Assessing Neurological Symptoms Essay Discussion Paper

Assessing Neurological Symptoms Essay Discussion Paper

Patient Information:

Initials: D.N Age: 47 years Sex: Female Race: Caucasian

S.

CC: “I have right wrist joint pain, and numbness and tingling sensation on the right-hand finger.”

HPI: D.N is a 47-year-old Caucasian female presenting with concerns of pain in the right wrist joint that is accompanied by tingling and numbing indications in the middle finger, index finger, and thumb. She reports that the symptoms began gradually in the past two weeks, and she gave the wrist pain a 2/10 as the pain rating when the joint is not moving but rises to 6 with movement. She characterizes the pain as aching and is spreading down the ventral area of the forearm on the right side of the body. Relaxing the joint alleviates the pain, which is worsened by the repeated joint movement, which is particularly apparent during hair styling. D.N also notes that using ibuprofen helps to alleviate the pain. She mentions being upset by the symptoms because she works as a hairdresser and that the pain makes it difficult for her to hold her hairstyle products in place Assessing Neurological Symptoms Essay Discussion Paper.

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Current Medication:

Ibuprofen 400 mg as needed.

Atorvastatin 10 mg daily.

Allergies: She reports penicillin allergy. Denies food and latex allergies.

PMHx: She has high cholesterol with no history of surgeries.

Soc Hx: Patient works as a hairdresser at a beauty salon. She admits to having used alcohol occasionally in the past, but she denies having ever smoked cigarettes or used illegal substances. She is a single mother of two children who lives with her mother. Swimming and dancing are two of her favorite pastimes.

Fam Hx: She is the second child in a family of four; two of her siblings are still alive and in good health, while the firstborn died as a result of cervical cancer when she was 51. Her father died in a car accident and had diabetes, and her mother is alive with a history of high cholesterol and high blood pressure. She has two children who are in good health Assessing Neurological Symptoms Essay Discussion Paper.

ROS:

GENERAL: Denies recent weight changes, fever, fatigue, chills, cold or heat intolerance, and appetite loss.

HEENT: Head: denies dizziness, seizures, head trauma, and headache. Eye: denies loss of vision, blurry vision, eye discharge, and eye pain. Ear: denies hearing loss, ear pain, tinnitus, and ear discharge. Nose: denies runny nose, nose bleeds, nasal obstruction, and sneezing. Throat: denies sore throat, swallowing difficulties, and voice hoarseness.

CARDIOVASCULAR: Denies shortness of breath, edema, and palpitations.

RESPIRATORY: Denies breathing problems, cough, and sputum production.

GASTROINTESTINAL: Denies abdominal pain, vomiting, nausea, heartburn, diarrhea, and loss of appetite.

GENITOURINARY: Denies incontinence, burning sensation, frequency, vaginal discharge, dysuria, oliguria, and hematuria.

NEUROLOGICAL: Reports tingling and numbness in the middle finger, index finger, and thumb. Denies ataxia, dizziness, paralysis, syncope, and headache.

MUSCULOSKELETAL: Reports joint pain in the right wrist. Denies muscle pain, back pain, and joint stiffness or swelling Assessing Neurological Symptoms Essay Discussion Paper.

HEMATOLOGIC: denies easy bruising, easy bleeding, and anemia.

LMPHATICS: Denies lymphadenopathy and splenectomy.

PSYCHIATRY: Denies depression, anxiety, hallucinations, suicidal thoughts, and a history of mental disorders.

ENDOCRINOLOGIC: Denies polydipsia, polyuria, night sweats, and heat or cold intolerance.

SKIN: Denies rash, hives, and itchy skin.

ALLERGIES: denies hives, rhinitis, eczema, or asthma.

O.

Vital signs: Ht- 5’6”, Wt- 179 lbs., BMI-28.6, BP- 112/82, PR-876, RR-17, Temp- 97.9, SpO2-97%,

General– She appears well-developed, well-nourished, and well-groomed. She is alert and oriented. Her speech is clear and coherent and maintains good eye contact.

HEENT: Atraumatic and normocephalic head, with no scars or swellings, and normal hair distribution. No tenderness or masses. Eye: PERRLA, normal visual acuity, intact extraocular movements, no eye discharge, clear conjunctiva, and sclera. Ear: Clear tympanic membrane without bulging, normal external auditory canal, and normal pinna. Nose: normal shape, moist and pink nasal mucous membranes. Nontender sinuses. Throat: moist and pink oral mucosa, smooth thyroid without nodules, no goiter. Tonsils 2+ bilaterally Assessing Neurological Symptoms Essay Discussion Paper.

Neck: No lymphadenopathy. No swellings or scars. Midline trachea, without tenderness or swellings.

Musculoskeletal: Weakened right thumb abduction, with 3/5 strength. Normal tendon reflexes and muscle power on other limbs. Steady gait, no bone deformities, and normal musculoskeletal development. Positive Phalen and Hoffmann-Tinel sign test.

Cardiovascular: no chest deformities or hyperpigmentation. S1 and S2apparent without murmurs, rubs, or gallops. Normal capillary refill. No tenderness, edema. Peripheral pulses palpable with normal rate and rhythm.

Respiratory: No chest deformities. Normal chest movement with respiration. Normal breath sounds clear to auscultation. Symmetrical and equal chest expansion, and no palpable masses.

Gastrointestinal: Symmetric flat abdomen without swelling, scars, and hyperpigmentation. No organomegaly or CVA tenderness. Bowel sounds clear to auscultation in all quadrants Assessing Neurological Symptoms Essay Discussion Paper.

Genitourinary: Normal external genitalia. No vaginal discharge. Non-palpable bladder without suprapubic tenderness. Normal sized uterus without cervical motion tenderness.

Neurological: Alert, awake, and oriented x3. Normal thought process. Normal reflexes and grossly intact cranial nerves. Normal sensations to pinprick and normal muscle tone.

Skin: Warm, normal skin turgor, and well-perfused. No rashes.

Diagnostic tests:

With regard to this patient, no particular blood tests are necessary at this time. However, other tests, like the HbA1c, may be performed to rule out diabetes. The client will not need any imaging procedures, however a nerve conduction test may be performed.

To establish an individual’s average blood glucose levels over the previous two to three months, clinicians use the HbA1c test (Chauhan, 2017).

It is essential to perform a nerve conduction test to evaluate the speed at which nerve impulses are carried through the nerve and to identify the presence or absence of nerve damage (Sartorio et al., 2020). This test will be performed in order to identify the severity of the nerve damage that has occurred in the right wrist joint of the client.

A.

Differential diagnosis

1. Carpal tunnel syndrome- Carpal tunnel syndrome is a collection of clinical manifestations that emerge as a result of constriction of the median nerve inside the carpal tunnel in the wrist (Annisa et al., 2021). The symptoms include tingling, numbness, and pain along the median nerve transmission. Pain in the right wrist joint, tingling and numbness indications in the middle finger, index finger, and thumb were all reported by D.N. She had a weaker right thumb on abduction, as well as a 3/5 strength in her right hand. The region above her carpal tunnel on her right wrist was sensitive. Additionally, both the Phalen and Hoffmann-Tinel sign tests were positive Assessing Neurological Symptoms Essay Discussion Paper.
2. Diabetic peripheral neuropathy- Diabetic peripheral neuropathy is defined as neurological impairment to one or more nerves that results in diminished movements or sensations (Khdour, 2020). It develops in individuals with diabetes. A history of diabetes is present in this client’s family, and her advanced age raises the risk of developing diabetes in the near future.
3. Thoracic outlet syndrome- The term “thoracic outlet syndrome” refers to a set of illnesses that develop due to pressure of blood vessels and nerves in the thoracic outlet (Jones et al., 2019). Pain in the neck and shoulder, as well as numbness in the fingers on the afflicted side, are the main symptoms. While the client in the given scenario did not have any shoulder or neck discomfort, she did experience tingling feelings in their fingers, which was unusual.

Assignment 1: Case Study Assignment: Assessing Neurological Symptoms

Please Refer to Instructor’s notes I am in Group A – Thank You

Group A (Listed Below)

A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Photo Credit: Getty Images/iStockphoto

Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.

In this Case Study Assignment, 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 a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
• Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style 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 Assessing Neurological Symptoms Essay Discussion Paper.

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.
  

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The Case Study Assignment

Use the Episodic/Focused SOAP Template and create 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 Assessing Neurological Symptoms Essay Discussion Paper.

 

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6512_Week_9_Assignment1_Rubric

 

	Excellent		Good	Fair	Poor
Using the Episodic/Focused SOAP Template: · Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.  ·  Provide evidence from the literature to support diagnostic tests that would be appropriate for your case.	45 (45%) – 50 (50%) The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study. The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.		39 (39%) – 44 (44%) The response accurately follows the SOAP format to document the patient in the assigned case study. The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.	33 (33%) – 38 (38%) The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy. The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected.	0 (0%) – 32 (32%) The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study. The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.
·   List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.	30 (30%) – 35 (35%) The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study and provides a thorough, accurate, and detailed justification for each of the five conditions selected.		24 (24%) – 29 (29%) The response lists four to five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected.	18 (18%) – 23 (23%) The response lists three to four possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or some inaccuracy in the conditions and/or justification for each.	0 (0%) – 17 (17%) The response lists three or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused–neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria Assessing Neurological Symptoms Essay Discussion Paper		4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive.	3 (3%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.	0 (0%) – 2 (2%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors.		4 (4%) – 4 (4%) Contains a few (1 or 2) grammar, spelling, and punctuation errors.	3 (3%) – 3 (3%) Contains several (3 or 4) grammar, spelling, and punctuation errors.	0 (0%) – 2 (2%) Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list.	5 (5%) – 5 (5%) Uses correct APA format with no errors. Assessing Neurological Symptoms Essay Discussion Paper		4 (4%) – 4 (4%) Contains a few (1 or 2) APA format errors.	3 (3%) – 3 (3%) Contains several (3 or 4) APA format errors.	0 (0%) – 2 (2%) Contains many (≥ 5) APA format errors.
		Total Points: 100

Name: NURS_6512_Week_9_Assignment1_Rubric

References

Annisa, D., Budhi Rianawati, S., Rahayu, M., Raisa, N., & Nandar Kurniawan, S. (2021). Carpal tunnel syndrome (Diagnosis and management). JPHV (Journal of Pain, Vertigo and Headache), 2(1), 5-7. https://doi.org/10.21776/ub.jphv.2021.002.01.2

Chauhan, N. (2017). Laboratory diagnosis of HbA1c: A review. Journal of Nanomedicine Research, 5(4). https://doi.org/10.15406/jnmr.2017.05.00120

Jones, M. R., Prabhakar, A., Viswanath, O., Urits, I., Green, J. B., Kendrick, J. B., Brunk, A. J., Eng, M. R., Orhurhu, V., Cornett, E. M., & Kaye, A. D. (2019). Thoracic outlet syndrome: A comprehensive review of pathophysiology, diagnosis, and treatment. Pain and Therapy, 8(1), 5-18. https://doi.org/10.1007/s40122-019-0124-2

Khdour, M. R. (2020). Treatment of diabetic peripheral neuropathy: A review. Journal of Pharmacy and Pharmacology, 72(7), 863-872. https://doi.org/10.1111/jphp.13241

Sartorio, F., Dal Negro, F., Bravini, E., Ferriero, G., Corna, S., Invernizzi, M., & Vercelli, S. (2020). Relationship between nerve conduction studies and the functional dexterity test in workers with carpal tunnel syndrome. BMC Musculoskeletal Disorders, 21(1). https://doi.org/10.1186/s12891-020-03651-1 Assessing Neurological Symptoms Essay Discussion Paper

Instructor’s Specific Instructions WK 9 Assignment 1 – Group A Case A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools. Week 9 Assignment Posted on: Sunday, October 24, 2021 11:59:00 PM EDT Students, This week’s assignment is Assessment of Cognition and the Neurologic System. You will be assigned 2 required and 1 practice assignment. I recommend that you start the DCE Shadow Health Assignment now since this assignment must be submitted timely, and must be passed to continue in the class. Assignment 1 (Please include title and reference pages using APA format). To Prepare By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the Case Studies assigned below. You will remain in the same groups you were assigned for Week 8 discussion. Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style 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. (Please create additional patient information). 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 neurological conditions that may be considered as a differential diagnosis for the patient. The Case Study Assignment Use the Episodic/Focused SOAP Template and create 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. You must pass this assignment to pass the course!! This includes both the DCE and the Provider Documentation note section!! In other words, you must obtain both 80% or greater for you DCE score and 80% or greater on the total score. In the rubric you will be asked to provide 3 diagnoses in that area you can add Comprehensive Physical Examination as one of your diagnoses. For diagnostic test/labs you can add whatever labs would be appropriate for that visit for example, CBC, Lipids, TSH, Mammogram based on the patient’s age, health risks or medical history. Documentation should be included for all systems and must be in detail. You should not use the words normal, WNL or no visible abnormality noted in your documentation. Please review the grading rubric before submitting your assignment, but review my announcement that I posted on Sunday with detailed instructions of this assignment. You must place your SH Provider notes on the appropriate template and submit to Blackboard for me to grade. I will not look for your documentation in SH.