Module 4: Musculoskeletal, Neurologic, and Mental Health Conditions
Week 9: Evaluation and Management of Musculoskeletal Conditions- iHuman Mabel Johnson V5 PC
In clinical settings, patients often present with musculoskeletal conditions such as chronic back pain. In recent years, there has been a dramatic increase in the acceptance and use of prescription opioids to help patients manage chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence about their long-term effectiveness (Centers for Disease Control and Prevention, 2017). Of all drugs prescribed, opioids are one of the most common, with more than 168 million prescriptions prescribed in 2018 in the United States and prescribing rates varying widely across different states and counties (Centers for Disease Control and Prevention, 2020b). This prevalence of prescribing narcotics has led to controversy among patients, providers, pharmacies, and lawmakers. Due to the short- and long-term effects of narcotic drugs, the controversy spans from overuse of narcotics to non-medical use of narcotics. For advanced practice nurses, it is essential to carefully observe and watch for signs of drug abuse during patient evaluations. Because not all musculoskeletal conditions require narcotics, a thorough patient evaluation will help to ensure the development of an appropriate treatment plan with patient safety in mind.
For this week, you will analyze an i-Human simulation case study about an adult patient with a musculoskeletal condition. 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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Learning Objectives
Students will:
- Formulate differential diagnoses for adult patients with musculoskeletal conditions
- Analyze pattern recognition in adult patient diagnoses
- Analyze the role of patient information in differential diagnosis
- Evaluate pharmacologic and non-pharmacologic treatment options for adult patients
- Create an appropriate treatment plan that includes health education and follow-up care
Assignment: i-Human Case Study: Evaluating and Managing Musculoskeletal Conditions-iHuman Mabel Johnson V5 PC
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. Based on the patient’s information, you will formulate a differential diagnosis, evaluate treatment options, and create an appropriate treatment plan for the patient.
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.
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
Sample
History Taking Questions | Chief Complaint: How can I help you today? HPI: O (Onset)-When did your pain in your knee(s) start? L (Location)-Where more precisely is the pain in your knee? Where more precisely is the swelling? Does the pain in your knee radiate to someplace else? Where? D(Duration) C (Characteristics)-Is there a pattern to the pain in your knees? What does the pain in your knee feel like? A (Aggravating)-Does anything make the pain in your hand(s) better or worse? Does anything make the pain in your knees better or worse? Does anything make your swelling problem better or worse? R(Relieving) T(Timing/Treatments) S (Severity)-How severe) 1-10scale) is the pain in your knee(s)? Past Medical History (PMH): ü Are you taking any over-the-counter or herbal medications? ü Have you been taking your medications as prescribed? ü Any new medical issues or diagnoses since your last visit? Review of Systems(ROS) ü Review all systems |
Physical Examination | Blood Pressure Pulse Rate Respiration HEENT: look in eyes with ophthalmoscope Chest Wall &Lungs: auscultate lungs(normal) Heart: auscultate heart(normal) Neurological: assess gait and stance Musculoskeletal: test range of motion Musculoskeletal: test stability Musculoskeletal: test strength: Extremities: visual inspection extremities Extremities: palpate extremities |
Problem List | ü Chronic continuous pain on the right knee as compared to the left knee (MSAP) ü Joint stiffness early in the morning ( both hands and knees) for more than one hour and worsens with cold (RELATED) ü Small effusion in the right knee (RELATED) ü Moderate swelling and pain of the fingers (RELATED) ü Impaired ability to perform ADLs ü Obese (RELATED) ü Bow legged( right-sided limp) (RELATED) ü Weakness of the lower extremity (RELATED) ü Hypertensive retinopathy (UNRELATED) ü Poorly controlled hypertension (UNRELATED) ü Peptic Ulcer Disease (PMH) (RESOLVED) |
Problem Statement | Ms. Johnson is a 76 year old obese woman with a significant history of renal disease, hypertension, and a PUD due to the use of ibuprofen. She presents with a complaint of progressive knee pain which is worse in the right knee than the left knee and a small effusion of the right knee. The pain is worse in the morning but improves with movement. Her knees have limited ROM and weight bearing exercise worsens the knee pain to an extent that she is restricted to perform ADLs. Currently, her hypertension is not well controlled despite being compliant to medications. |
Problem Category | Musculoskeletal |
Differential Diagnoses | ü Osteoarthritis (Lead) ü Rheumatoid Arthritis(Alternative) ü Gout (MnM)(Alternative) ü Septic arthritis (MnM)(Alternative) ü Calcium pyrophosphate dehydrate deposition disease (CPPD)/pseudogout(Alternative) |
Diagnostic Tests | Osteoarthritis ü Right-knee x-ray ü Left-knee x-ray ü Synovial fluid analysis (joint fluid analysis) Rheumatoid arthritis ü Erythrocyte sedimentation rate ü Antinuclear antibody (ANA) ü Synovial fluid analysis (joint fluid analysis) Pseudogout/CPPD ü Synovial fluid analysis Gout ü Uric acid, serum ü Synovial fluid analysis (joint fluid analysis) Septic arthritis ü Complete blood count ü Erythrocyte sedimentation rate ü Synovial fluid analysis(joint fluid analysis) |
Diagnosis | Osteoarthritis |
Management | Consult with an orthopedic surgeon for a possible knee replacement Corticosteroid knee injections for pain relief |
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