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NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Week 8: Assessment of the Musculoskeletal System

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NURS 6512 Advanced Health Assessment and Diagnostic Reasoning Week 8: Assessment of the Musculoskeletal System Nurs-6512 Discussion Wk8 Discussion: Assessing Musculoskeletal Pain In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting. To prepare: Your Discussion post should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case. Review the following case studies: Case Study: 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 assessment will you perform? What special maneuvers will you perform? Should you apply the Ottawa ankle rules to determine if you need additional testing? 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 assesments 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. Assignment Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each

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NURS 6512 Advanced Health Assessment and Diagnostic Reasoning

Week 8: Assessment of the Musculoskeletal System


Case Study #2

A 46-year-old female with complaints of pain in both of her ankles, but more pain and
concern about the right ankle. She heard a “pop” when she was playing soccer this past
weekend. She has the ability to bear weight but has discomfort when she does.

Patient Information:

Name: TR Age: 46-year-old Sex: Female Race: Caucasian

S.

CC: “My ankles hurt but is much worse on the right side”

HPI: TR is a 46-year-old Caucasian female who presents to the clinic with bilateral ankle pain
for the past 2 days. The pain started after she was playing soccer over the weekend and noticed a
pop sound while playing. The pain feels like it is throbbing and achy. She can bear weight on
both ankles but noticed the discomfort is worse on the right side. Her pain is a 5/10 in both
ankles but increases to a 7/10 on the right side when walking or standing. Elevation and
applying ice packs have provided relief but she has noticed her right ankle has become swollen.
Currently her pain is 6/10 on her right ankle and 2/10 on the left side.

Current Medications:

1. Multivitamin PO daily

2. Ibuprofen 200mg-2 PO PRN for pain

3. Tylenol 325mg-2 PO PRN for pain

4. Oral contraceptive 1 PO daily in the morning unsure of the name.

Allergies: NKA

PMHx: Right ankle sprain in 2012, no surgical history, immunizations are up to date and last
influenza vaccine was this season. Tetanus was 2 years ago. Last menstrual period was 28 days
ago.


Soc Hx: She works as a middle school teacher and coaches the girls’ soccer team. She is single.
She drinks alcohol occasionally. Denies smoking and recreational drug use.



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