pain, tingling and numbness, and muscle weakness in the affected limb (Iqbal et al., 2018). The patient in the case study does not have any history of systemic disease, infection or nutritional deficiencies, hence, the least likely cause of the health problem.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

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References

Barbaro, K., & Midgley, J. (2021). Priapism, a symptom of claudication of the cauda equina in spinal stenosis. Musculoskeletal Science and Practice, 52, 102337. https://doi.org/10.1016/j.msksp.2021.102337

Hicks, C. W., & Selvin, E. (2019). Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Current Diabetes Reports, 19(10), 86. https://doi.org/10.1007/s11892-019-1212-8

Iqbal, Z., Azmi, S., Yadav, R., Ferdousi, M., Kumar, M., Cuthbertson, D. J., Lim, J., Malik, R. A., & Alam, U. (2018). Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clinical Therapeutics, 40(6), 828–849. https://doi.org/10.1016/j.clinthera.2018.04.001

Jensen, R. K., Kongsted, A., Kjaer, P., & Koes, B. (2019). Diagnosis and treatment of sciatica. BMJ, 367, l6273. https://doi.org/10.1136/bmj.l6273

Maslak, J. P., Jenkins, T. J., Weiner, J. A., Kannan, A. S., Patoli, D. M., McCarthy, M. H., Hsu, W. K., & Patel, A. A. (2020). Burden of Sciatica on US Medicare Recipients. JAAOS – Journal of the American Academy of Orthopaedic Surgeons, 28(10), e433. https://doi.org/10.5435/JAAOS-D-19-00174

Bottom of Form

 

Photo Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

 

Discussion: Assessing Musculoskeletal Pain

Photo Credit: Getty Images/Fotosearch RF

The body is constantly sending signals about its health. One of the most easily recognized signals is pain. Musculoskeletal conditions comprise one of the leading causes of severe long-term pain in patients. The musculoskeletal system is an elaborate system of interconnected levers that provides the body with support and mobility. Because of the interconnectedness of the musculoskeletal system, identifying the causes of pain can be challenging. Accurately interpreting the cause of musculoskeletal pain requires an assessment process informed by patient history and physical exams.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

To prepare:

• By Day 1 of this week, you will be assigned to one of the following specific case studies for this Discussion. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
• Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
• Review the following case studies:

Case 1: Back Pain

Photo Credit: University of Virginia. (n.d.). Lumbar Spine Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/5lumbar/01anatomy.html. Used with permission of University of Virginia.

A 42-year-old male reports pain in his lower back for the past month. The pain sometimes radiates to his left leg. In determining the cause of the back pain, based on your knowledge of anatomy, what nerve roots might be involved? How would you test for each of them? What other symptoms need to be explored? What are your differential diagnoses for acute low back pain? Consider the possible origins using the Agency for Healthcare Research and Quality (AHRQ) guidelines as a framework. What physical examination will you perform? What special maneuvers will you perform?

Case 2: Ankle Pain

Photo Credit: University of Virginia. (n.d.). Lateral view of ankle showing Boehler’s angle [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/8ankle/01anatomy.html. Used with permission of University of Virginia.

A 46-year-old female reports pain in both of her ankles, but she is more concerned about her right ankle. She was playing soccer over the weekend and heard a “pop.” She is able to bear weight, but it is uncomfortable. In determining the cause of the ankle pain, based on your knowledge of anatomy, what foot structures are likely involved? What other symptoms need to be explored? What are your differential diagnoses for ankle pain? What physical examination will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing?

Case 3: Knee Pain

Photo Credit: University of Virginia. (n.d.). Normal Knee Anatomy [Photograph]. Retrieved from http://www.med-ed.virginia.edu/courses/rad/ext/7knee/01anatomy.html. Used with permission of University of Virginia.

A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

With regard to the case study you were assigned:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study you were assigned.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 8”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3 of Week 8

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6 of Week 8

Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 8 Discussion Rubric

 

Post by Day 3 of Week 8 and Respond by Day 6 of Week 8

To Participate in this Discussion:

Week 8 Discussion

 

Rubric Detail

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Content

Name: NURS_6512_Week_8_Discussion_Rubric

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		Excellent	Good	Fair	Poor
Main Posting		Points Range: 45 (45%) – 50 (50%) “Answers all parts of the Discussion question(s) with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources. Supported by at least three current, credible sources. Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 40 (40%) – 44 (44%) “Responds to the Discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module. At least 75% of post has exceptional depth and breadth. Supported by at least three credible sources. Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.	Points Range: 35 (35%) – 39 (39%) “Responds to some of the Discussion question(s). One or two criteria are not addressed or are superficially addressed. Is somewhat lacking reflection and critical analysis and synthesis. Somewhat represents knowledge gained from the course readings for the module. Post is cited with two credible sources. Written somewhat concisely; may contain more than two spelling or grammatical errors. Contains some APA formatting errors.	Points Range: 0 (0%) – 34 (34%) “Does not respond to the Discussion question(s) adequately. Lacks depth or superficially addresses criteria. Lacks reflection and critical analysis and synthesis. Does not represent knowledge gained from the course readings for the module. Contains only one or no credible sources. Not written clearly or concisely. Contains more than two spelling or grammatical errors. Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness		Points Range: 10 (10%) – 10 (10%) Posts main post by Day 3.	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) Does not post main post by Day 3.
First Response		Points Range: 17 (17%) – 18 (18%) “Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 15 (15%) – 16 (16%) “Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 13 (13%) – 14 (14%) “Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 12 (12%) “Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Second Response		Points Range: 16 (16%) – 17 (17%) “Response exhibits synthesis, critical thinking, and application to practice settings. Provides clear, concise opinions and ideas that are supported by at least two scholarly sources. Demonstrates synthesis and understanding of Learning Objectives. Communication is professional and respectful to colleagues. Responses to faculty questions are fully answered, if posed. Response is effectively written in standard, edited English.	Points Range: 14 (14%) – 15 (15%) “Response exhibits critical thinking and application to practice settings. Communication is professional and respectful to colleagues. Responses to faculty questions are answered, if posed. Provides clear, concise opinions and ideas that are supported by two or more credible sources. Response is effectively written in standard, edited English.	Points Range: 12 (12%) – 13 (13%) “Response is on topic and may have some depth. Responses posted in the Discussion may lack effective professional communication. Responses to faculty questions are somewhat answered, if posed. Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.	Points Range: 0 (0%) – 11 (11%) “Response may not be on topic and lacks depth. Responses posted in the Discussion lack effective professional communication. Responses to faculty questions are missing. No credible sources are cited.
Participation		Points Range: 5 (5%) – 5 (5%) Meets requirements for participation by posting on three different days.	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) N/A	Points Range: 0 (0%) – 0 (0%) Does not meet requirements for participation by posting on three different days.
Total Points: 100