Discussion: Assessing Musculoskeletal Pain

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:

· You will be assigned to one of the following specific case study.

· 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 study.

Case 2: Ankle Pain

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?

Please use soap template below:

Episodic/Focused SOAP Note Template

Patient Information:

Initials, Age, Sex, Race

S.

CC (chief complaint) a BRIEF statement identifying why the patient is here – in the patient’s own words – for instance “headache”, NOT “bad headache for 3 days”.

HPI: This is the symptom analysis section of your note. Thorough documentation in this section is essential for patient care, coding, and billing analysis. Paint a picture of what is wrong with the patient. Use LOCATES Mnemonic to complete your HPI. You need to start EVERY HPI with age, race, and gender (e.g., 34-year-old AA male). You must include the seven attributes of each principal symptom in paragraph form not a list. If the CC was “headache”, the LOCATES for the HPI might look like the following example:

Location: head

Onset: 3 days ago

Character: pounding, pressure around the eyes and temples

Associated signs and symptoms: nausea, vomiting, photophobia, phonophobia

Timing: after being on the computer all day at work

Exacerbating/ relieving factors: light bothers eyes, Aleve makes it tolerable but not completely better

Severity: 7/10 pain scale

Current Medications: include dosage, frequency, length of time used and reason for use; also include OTC or homeopathic products.

Allergies: include medication, food, and environmental allergies separately (a description of what the allergy is ie angioedema, anaphylaxis, etc. This will help determine a true reaction vs intolerance).

PMHx: include immunization status (note date of last tetanus for all adults), past major illnesses and surgeries. Depending on the CC, more info is sometimes needed
Soc Hx: include occupation and major hobbies, family status, tobacco & alcohol use (previous and current use), any other pertinent data. Always add some health promo question here – such as whether they use seat belts all the time or whether they have working smoke detectors in the house, living environment, text/cell phone use while driving, and support system.

Fam Hx: illnesses with possible genetic predisposition, contagious or chronic illnesses. Reason for death of any deceased first degree relatives should be included. Include parents, grandparents, siblings, and children. Include grandchildren if pertinent.

ROS: cover all body systems that may help you include or rule out a differential diagnosis You should list each system as follows: General: HeadEENT: etc. You should list these in bullet format and document the systems in order from head to toe.

Example of Complete ROS:

GENERAL:  No weight loss, fever, chills, weakness or fatigue.

HEENT:  Eyes:  No visual loss, blurred vision, double vision or yellow sclerae. Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat.

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.

GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood.

GENITOURINARY:  Burning on urination. Pregnancy. Last menstrual period, MM/DD/YYYY.

NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control.

MUSCULOSKELETAL:  No muscle, back pain, joint pain or stiffness.

HEMATOLOGIC:  No anemia, bleeding or bruising.

LYMPHATICS:  No enlarged nodes. No history of splenectomy.

PSYCHIATRIC:  No history of depression or anxiety.

ENDOCRINOLOGIC:  No reports of sweating, cold or heat intolerance. No polyuria or polydipsia.

ALLERGIES:  No history of asthma, hives, eczema or rhinitis.

O.

Physical exam: From head-to-toe, include what you see, hear, and feel when doing your physical exam. You only need to examine the systems that are pertinent to the CC, HPI, and History. Do not use “WNL” or “normal.” You must describe what you see. Always document in head to toe format i.e. General: Head: EENT: etc.

Diagnostic results: Include any labs, x-rays, or other diagnostics that are needed to develop the differential diagnoses (support with evidenced and guidelines)

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.

P.

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

References

You are required to include at least three evidence based peer-reviewed journal articles or evidenced based guidelines which relates to this case to support your diagnostics and differentials diagnoses. Be sure to use correct APA 6th edition formatting.

Resource for reference

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

  • Chapter 4, “Vital Signs and      Pain Assessment” (Previously read in Week 6)
  • Chapter 22, “Musculoskeletal System”

    This chapter describes the process of assessing the musculoskeletal      system. In addition, the authors explore the anatomy and physiology of the      musculoskeletal system.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.

Chapter 22, “Lower Extremity Limb Pain”
This chapter outlines how to take a focused history and perform a physical exam to determine the cause of limb pain. It includes a discussion of the most common tests used to assess musculoskeletal disorders.

Chapter 24, “Low Back Pain (Acute)”
The focus of this chapter is the identification of the causes of lower back pain. It includes suggested physical exams and potential diagnoses.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

  • Chapter 2, “The      Comprehensive History and Physical Exam” (“Muscle Strength      Grading”) (Previously read in Weeks 1, 2, 3, 4, and 5)
  • Chapter 3, “SOAP Notes”

    This section explains the procedural knowledge needed to perform      musculoskeletal procedures.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Student checklist. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Musculoskeletal system: Key points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.

Credit Line: Seidel’s Guide to Physical Examination, 9th Edition by Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2019 by Elsevier Health Sciences. Reprinted by permission of Elsevier Health Sciences via the Copyright Clearance Center.

Katz, J. N., Lyons, N., Wolff, L. S., Silverman, J., Emrani, P., Holt, H. L., … Losina, E. (2011). Medical decision-making among Hispanics and non-Hispanic Whites with chronic back and knee pain: A qualitative study. BMC Musculoskeletal Disorders, 12(1), 78–85.

This study examines the medical decision making among Hispanics and non-Hispanic whites. The authors also analyze the preferred information sources used for making decisions in these populations.

Smuck, M., Kao, M., Brar, N., Martinez-Ith, A., Choi, J., & Tomkins-Lane, C. C. (2014). Does physical activity influence the relationship between low back pain and obesity? The Spine Journal, 14(2), 209–216. doi:10.1016/j.spinee.2013.11.010

Shiri, R., Solovieva, S., Husgafvel-Pursiainen, K., Telama, R., Yang, X., Viikari, J., Raitakari, O. T., & Viikari-Juntura, E. (2013). The role of obesity and physical activity in non-specific and radiating low back pain: The Young Finns study. Seminars in Arthritis & Rheumatism, 42(6), 640–650. doi:10.1016/j.semarthrit.2012.09.002

Document: Episodic/Focused SOAP Note Exemplar (Word document)

 

Document: Episodic/Focused SOAP Note Template (Word document)

 

Optional Resource

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

  • Chapter 13, “The Spine, Pelvis, and      Extremities” (pp. 585–682)

    In this chapter, the authors explain the physiology of the spine, pelvis,      and extremities. The chapter also describes how to examine the spine,      pelvis, and extremities.

Order Solution Now

Click HERE to order a unique plagiarism free paper done by 

professional writers and delivered before your deadline

In the dynamic world we currently live in, it’s becoming increasingly difficult for students to balance academics, co-curricular activities and entertainment among others. Students are required to submit countless assignments in a short time frame. These assignments should not be taken lightly as they form a major part of the grade when it comes to the end of the semester. Understanding the value of education and how these grades are important to students, Infinite Essays has made it its mission in life to offer customized essays to students at an affordable cost.

Click HERE to order a unique plagiarism free paper done by 

professional writers and delivered before your deadline

There are plenty of reasons why you should order a paper with Infinite Essays. We have reliable writers who are also very competent. They have over the years managed to work under tight schedules and deadlines. Whenever you order an essay with Infinite Essays, you are guaranteed a fast turnaround of your project and this is done on time. Other than writing custom papers, our writers provide value added services that include academic assistance in the areas that they have specialized in. We ensure that the work that we offer is free of plagiarism. Infinite Essays does not condone plagiarism in whatsoever manner. Our writers are very experienced and can handle of sorts of formats such as Turabian, Chicago, Harvard as well as APA and MLA. Infinite Essays covers a wide range of topics. At the moment, we specialize with over 68 topics. We understand the importance of maintaining confidentiality when dealing with our clients. It’s for this reason that we will never reveal the identity of our clients to whoever may be interested. Finally, we offer the most competitive rates in the industry.

Click HERE to order a unique plagiarism free paper done by 

professional writers and delivered before your deadline

Whenever you want to make an order with us, you will use our automated online ordering system. If you are having some difficulties of any sort, feel free to contact our live support and they will be more than happy to assist you. Ensure that you fill all the relevant information regarding your order. This is the area where you have to include the deadline of your assignment, the formatting style to be used and even the kind of academic paper you desire. The more information you give to our writers, the better.

Click HERE to order a unique plagiarism free paper done by 

professional writers and delivered before your deadline

Brief explanations of how our services work 1. Provide us with the necessary instructions. Go to the Order Now page and click the order now button. This is the part where you have to attach all the relevant attachments. At the same time, remember to add the instructions sheet here. Once you are sure that you have submitted all relevant information, please submit the final draft to us. 2. The second step will involve paying for the services. This is where an invoice will be sent to you. However, the easiest process is clicking the payment link and following all the prompts that come along. At the moment, all payments are made through PayPal only. 3. Working on your paper. Once you have made the payment, we will assign the order to a writer who will follow the instructions. Remember that our writers will spend countless hour laboring to ensure that the work they provide is meticulously researched. 4. Download your paper. When the writer is finished with the assignment, they will submit it to our writers who will then go through the paper to ensure that the paper has followed all instructions and there are no grammatical errors. We will then forward a copy of the assignment to your email. 5. Tell your friends. We always happy to receive a referral. Whenever a friend tells us that you recommended our services to them, we will give you a 40 percent discount for your next order. Whenever you have provided us with the necessary details, we will forward them to qualified writers who will handle the assignment for you. Remember that the writers will begin working on the assignment immediately. This is the sole reason we encourage our clients to provide their exact specifications during the first time.

Click HERE to order a unique plagiarism free paper done by 

professional writers and delivered before your deadline

Tackling an order may be challenging but we always offer the best. Before the assignment can be passed to you by our writers, it will be passed through a team of qualified editors and proofreaders to ensure that the paper is accurate and of the required quality. Once the editors are satisfied with the assignment, they will forward the assignment to your account and a copy to your email.

Click HERE to order a unique plagiarism free paper done by 

professional writers and delivered before your deadline

Discounts We offer the best prices in the industry. We currently have a 20 percent discount for all of our customers. If you feel the budget is putting a strain on you, contact our live support and they might consider you case. We treat each case differently. Remember that our main goal is to continue with education transformation. At the moment, we only accept payments in form of PayPal.

Click HERE to order a unique plagiarism free paper done by 

professional writers and delivered before your deadline

Why Choose Us While there are many companies in the writing service industry claiming to offer platinum services, none can match the services offered by Infinite Essays. Some of our writers have been with us since 2010. The testimonials that have been written by some of our happy customers is an indication of the good services that we offer.

Click HERE to order a unique plagiarism free paper done by 

professional writers and delivered before your deadline