NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
Walden University NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders-Step-By-Step Guide
This guide will demonstrate how to complete the Walden University NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.
How to Research and Prepare for NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
Whether one passes or fails an academic assignment such as the Walden University NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.
After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.
How to Write the Introduction for NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
The introduction for the Walden University NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.
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How to Write the Body for NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
After the introduction, move into the main part of the NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.
Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.
How to Write the Conclusion for NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.
How to Format the References List for NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.
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NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
A sample Answer For the Assignment: NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
Introduction
The most common trigger of dementia in senior individuals, which affects many people worldwide, is Alzheimer’s disease. It is classified as a neurodegenerative condition brought on by the harmful progression of age-dependent cognitive decline. There is accumulation of amyloid plaques made up of abnormal deposits of located in the extracellular brain parenchyma and hippocampus. In AD, neurofibril tangles can also form inside of the neuron. Alzheimer’s disease is characterized by a progressive memory loss and cognitive abnormalities.
The case study of Mr. Akkad, a 76-year-old Iranian man who was brought in by his son, will be covered in this essay. Following a clinical assessment and mini-mental state evaluation, the patient is identified as having a significant neurodegenerative illness caused by Alzheimer’s disease (DementiaCareCentral.com, 2020)
Decision 1 Begin Exelon (rivastigmine) 1.5 mg orally BID with an increase to 3 mg orally BID in 2weeks
Rivastigmine is a drug containing a cholinesterase inhibitor with the potential benefit of being pseudo-irreversible. The reversible binding and inactivation of cholinesterase by rivastigmine results in an increase in the level of acetylcholine at cholinergic synapses by blocking acetylcholine’s breakdown. The cholinesterase inhibitor rivastigmine is licensed for use in the treatment of mild to moderate dementia associated with Parkinson’s and Alzheimer’s diseases.
Alzheimer’s disease will develop more slowly as a result of the Exelon. The non-cognitive manifestations of Alzheimer’s disease may be treated with this medication. According to published reports, this medicine improves an Alzheimer’s patient’s cognitive functioning. In the instance of Mr. Akkad, this pharmacological therapy seeks to maximize and uphold the patient’s autonomy, functional capacity, and life quality (Rosenthal & Burchum, 2021).
In a certain period, the patient will start to show the potential effects of the medication. Exelon will slow the spread of the condition, but the patient won’t notice any effects right away. Therefore, doctors advised patients to report any potential changes in their health within three to six weeks, with or without improvement.
Following the commencement of treatment, doctors should schedule meetings with the patient and family every three to six weeks to assess any changes in cognitive and behavioral issues and to gauge how the patient is responding to the medicine. Mr. Akkad’s patient visited the clinic again after 4 weeks, however there was no improvement in his conduct or cognitive abilities (Kazmierski et al., 2020)
Decision 2 Increase Exelon to 4.5 mg orally BID
The client has returned, and according to his son, neither his father’s cognitive nor behavioral functioning had improved. Additionally, the MMSE test results showed that the drugs’ recommended dosage was not likely to have any positive effects. Mini-mental status examination is a helpful tool for gauging how well a patient is responding to treatment, and family input is crucial for determining the patient’s daily interests. The second choice is to raise the dosage of rivastigmine in order to reduce symptoms. Exelon lessens the symptoms and slows the disease’s course, although it could take 6 to 8 weeks before memory and behavior start to improve (Kazmierski et al., 2020).
To achieve the best results, the clinical studies advise titrating the Exelon dose to the highest tolerable level. The patient came back with his son after four weeks. According to his son, he is tolerating the medication, attending religious services with family, and everyone is content. One issue is that his dad still finds humor in things that he once found to be serious (Kim et al., 2021).
Decision 3 Maintain current dose of Exelon
The third option is to keep the present dosage of medicine after assessing the condition of the patient by raising the amount in the second choice. Since this patient is responding effectively to the dosage and because there are no negative side effects from this dosage. The patient’s symptoms are reportedly getting better gradually. Behavioral, cognitive, and daily living activity tests have shown that oral Exelon’s effectiveness is dose dependent (Kim et al., 2021).
The suggested course of treatment lessens symptoms while delaying the onset of the illness. It does not, however, completely reverse the disease. Healthcare professionals have a crucial role in educating patients about Alzheimer’s disease, including its signs, problems, treatment options, and positive and negative impacts. They can also help patients and their families find financial and legal resources.
However, it is vital to explain to the client and his kid that this illness is permanent and medications only help to lessen the clinical manifestations and help improve the patient’s cognitive and behavioral functionality. The patient did not report side effects of the medication during the re- visit. Additionally, you have the choice of increasing the dosage or supplementing it with an additional drug such as Namenda (Rosenthal & Burchum, 2021).
Conclusion
In conclusion, there is no therapy option that can offer a long-term solution for Alzheimer’s disease. The patient’s quality of life, ability to do everyday tasks, and cognitive and behavioral capabilities can all be enhanced by prescribed medications and suggested therapy. It is a neurogenerative condition that develops slowly and places a heavy strain on sufferers and family.
In order to reduce the negative impacts of this condition on patients and their families, it is crucial to create appropriate and effective decisions. Making sure patients with it have enough sleep and rest in between stimulating activities and providing a tranquil environment for these individuals are crucial (DementiaCareCentral.com, 2020).
References
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Kim, B., Noh, G. O., & Kim, K. (2021). Behavioral and psychological symptoms of dementia in patients with Alzheimer’s disease and family caregiver burden: a path analysis. BMC Geriatrics, 21(1), 160.https://doi-org.ezp.waldenulibrary.org/10.1186/s12877-021-02109 w
DementiaCareCentral.com. (2020, October 7). Mini-mental state exam (MMSE) alzheimer’s /dementia test: Administration, accuracy and scoring. Dementia CareCentral.https://www.dementiacarecentral.com/mini-mental-state-exam/.
Kazmierski, J., Messini-Zachou, C., Gkioka, M., & Tsolaki, M. (2018). The impact of a long- term rivastigmine and donepezil treatment on all-cause mortality in patients with Alzheimer’s disease. American Journal of Alzheimer’s Disease & OtherDementias®,33(6), 385-393
Alzheimer’s is a common progressive neurological disorder caused by dementia among older adults. The disorder is characterized by mild to moderate cognitive symptoms at first which lead to severe memory loss as the individual ages. Several treatment options have however been provided to help promote the quality of life and reduce suffering among patients diagnosed with this disorder (Tsolaki, 2018). The purpose of this paper is to demonstrate the choice of medication based on pharmacokinetic and pharmacodynamic factors for an elderly patient with Alzheimer’s disease.
Patient Case Study Summary
The patient in the provided case study is a 76-year-old Iranian male who presented to the clinic with strange behaviors. The patient reports symptoms of Alzheimer’s such as confusion, loss of interest in religious activities, and forgetfulness for the past 2 years.
Some of the pharmacodynamic and pharmacokinetic factors that might affect the choice of medication for the patient include his male gender, advanced age, and Iranian race, in addition to the mini-mental examination results which reveal moderate dementia (Tan et al., 2018). The patient’s diagnosis of major neurocognitive disorder resulting from Alzheimer’s disease will also be considered.
Treatment Decisions
Based on the above-mentioned pharmacokinetic and pharmacodynamic factors, the best treatment choice for the patient out of the available options was to initiate 1.5 mg Exelon (rivastigmine) twice daily. Studies have reported great effectiveness with the use of rivastigmine as the first-line medication for the management of Alzheimer’s disease, with great tolerance and safety profile (dos Santos et al., 2018).
The second intervention was to titrate the dose upwards from 1.5mg to 4.5 mg twice daily as recommended by clinical guidelines, given that the patient displayed limited reemission of symptoms with the use of 1.5 mg rivastigmine for the past 4 weeks. Despite the patient exhibiting great tolerance to the medication, its effectiveness was still limited which led to the final decision to increase the dose to 6mg orally twice daily.
Expected Outcome
Studies show that rivastigmine may take up to 8 to 12 weeks to completely manage the symptoms of dementia. The dose must however be titrated at intervals of 1.5mg after every 2 weeks, after an initial dose of 1.5mg twice daily, to attain the optimum dose for an effective outcome. The patient should however not exceed 6mg twice daily (Nguyen et al., 2021). As such, the patient was expected to display remission of symptoms, within 8 weeks, with minimal mental examination results of less than 10.
NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
Difference Between Expected Outcome and Actual Outcome
The patient responded adequately to the medication as expected. Within the first four weeks, minimal remission of symptoms was experienced with no side effects as expected. The dose was increased which led to better results until the optimum dose was attained with no side effects (Khoury et al., 2018). As such the patient exhibited great tolerance and adherence to the medication with great effectiveness just as expected.
Conclusion
Alzheimer’s disorder is a disabling condition that requires timely treatment to promote the patient’s quality of life. Several treatment options are however available which require keen consideration of the patient’s pharmacokinetic and pharmacodynamic factors when selecting which drug to use for which patient. The 76-year-old Iranian male patient described above displayed great tolerance and adherence to the use of rivastigmine.
References
dos Santos, P., Leide, C., Ozela, P. F., de Fatima de Brito, M., Pinheiro, A. A., Padilha, E. C., … & Izabel, L. (2018). Alzheimer’s disease: a review from the pathophysiology to diagnosis, new perspectives for pharmacological treatment. Current medicinal chemistry, 25(26), 3141-3159. https://doi.org/10.2174/0929867323666161213101126
Khoury, R., Rajamanickam, J., & Grossberg, G. T. (2018). An update on the safety of current therapies for Alzheimer’s disease: focus on rivastigmine. Therapeutic Advances in Drug Safety, 9(3), 171-178. https://doi.org/10.1177/2042098617750555
Nguyen, K., Hoffman, H., Chakkamparambil, B., & Grossberg, G. T. (2021). Evaluation of rivastigmine in Alzheimer’s disease. Neurodegenerative Disease Management, 11(1), 35-48. https://doi.org/10.2217/nmt-2020-0052
Tan, E. C., Hilmer, S. N., Garcia-Ptacek, S., & Bell, J. (2018). Current approaches to the pharmacological treatment of Alzheimer’s disease. Australian Journal of general practice, 47(9), 586-592. https://search.informit.org/doi/10.3316/informit.849432651288623
Tsolaki, M. (2018). An old and new challenge for the treatment of Alzheimer’s disease. Journal of Neurology and Neuroscience, 09. https://doi.org/10.21767/2171-6625-c3-013
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NURS 6512 Assignment: Decision Tree for Neurological and Musculoskeletal Disorders
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Disorders of The Nervous System
Reflect on the comprehensive review of disorders of the nervous system and think about how you might recommend or prescribe pharmacotherapeutics to treat these disorders. (15m)
Multiple sclerosis (MS) is a nervous system disorder affecting the spinal cord and the brain. The myelin sheath is normally destroyed in people diagnosed with MS, slowing down or blocking messages between the body and the brain leading to the associated symptoms. Most people normally start displaying symptoms between the ages of 20 and 40 years (Ferraro et al., 2018).
Such symptoms include muscle weakness, visual disturbances, coordination, and balance problems, numbness, and memory problems among others. However, with appropriate treatment patients’ quality of life and well-being can be improved. The purpose of this paper is to demonstrate appropriate decision-making in selecting the most effective medication for the treatment of a 26-year-old with multiple sclerosis.
Summarize the Patient Case Study
The patient in the provided case study is a 26-year-old female with a diagnosis of multiple sclerosis. She was scheduled for a follow-up appointment with her physician but is still concerned about more knowledge about her MS diagnosis. She also needs to be informed concerning the impact of the disorder on her neurologic and musculoskeletal system in addition to the specific drug therapy plans on which she can decide.
Treatment Decisions
From the available option, the best medication to consider for initial therapy for the patient is 25mg Amitriptyline orally at bedtime. Based on the patient outcome, the drug can be titrated upwards at intervals of 25mg per week, not exceeding 200mg per day. Amitriptyline is a tricyclic antidepressant that has proven to be effective in the management of painful parenthesis in the legs and arms among MS patients (Rae-Grant et al., 2018).
The second intervention was to continue with the same medication and increase the dose to 125mg at bedtime given that the patient displayed a minimal reduction of symptoms but great tolerance to the medication. The last intervention was to continue the same drug and dose, 125mg amitryptiline at bedtime, and advise the patient to see a life coach for counseling on good dietary habits and exercise (Mésidor et al., 2021). This decision was based on the great effectiveness displayed by the drug in the management of the patient’s symptoms, with weight gain as the only side effect.
Expected Outcome
With the use of Amitriptyline 25mg once daily, the patient was expected to display at least 50% remission of symptoms, with common side effects such as nausea, vomiting, headache, and dry mouth (Stankiewicz & Weiner, 2020). These side effects were however expected to diminish with time as the patient continues taking the drug. The dose was expected to be titrated upwards at the rate of 25 mg per week to an optimal dose with complete remission of the patient’s symptoms within 8 to 12 weeks.
Difference Between Expected and Actual Outcome
The patient displayed great effectiveness with the medication just as expected. Her pain level reduced gradually with an increased dose with the optimum dose attained at 125mg orally at bedtime (Stamoula et al., 2021). However, she displayed significant weight gain which was not expected. As such, it was necessary to introduce a life coach to help with lifestyle modification that will help the patient maintain healthy body weight.
Conclusion
Multiple sclerosis is a disabling neurological and musculoskeletal disorder that can be managed by the use of several medications. For the 26-year-old patient in the provided case study, the use of 125mg amitriptyline once daily displayed great effectiveness in the management of the MS symptoms.
References
Ferraro, D., Plantone, D., Morselli, F., Dallari, G., Simone, A. M., Vitetta, F., … & Vollono, C. (2018). Systematic assessment and characterization of chronic pain in multiple sclerosis patients. Neurological Sciences, 39(3), 445-453. https://doi.org/10.1007/s10072-017-3217-x
Mésidor, M., Rousseau, M. C., Duquette, P., & Sylvestre, M. P. (2021). Classification and visualization of longitudinal patterns of medication dose: An application to interferon‐beta‐1a and amitriptyline in patients with multiple sclerosis. Pharmacoepidemiology and drug safety, 30(9), 1214-1223. https://doi.org/10.1002/pds.5297
Rae-Grant, A., Day, G. S., Marrie, R. A., Rabinstein, A., Cree, B. A., Gronseth, G. S., … & Pringsheim, T. (2018). Practice guideline recommendations summary: disease-modifying therapies for adults with multiple sclerosis: report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology, 90(17), 777-788. https://doi.org/10.1212/WNL.0000000000005347
Stamoula, E., Siafis, S., Dardalas, I., Ainatzoglou, A., Matsas, A., Athanasiadis, T., … & Papazisis, G. (2021). Antidepressants on multiple sclerosis: a review of in vitro and in vivo models. Frontiers in Immunology, 12. DOI: 10.3389/fimmu.2021.677879
Stankiewicz, J. M., & Weiner, H. L. (2020). An argument for broad use of high efficacy treatments in early multiple sclerosis. Neurology-Neuroimmunology Neuroinflammation, 7(1). https://doi.org/10.1212/NXI.0000000000000636
The case study concerns a 43-year-old man with a history of chronic pain for several years after sustaining a fall and now ambulates with crutches. He has been referred for a psychiatric evaluation by his family physician after suspecting his pain is psychological, and he has been exaggerating the pain to get a narcotic prescription to get high. He complains of cooling and intense cramping in the right leg. He has been diagnosed with complex regional pain syndrome (CRPS). The purpose of this paper is to explain the interventions for each decision and if they are backed by evidence-based literature.
Decisions Recommended For the Patient Case Study
The first decision was to start Amitriptyline 25 mg PO QHS and increase it by 25 mg every week to a maximum of 200 mg daily. The decision is supported by the study by Shim et al. (2019), which found that Amitriptyline is an effective evidence-based treatment for neuropathic pain disorder and peripheral diabetic neuropathic pain. In decision two, I maintained Amitriptyline and increased the dose to 125 mg with a maximum target of 200 mg.
The patient was to take the medication an hour earlier than usual. Increasing the dose is supported by the article by Eldufani et al. (2020), which recommends slow titration of the Amitriptyline dose if a patient exhibits a positive response to the initial dose. It also recommends taking the bedtime dose an hour earlier to minimize morning sleepiness.
In decision three, I continued Amitriptyline at 125 mg and referred the patient to a life coach for counseling on nutrition and exercise. Weight gain is a documented side effect of Amitriptyline. Brueckle (2020) backs this intervention by asserting that patients on medications associated with weight gain should be counseled on lifestyle modification in diet and exercise for a healthy weight.
What I Was Hoping To Achieve With the Decisions I Recommended For the Patient Case Study
By initiating the patient on Amitriptyline, I hoped it would help improve the client’s mood swings, alleviate pain to 4/10, and ambulate without crutches within four weeks. Komoly (2019) established that Amitriptyline helps alleviate pain and autonomic and motor symptoms in CRPS cases. I hoped that increasing Amitriptyline to 125 mg would alleviate the limb to 3/10, and taking the drug an hour earlier would prevent morning sleepiness. Taking the medication an hour earlier decreases morning sleepiness (Rosenthal & Burchum, 2021).
In decision three, I hoped that referring the client for lifestyle modification counseling would guide him in practicing a healthy lifestyle in dietary and physical exercise habits that would prevent unhealthy weight gain. Aguilar-Latorre et al. (2022) recommend counseling on lifestyle modification to enable patients on TCAs to manage their weight and avoid being overweight/obese.
Difference between What You Expected To Achieve With Each of the Decisions and the Results of the Decision in the Exercise
In the first decision, the pain decreased to a 6/10, and the patient ambulated without crutches. The pain severity was not as anticipated, probably because of the low Amitriptyline dose and duration it takes to have maximum effect. In the second decision, the patient’s pain was reduced to 4/10, comparable to the expected outcome of a pain severity of 3/10.
Conclusion
The PMHNP started the patient on an initial dose of Amitriptyline of 25 mg QHS, which was to be increased by 25 mg weekly to 200 mg. The drug led to a positive response and was increased to 125 mg QHS to improve the patient’s pain. The medication led to weight gain, and the PMHNP referred the client to a life coach for counseling on a healthy lifestyle.
References
Aguilar-Latorre, A., Pérez Algorta, G., Navarro-Guzmán, C., Serrano-Ripoll, M. J., & Oliván-Blázquez, B. (2022). Effectiveness of a lifestyle modification programme in the treatment of depression symptoms in primary care. Frontiers in medicine, 9, 954644. https://doi.org/10.3389/fmed.2022.954644
Brueckle, M. S., Thomas, E. T., Seide, S. E., Pilz, M., Gonzalez-Gonzalez, A. I., Nguyen, T. S., … & Muth, C. (2020). Adverse drug reactions associated with Amitriptyline—protocol for a systematic multiple-indication review and meta-analysis. Systematic reviews, 9(1), 1-8. https://doi.org/10.1186/s13643-020-01296-8
Eldufani, J., Elahmer, N., & Blaise, G. (2020). A medical mystery of complex regional pain syndrome. Heliyon, 6(2), e03329. https://doi.org/10.1016/j.heliyon.2020.e03329
Komoly, S. (2019). Treatment of complex regional pain syndrome with Amitriptyline. Ideggyogyaszati szemle, 72(7-8), 279-281. https://doi.org/10.18071/isz.72.0279
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.
Shim, H., Rose, J., Halle, S., & Shekane, P. (2019). Complex regional pain syndrome: a narrative review for the practicing clinician. British Journal of Anaesthesia, 123(2), e424–e433. https://doi.org/10.1016/j.bja.2019.03.030
Episodic/Focused SOAP Note Template
Patient Information:
CE, 46, F, African American
S.
CC : ankle pain
HPI: 46 year old female complaining of bilateral ankle pain with worse pain on the right side following playing soccer over the weekend the patient heard a popping sound. She is able to bear weight with some mild discomfort. Patient rates the pain a 4 on a scale of 0-10. She has not taken anything at home to help relieve pain.
Current Medications: None
Allergies: NKA
PMHx: Immunizations up to date. Flu vaccine current. Tetanus vaccine 2 years ago. No past medical or surgical history.
Soc Hx: Patient is a patient care technician for the last 18 years. He has been married for 20 years with 2 daughters and 1 son (currently living at home). She enjoys shopping and traveling with her husband and children on the weekends. Negative for tobacco use. Denies consumption of any alcohol or illicit drugs.
Fam Hx:
- Mother- DM
- Father- CVA & HTN
Both parents are still alive, no illnesses related to injury.
ROS:
GENERAL: No weight loss, fever, chills, weakness or fatigue.
SKIN: No rash or itching.
CARDIOVASCULAR: No chest pain, chest pressure or chest discomfort. No palpitations or edema.
RESPIRATORY: No shortness of breath, cough or sputum.
MUSCULOSKELETAL: No muscle, back pain, joint pain or stiffness.
O.
Physical exam:
GENERAL: Pt appears alert and oriented x3. No acute distress noted. Pt is well groomed and appropriate
SKIN: Skin is consistent throughout, no lesions or ulcerations. Skin is consistent with ethnicity. Skin is warm to touch and elastic.
CARDIOVASCULAR: RRR, S1 and S2 sounds heard upon auscultation, no murmurs heard. Radial and pedal pulses 2+
RESPIRATORY: Lung sounds clear in all fields, no adventitious breath sounds heard upon auscultation.
MUSCULOSKELETAL: Limited ROM in right ankle and 3/5 muscle strength for right foot, all other extremities 5/5 muscle strength
Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)
X-Ray
MRI
CT Scan
A.
Differential Diagnoses (list a minimum of 3 differential diagnoses).Your primary or presumptive diagnosis should be at the top of the list. For each diagnosis, provide supportive documentation with evidence based guidelines.
Ankle strain- an ankle strain would be the initial diagnosis, due to the nature of the injury and the fact that the patient is able to bear weight and pain is bearable. Clinician would still need to evaluate and eliminate other diagnosis before referencing a strain as the primary diagnosis. Imaging would help to identify and a physical exam of any swelling or discoloration would also help to identify a diagnosis.
To confirm a diagnosis during a physical, your doctor will examine your ankle, foot and lower leg. The doctor will touch the skin around the injury to check for points of tenderness and move your foot to check the range of motion and to understand what positions cause discomfort or pain (Mayo Clinic, 2022).
Ankle Sprain- Ankle sprain could possibly be one of the diagnosis because the patient is complaining of pain in the ankle following an activity. Acute ankle sprains are commonly seen in both primary care practices and emergency departments and can result in significant short-term morbidity, recurrent injuries, and functional instability (Melanson, 2022). Ankle sprains are one of the most common injuries in sports (Melanson, 2022). Imaging would help to successfully diagnosis this case.
Ankle Fracture- Ankle fracture could be another option, but it would be one of the last diagnosis but important to evaluate and rule out. The patient is able to bear weight and pain is not too intensive therefore patient is more than likely not experiencing a fracture. A stable fracture may not be treated with surgery but an unstable fracture would be treated with surgery. Ankle fractures are common, representing 14% of all fractures requiring hospitalization and can cause many physical and psychosocial concerns(Khan, 2021). This would need to be evaluated with imaging and treated accordingly.
This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Khan , W. (2021). Principles and guidelines in the management of ankle fractures in … Sage Journals . Retrieved February 7, 2023, from https://journals.sagepub.com/doi/10.1177/1750458920969029
Mayo Foundation for Medical Education and Research. (2022, August 11). Sprained ankle. Mayo Clinic. Retrieved February 6, 2023, from https://www.mayoclinic.org/diseases-conditions/sprained-ankle/diagnosis-treatment/drc-20353231
Melanson , S. (n.d.). Acute ankle sprain – statpearls – NCBI bookshelf. National Library of Medicine . Retrieved February 7, 2023, from https://www.ncbi.nlm.nih.gov/books/NBK459212/
The case study depicts a 43-year-old white male who presents with a complaint of pain. He uses a set of clutches when ambulating. The patient reports that he has been referred for psychiatric assessment by his family doctor since the doctor perceived that he had psychological pain (Laureate Education, 2016). The pain began seven years ago after sustaining a fall and landed on the right hip. Four years ago, it was revealed that the cartilage around the right hip joint had a 75% tear.
However, no surgeon was willing to perform a total hip replacement since they believed that there would be tissue repair over time (Laureate Education, 2016). He reports having severe cramping of the right extremity. A neurologist diagnosed him with complex regional pain syndrome (CRPS). He states that he gets low moods at times but denies being depressed. He had been prescribed with Hydrocone but used it in low doses due to drowsiness and constipation, and the drug does not manage pain effectively (Laureate Education, 2016). The mental status exam is unremarkable.
Decision Point One: Savella 12.5 mg orally once daily on Day 1, followed by 12.5 mg BD on Day 2 and 3, then 25 mg BD on days 4-7 and then 50 mg BD after that.
Reason: Savella is a serotonin-norepinephrine reuptake inhibitor that has NMDA antagonist activity, which brings analgesia at the nerve endings (Cording et al., 2015). It is indicated for fibromyalgia and thus effective for this client (Cording et al., 2015). I prescribed Savella to help in pain management and improve the overall mood.
Expected Result: I anticipated that Savella would lower the degree of pain. However, it was expected that the client would experience adverse effects such as nausea, constipation, headache, hot flushes, and insomnia.
Expected Vs. Actual Results: The client returned to the clinic after for weeks without using crutches but with a bit of limping. He states that the pain has been more manageable. The pain is severe in the morning but improves throughout the day (Laureate Education, 2016). On a scale of 1-10, the client rates the pain at four and states that he gets to a point on most days where he does not need crutches. Nevertheless, he reported having increased sweating, sleeping difficulties, nausea, and palpitations (Laureate Education, 2016). His BP was 147/92, and the pulse at 110. He denied having suicidal ideations and was still future-oriented.
Decision Point 2: Continue with Savella but lower dose to 25 mg twice a day.
Reason: I selected this decision to lower the severity of the adverse effects of Savella, which include nausea, constipation, headache, hot flushes, and insomnia (Cording et al., 2015).
Expected Result: Reduction in the dose of Savella would help control the side effects but lower the degree of pain control.
Expected Vs. Actual Results: The client returned to the clinic in four weeks using crutches and rates his current pain at 7/10. He reports that his condition has declined since the previous month (Laureate Education, 2016). He states that he sleeps at night but frequently wakes up due to pain in the right leg and foot. The BP is at 124/87 and pulse at 87. He denies having palpitations and suicidal ideations but is discouraged by the slip in pain management and seems sad.
Decision Point 3: Change Savella to 25 mg in the morning and 50 mg at Bedtime.
I reduced the dosage in the morning since the pain is mostly under control and increased the dose at Bedtime when there is less control (Resmini et al., 2015).
Expected Result: By lowering the morning dose and increasing the bedtime dose, I expected that the client’s pain symptom would improve while at the same time controlling the side effects of Savella (Resmini et al., 2015).
Expected Vs. Actual Results: The client reported an improvement in the pain with a rate of 3/10 denied having any side effects from the drug.
References
Cording, M., Derry, S., Phillips, T., Moore, R. A., & Wiffen, P. J. (2015). Milnacipran for pain in fibromyalgia in adults. Cochrane Database of Systematic Reviews, (10).
Laureate Education. (2016). Case Study: A Caucasian man with hip pain. Baltimore, MD: Author.
Resmini, G., Ratti, C., Canton, G., Murena, L., Moretti, A., & Iolascon, G. (2015). Treatment of complex regional pain syndrome. Clinical cases in mineral and bone metabolism: the official journal of the Italian Society of Osteoporosis, Mineral Metabolism, and Skeletal Diseases, 12(Suppl 1), 26–30. https://doi.org/10.11138/ccmbm/2015.12.3s.026
Rubric Detail
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Content
Name: NURS_6521_Week8_Assignment_Rubric
| Excellent | Good | Fair | Poor | ||
| Briefly summarize the patient case study you were assigned, including each of the three decisions you took for the patient presented. Be specific. | Points Range: 18 (18%) – 20 (20%)
The response accurately and thoroughly summarizes in detail the patient case study assigned, including specific and complete details on each of the three decisions made for the patient presented. | Points Range: 16 (16%) – 17 (17%)
The response accurately summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented. | Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented. | Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely summarizes the patient case study assigned, including details on each of the three decisions made for the patient presented, or is missing. | |
| Based on the decisions you recommended for the patient case study, explain whether you believe the decisions provided were supported by the evidence-based literature. Be specific and provide examples. Be sure to support your response with evidence and references from outside resources. | Points Range: 23 (23%) – 25 (25%)
The response accurately and thoroughly explains in detail how the decisions recommended for the patient case study are supported by the evidence-based literature. The response includes specific and relevant outside reference examples that fully support the explanation provided. | Points Range: 20 (20%) – 22 (22%)
The response accurately explains how the decisions recommended for the patient case study are supported by the evidence-based literature. The response includes relevant outside reference examples that lend support for the explanation provided that are accurate. | Points Range: 18 (18%) – 19 (19%)
The response inaccurately or vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature. The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided. | Points Range: 0 (0%) – 17 (17%)
The response inaccurately and vaguely explains how the decisions recommended for the patient case study are supported by the evidence-based literature, or is missing. The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing. | |
| What were you hoping to achieve with the decisions you recommended for the patient case study you were assigned? Support your response with evidence and references from outside resources. | Points Range: 18 (18%) – 20 (20%)
The response accurately and thorough explains in detail what they were hoping to achieve with the decisions recommend for the patient case study assigned. The response includes specific and relevant outside reference examples that fully support the explanation provided. | Points Range: 16 (16%) – 17 (17%)
The response accurately explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. The response includes relevant outside reference examples that lend support for the explanation provided that are accurate. | Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned. The response includes inaccurate or vague outside reference examples that may or may not lend support for the explanation provided or are misaligned to the explanation provided. | Points Range: 0 (0%) – 13 (13%)
The response inaccurately and vaguely explains what they were hoping to achieve with the decisions recommended for the patient case study assigned, or is missing. The response includes inaccurate and vague outside reference examples that do not lend support for the explanation provided, or is missing. | |
| Explain any difference between what you expected to achieve with each of the decisions and the results of the decisions in the exercise. Describe whether they were different. Be specific and provide examples. | Points Range: 18 (18%) – 20 (20%)
The response accurately and clearly explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. The response provides specific, accurate, and relevant examples that fully support whether there were differences between the decisions made and the decisions available in the exercise. | Points Range: 16 (16%) – 17 (17%)
The response accurately explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. The response provides accurate examples that support whether there were differences between the decisions made and the decisions available in the exercise. | Points Range: 14 (14%) – 15 (15%)
The response inaccurately or vaguely explains any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise. The response provides inaccurate or vague examples that may or may not support whether there were differences between the decisions made and the decisions available in the exercise. | Points Range: 0 (0%) – 13 (13%)
vaguely explains in detail any differences between what they expected to achieve with each of the decisions and the results of the decisions in the exercise, or is missing. The response provides inaccurate and vague examples that do not support whether there were differences between the decisions made and the decisions available in the exercise, or is missing. | |
| 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. | Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. | Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. | Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. | Points Range: 0 (0%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity less than 60% of the time. | |
| Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation | Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors | Points Range: 4 (4%) – 4 (4%)
Contains a few (1–2) grammar, spelling, and punctuation errors | Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) grammar, spelling, and punctuation errors | Points Range: 0 (0%) – 3 (3%)
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 head, parenthetical/in-text citations, and reference list. | Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors | Points Range: 4 (4%) – 4 (4%)
Contains a few (1–2) APA format errors | Points Range: 3.5 (3.5%) – 3.5 (3.5%)
Contains several (3–4) APA format errors | Points Range: 0 (0%) – 3 (3%)
Contains many (≥ 5) APA format errors | |
| Total Points: 100 | |||||
Name: NURS_6521_Week8_Assignment_Rubric
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