NRNP 6531 WK 9 HUMAN Assignment

NRNP 6531 WK 9 HUMAN Assignment

WK 9 Assignment: i-Human Case Study: Evaluating and Managing Musculoskeletal Conditions Patients frequently present with complaints of pain, such as chronic back pain.

They often seek medical care with the intent of receiving drugs to manage the pain. Typically, for this type of pain, narcotic drugs are often prescribed.

This can pose challenges for you as the advanced practice nurse prescribing the drugs. While there is a process for evaluating back pain, it can be difficult to assess the intensity of a patient’s pain since pain is a subjective experience.

Only the person experiencing the pain truly knows whether there is a need for drug treatments. For this Case Study Assignment, you will analyze an i-Human simulation case study about an adult patient with a musculoskeletal condition. NRNP 6531 WK 9 HUMAN Assignment

Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.

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Photo Credit: SCIEPRO / Science Photo Library / Getty Images

To prepare:

Review this week’s Learning Resources. Consider how to assess, diagnose, and treat patients with musculoskeletal conditions.
Access i-Human from this week’s Learning Resources and review this week’s i-Human case study. Based on the provided patient information, think about the health history you would need to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. Reflect on how the results would be used to make a diagnosis.
Identify three to five possible conditions that may be considered in a differential diagnosis for the patient.
Consider the patient’s diagnosis. Think about clinical guidelines that might support this diagnosis.
Develop a treatment plan for the patient that includes health promotion and patient education strategies for patients with musculoskeletal conditions. NRNP 6531 WK 9 HUMAN Assignment
Assignment As you interact with this week’s i-Human patient, complete the assigned case study. For guidance on using i-Human, refer to the i-Human Graduate Programs Help link within the i-Human platform.
By Day 7 Complete your Assignment in i-Human.
Submission and Grading Information To submit your completed Assignment for review and grading, do the following:
Please save your Assignment using the naming convention “WK9Assgn+last name+first initial.(extension)” as the name.
Click the Week 9 Assignment Rubric to review the Grading Criteria for the Assignment
Click the Week 9 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn+last name+first initial.(extension)” and click Open.
If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database. • Click on the Submit button to complete your submission. Grading Criteria
– 80 percent of the class don’t write the risk factors down. So there goes two points or three points right there, which you can have. So, make sure you write the HPI in the right place.

– You have to go to EMR button, click on there and posted in there, and then add your risk factors to your usual onset location and information and guaranteed, that you won’t lose points there.

– As far as testing, you have to research it. There’s just no two ways about it. If your expectation is that you can sit down and just work through the eye human, whether knowledge as a nurse, you are mistaken and because you, you need additional information.

– Make sure that you look at the link that she posted and then will discuss briefly what tests to order. Make sure you look at the link that the instructor posted, and she discusses briefly talking about what tests to order. Now, if you and you don’t get graded down for ordering too many tests. However, if you order X-ray, an MRI and CT scan, for sure, you are going to get graded down because you can’t order all three. Insurance doesn’t allow it. Prior authorization doesn’t allow it.

– However, if you order X-ray, an MRI and CT scan, for sure, you are going to get graded down because you can’t order all three. Insurance doesn’t allow it. Prior authorization doesn’t allow it. So, all you are doing is delaying patient care because you have to do authorization. They call you from x-ray, they call you from CT. They say, well, what do you want? So do familiarize yourself with what you are looking for and which test. It shows that the based as far as the BMP and a CMP, remember what’s on it and then ask yourself, how does knowledge about a BMP relate to back pain?

– So do familiarize yourself with what you are looking for and which taste. It shows that the based as far as the the BMP and a CMP, remember what’s on it and then ask yourself, how does knowledge about a BMP relate to back pain?….There really isn’t!

– So the same with a CBC. What are the two main factors for you to order a CBC? Look at a white blood cell to see if there is an infection there. Or look at the hemoglobin and hematocrit to see if there is anemia. Does anemia relate to back pain? And then of course platelets because low platelets may be an indication of bleeding or
something else going on in the bone, which will be important. So think about it when you order tests, approach it in that manner. NRNP 6531 WK 9 HUMAN Assignment

– For instance, with this week well as Sed Rate or is RB valuable? I think so because it’s an indication for acute inflammation.

– It is very true to a real life. So, make sure you ask the appropriate questions or order the appropriate tests. Because it, again, you don’t get graded down, but you will get graded down if you order a CT or MRI or an MRI and back x-ray because it just doesn’t work that way!

So that’s about our testing. Then as far as your differential diagnosis, she still believes that the best way to come up with your differential diagnosis is to look at your symptoms, organize your symptoms in acute and chronic.

So, if a patient arrives with, for instance, let’s lady with back pain and she tells you she’s had back pain for seven years. You really must decide. Does she have chronic back pain or is this an acute event? And for that reason, you then look at what is going on and we’ll walk through it here in a minute specifically.

As far as the Plan, you do not need to write a SOAP NOTE! You write a soap note. I’m not even going to look at it. The score is 0. It is not a soap note. You must follow the outline that is listed below these instructions. You write orders. You don’t have to write in rationale for me, I want to see what your order is.

– Now, some of you still get tripped up with if this is that or if this doesn’t work in that it doesn’t work that way because you write orders for right now patient in front of you. And this is a Case Study not about what needs to be done. It’s orders for RIGHT NOW. You need not list your differential diagnosis or a rationale for your differential diagnosis.

– And then finally, you must have references. And that is you list the references at the bottom. You need three references. But again, no rationale is needed. All right. So, let’s look at back pain, to successfully treat back pain, you have to know that back pain is one of the TOP 5 complaints that patients will present to you in the clinic with it affects more men than women.

– An onset is as early as 40 years of age start coming in with back pain. Now that doesn’t mean that at 21 years of age people are coming in with back pain or an 80 year old can present. This is just the most time they present. Finally, the most common diagnosis itself is herniated discs.

– You should focus your interview on ruling out a herniated disc in my right because that is historically and research shows is the most common complain.

– Knowing that you also need to look at your “Onset”.

– We are going back to physiology. I jumped that. So, let’s look at the spine, the spinal discs that are stacked on top of each other. And in-between is this glutinous gel that kind of space it out as well as the muscles on the side that keeps your spinal cord. The kind of stacked up.

– So when you have pain in your back, you have to consider disc problems as well as muscle because those are the two primary things that can cause back pain. So, muscle strain can cause back pain, but it’s got nothing to do with the disk. Whereas a herniated disc or discitis is trauma to a fracture. Fracture to the back can be excruciating painful, but I have nothing to do with the with the muscle itself. NRNP 6531 WK 9 HUMAN Assignment

– Don’t get tripped up by that. Because osteoarthritis is degeneration of the disc that glutinous it’s area. It’s sort of this integrates. Now that disc is closer on each other. They wrap around each other. They get displaced. They cause inflammation.

– People start having leaning over this way or they walk that way. Now that I have muscle pain from that too because they are compensating for what’s going on in there in the back. So let me just make sure I have everything. So then if it is a herniation or the location is very important because herniation can be both in the cervical spine, the thoracic spine, or the lumbar spine. So, it’s very important to differentiate if it’s lumbar or thoracic when you call it a herniation.

– Most common differentials then for visiting back pain in the office is going to be osteoarthritis. This irradiation, trauma, blunt force because of a motor vehicle accident, this narrowing and spinal stenosis. But remember you can’t diagnose spice spinal stenosis or a herniation or anything for that matter until you have an X-ray.

– So would I make that? I would put it on my list my list of things going on. But I can’t make the diagnosis. It’s back pain until I can figure out what kind of back pain it or lumbar pain or lumbar lumbar curve is another word that we use. . So, you have to look. You’re going to be guided with acute onset or chronic. So, it’s easy to rule out the chronic. First, you watch your patient walking into the room.

– In fact, in my office, I asked my nurse not to put anybody on the exam and table. Doesn’t matter for what your complaint is. They sit in the chair, get their blood pressure in the
WK 9 i-Human Notes: Gloria Jenkins

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chair. And then I ask them to get on there because that is a great way to examine how mobile they are, how uncomfortable they are. So that way you look at them. If they can’t get on the table, you will simply say, “Can you tie a shoe?” Osteoarthritis or the back limits range of motion. So those people can’t bend down to tie their shoe. They can’t move from side to side, reach to the left because they stiff.

– You can quickly figure out if this is an acute problem or a chronic problem. So then we get to the that the list of things that are also back pain. But it’s kind of like the things you want to put in the back of your mind. And I’m going to look at my lips list here. Always. First on my list is history of cancer. If you have been a woman and it can be a 40-year-old that has a history of breast cancer, or it can be a 80 year old that has a history of colon cancer inherit, resected and now they fight. NRNP 6531 WK 9 HUMAN Assignment

– Or a history or undiagnosed cancer. Compression fraction is the first thing that comes into my mind. I always put that there. Then medications. So, people use steroids. A young guy that comes in with terrible back pain, and he has point tenderness of the spine. he’s either using steroids, anabolic steroids, do puffed himself up and don’t forget the 60-year-old man that’s getting into it and getting it on. He looks like he’s 70 up here, but his body looks like is a 40-year-old that guides using steroids. Steroids causes bone problems. So you want to put that in the back of your mind. Then piriformis syndrome is another one of my favorites. People forget about. Piriformis syndrome is the nerve that runs through the kind of from the spine through this little hole pair from hole that sits where the gluteus maximus overlaps the gluteus minimus and the leg muscle comes in little hole that goes through.

– – So if you have any inflammation of your muscle, you’re going to have piriformis syndrome and it is not backed by it. It feels like back pain, and it feels like sciatica, but it’s not. Then the other thing you must consider sciatica. Sciatica is deferred pain. That means it is nerve pain that is radiating down the leg. You must have a back problem for you to have sciatica because it’s I had it somewhere that you have a pinched nerve that’s causing radiation TO leg, that is a problem for you. So bear that in mind.

– Other things is a UTI, make sure that they don’t have any symptoms of a UTI. And remember though, if they are not symptomatic in you do find a UA and you will not treat because the only thing it’s back pain. So, make sure it’s kind of hard to say well, I order a U/A. The lady that comes in now because she has very specific symptoms that tells you exactly what the problem is, and I already gave you most of the diagnosis so you should know where to start. Then. Don’t forget about kidney stones can cause back pain, pyelonephritis can aortic dissection, peripheral vascular disease can
claudication. Backload that is imputed to legs can cause it. Already talked about cancers and steroids. Osteoporosis is another one.

– – There is 2 that you definitely cannot miss. Herpes Zoster (shingles), So you have to lift your patient’s gown. Not just feel for it because I’ve done that. I’ve missed disaster ones because I didn’t actually look at it back. And it was clearly this string of vesicles. Make sure you look, you actually visualize it.

– And then lastly, there are people that are malingering. So, if you are seeing somebody that comes in repeatedly for back pain and you’ve ruled everything out. Both inflammatory disorders, which is your lupus or poly myalgia, rheumatic, as well as your your acute in osteoarthritis and your herniated disc or trauma,

– So if you are seeing somebody that comes in repeatedly for back pain and you’ve ruled everything out. Both inflammatory disorders, which is your lupus or poly myalgia, rheumatic, as well as your acute in osteoarthritis and your herniated disc or trauma, you have to at some stage consider malingering and diplomatically address that.

– So what are the symptoms? So we’re going to just quickly look at symptoms. Usually, it’s pain. It can be chronic or acute onset pain. And again, it can be point tenderness of the spine. If you have point tenderness at the spine, they have a herniated disc, but you cannot miss infectious discitis of the left. But you can only have discitis is if you have somebody that has a fever or chills. So CR my ruling this out.

But herniated disc can be trauma, it can be a exercise. It can be somebody that’s moving, and I keep picked up boxes. All of those things can cause it. So pain, make sure that you rule out according to the symptoms associated with it. It can be numbness and tingling. If you have numbness and tingling, report it is in the upper, then you look at a cervical fold, your CT of the cervical spine.

If it is lower extremity, then you have to look at your MRI. – It’s important to know is your do they have sensation? Do they have numbness or tingling? And do they have problems with with stool or urination? So those are the those are the criteria for ordering an MRI. Okay. Now, the other one is muscle weakness.

When you order, when you consider much muscle weakness, something else you have to put in there is deconditioning. So are they do they look like they have sarcopenia, which is muscle wasting. Do they have Is it potentially a stroke?

– Now remember, if you have a stroke, your upper and lower is affected. So you have to decide yourself, what am I going to scan the brain? But you must have the symptoms to prove that you’re going to scan the brain. And then you have paralysis. If you have paralysis, you have a problem. So P and P paralysis is a problem. You need to do an MRI and you need to scan the brain too, because sudden onset paralysis is a problem. If they had a motor vehicle accident. Very possible that they May be acquired.

But you will not be seeing that patient in the office. And if a patient comes to your office with back pain after they’ve been in a motor vehicle accident, you immediately going to defer them to the emergency room because first of all, there’s usually going to be litigation. So, unless you want to be caught up in that litigation and be accused of missing something or in appropriately managing the patient needs to be seen in the emergency room and a proper scan of the of the spine or whatever the problem will be needs to be done.

– With symptoms if they look at and fevers, chills. If they have fever or chills show your primary diagnosis is going to be either they have discitis or have a urinary tract infection and its deferred pain.

– Do you see any edema that is there an open wound, sacred wound? These old people don’t wipe themselves very well. They’re not very well hygiene they sit on there but the whole day then I know that they have sacred author, but there it is. Now it’s causing pain for them. Then numbness and tingling. You always ask about it but there’s no way to examine them if they have numbness and tingling, be aware of that.

– But you can do a filament test way you evaluate this sensation because they may have diabetic neuropathy or just the neuropathy from some other problem. So, you have to document sensation. Then. We already talked about the muscle. Look at is it muscle is the muscle weakness? Is there is the muscle a good tone? Or is it totally muscle wasted? And then if you are concerned about a neurological problem, there’s two ways to do it. You’re going to check reflexes in any case to see if the reflex is intact. But you can also do the anal wink.

– when you examine this patient, you ask them to take take your pants off and you just take your finger and tap it right on the the anus. If there is a contraction there, you will. You have normal reflexes or normal neural nearby neurological nerve innervation to the lower body because it’s right there. Now. It doesn’t mean that now you’re done. You can leave your neurological exam. That’s a whole different ballgame. If you have a neurological problem or suspected, you have to do a neuro exam which is different from a simple back exam.

– Document gait.

– We kind of talked about BMP and CMP, CBC. If you’re going to do that. Inflammatory markers, you don’t need SED Rate and lactic acid and a CPA CRP. One is, is usually enough. I find a sed rate most effective because all it tells you is this inflammation. You can have elevated sed rate with osteoarthritis. But it’s mostly effective for me with the malingering patient that you’ve done all the scans, nothing shows. You do a Sed Rate if that Sed Rate is elevated, they have something going on there. They have inflammation. So, you do have something to treat.

– Standard is the X-ray, spinal X-ray or a hip x-ray or a x-ray of the upper extremity, the femur. So most insurance companies, mostly Medicare and Medicaid, because we have these back problems mostly when they get older, will not jump to an a CT scan or MRI unless an X-ray has been done because the first thing you have to rule out is a fracture, be that a compression fracture or blunt fracture innovation by avulsion fracture, you have to do that if they have deferred pain. So you palpate the spine, you’re going to do an X-ray if they have a lumbar pain but it’s not on the spine but it’s actually on the sides.

– Don’t forget your frog leg, hip. They especially if they fell because they can have a site grow for the fracture. They can have a hip fracture, or they can have and I’m just thinking that it’s blowing out. I just had somebody with it in yeah. The piriformis syndrome. So you’re going to do your X-ray. The X-ray will not show you or it will just rule out anything in your back. So it’s a diagnosis of exclusion, a piriformis syndrome point tenderness right on the middle of the butt.

Then your next one will be your CT scan. If you have an X-ray that shows a herniated disc with cause that’s what you’ll see on an X-ray, herniated disc for foramina, stenosis for Amnon, a narrowing. Those are the things you’ll see on you on your X-ray or fractures. If you see an X-ray that shows that you have inflammatory changes because you can see it because they will be shadowing around it, then your next step will be a CT scan. So, when you want to rule out this guide us.

When you have somebody with blunt force trauma that has numbness and tingling, anybody that has signs and symptoms of sciatica, you’re going to start with an x-ray and then you proceed to a CT scan. Or if you have both, you can order both, but you probably going to have to do a prior authorization and they’ll do the X-ray first before they will do the CT scan. NRNP 6531 WK 9 HUMAN Assignment

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Simply, good money management for that. And then finally your MRI. The MRI is your soft tissue.

– When you write pain medication, you always have to remember that you’re actually increase this person’s chances of getting worse. First of all, they’re going to sit around because they sedated and they think they don’t have it. You need them to move. So what are you going to do to get them moving? If they are narcotics, they don’t want tomove.

They just sit around and do nothing. If you prescribe non-steroidal. You have to know who is a high-risk candidate for still non-steroidal and who is not a high-risk? Is this person appropriate? So for instance, my 80 year old that comes in with back pain, they don’t get any narcotics, aren’t even look at narcotics. Non-steroidal. Last ditch Either like it because it causes GI bleeding and by the time the 80, what is the risk factor GI bleed? So, groom your critical thinking to always say what is in the patient’s best interests.

– Because part of your treatment plan should be grooming your passion of what they pay in expectation is, if you have a disc herniation and you’re not a candidate for any intervention other than medication and physical therapy, European expectation will never be 0. And you just must be honest with your patient. And that’s we respect comes in if you tell them, hey, our goal is going to be keep your pain in the 45 range. They will appreciate you for that.

They will. So, make sure you’re paying expectation is your treatment plan is safe, it’s appropriate medications for the age and that you it doesn’t nobody can walk away with no pain. Then you don’t have to write the dive diagnosis. Right. Orders. I don’t want to see this. If the Tylenol doesn’t help, we will send him to the orthopedist. What is that? That’s not an order. You are managing this, so you must give it a good shot. And just as an FYI, when you refer somebody to a gastroenterologist or a hematologist, they expect a good baseline workup has been completed.

So, the first time somebody presents with back pain, you must at least make a good effort of diagnosing it in treating it before you refer them to a surgeon. Unless of course, it is something that is that you must have back surgery for. But because your X-ray or CT scan shows that, but you must at least have a good workout before you can send them off to refer. Alrighty. Good luck with it. Make sure you do all effort to attain that tutorial on the 25th. It will be recorded, so it will be available for you to watch.

i-Human outline and EXAMPL for the plan

Posted Monday, November 22, 2021 8:32:21 PM Last Edited:Friday, December 3, 2021 12:28:28 PM You MUST follow this outline.

If you write an essay or a book, or a story you will receive ZERO.

Therapeutic & non-therapeutic modalities (should be written as orders or rx. Not an essay) 5 pts (note there may be 8/9 orders or as little as 3/4, but there will be very specific key things that you cannot miss) Additional labs or diagnostic tests 5 pts (note, there may be 3/4 or nothing) Health Promotion 5 pts Patient Education 5 pts

Consults 5 pts Disposition w/ rational 5 pts EXAMPLE PLAN (30 points) : YOU MUST WRITE ORDERS. NO ESSAYS!

Therapeutic and non-therapeutic modalities: (5 points)

Meloxicam 5mg Po Daily
Vitamin D 1000units Po weekly
Tylenol 1000mg Po TID
Alternate Ice and heat
Knee brace on during the day, off at night Additional labs or diagnostic test
1. Rheumatoid factor and Uric Acid Health Promotion: (5 points) -Schedule osteoporosis screening -Goal weight loss is 5% -Update your flu vaccine and take your COVID booster -AHA rec exercise most days of the week: consider water aerobics – Stop smoking Education: (5 points)

You have OA in your knee that is causing pain. First line tx is tylenol. NSAIDs and PT. Avoid Narcotics for risk of fall
Meloxicam can cause BLE edema/CHF and kidney injury. Take only once a day and complete after 7 days. If you notice blood in your stool or swelling in your legs call the office
Avoid repetitive movements like running /walking long distances
You are at risk for fall . Make sure you work on balance and may use a walker
Notify your job that you should limit weight bearing to 10lbs Consult w/ brief rational (5 points)
Orthopedic surgeon: evaluate steroid knee injection
Physical Therapy: strength training F/U and rational (5 points)
1 month to evaluate effectiveness of brace and progress with strength Screen for SE of Nsaid use and effectiveness of plan
WK 9 i-Human Notes: Gloria Jenkins
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