Assessing Neurological Symptoms Essay Discussion 

 Assessing Neurological Symptoms Essay Discussion 

 Assessing Neurological Symptoms Essay Discussion 

 Patient Information:

Initials: V.A                            Age: 47 years

Sex: Female                            Race: White

S.

CC: “Pain in the right wrist.”

HPI:

V.A is a 47-year-old White woman who presents with complaints of pain in the right wrist. She mentions that the wrist pain began two weeks ago. She states that the wrist pain is associated with a tingling sensation and numbness in the thumb, index, and middle fingers, which also began two weeks ago. The pain is associated with activity primarily when she is suing the right hand and is relieved to some degree by rest. The patient states that the wrist pain interferes with her work since she often drops her hair-styling tools. She rates the pain at 3/10.

Current Medications: None.

Allergies: No known allergies.

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PMHx: Immunization is current. The last TT- was 18 months ago; the last Influenza shot- was four months ago. The patient has had a history of overweight/obesity since she was 25. No history of other chronic illnesses or surgery.

Soc Hx: V.A is a hairdresser and runs a salon in Brooklyn, NY. She has a diploma in hair and beauty and has worked as a hairdresser for almost 25 years. The patient is married and has two children, 25 and 20. Her hobbies include watching fashion shows and baking. She admits consuming 3-4 beers on weekends but denies using tobacco or illicit substances. The patient takes three meals daily, although she admits to mainly eating fast foods for lunch. She states that she rarely exercises apart from walking to work. 

Fam Hx: The patient’s grandfather had DM, and the grandmother died from pancreatic cancer. The children have no chronic conditions.

ROS:

GENERAL:  Negative for fatigue, body weakness, hotness of the body, or chills.

CARDIOVASCULAR:  Negative for racing heart, skipped heartbeats, chest discomfort, edema, dyspnea on exertion.

RESPIRATORY:  Negative for cough, sputum, chest pain, or wheezing.

NEUROLOGICAL:  Positive for tingling sensation and numbness in the fingers. Negative for headache, syncope, or dizziness.

MUSCULOSKELETAL: Positive for wrist pain. Negative for muscle pain or joint pain/stiffness.

O.

Physical exam:

Vital signs: BP- 126/84; HR-84; RR- 18; Temp- 98.4F

            Wt-192 lbs; Ht-5’45; BMI- 33.0

General: Obese female, calm, and not in distress. She is well-groomed and maintains adequate eye contact. Her speech is clear and goal-directed, and she exhibits a positive attitude.

Cardiovascular:  Regular heart rate and rhythm. S1 and S2 were heard with a normal rhythm. No S gallop or systolic murmurs were auscultated.

Respiratory: Smooth respirations with unison chest rise and fall. Breath sounds are heard bilaterally, and lungs are clear.

Neurological: Normal gait, balance, and posture. Sensory abnormalities in the palmar side of the right thumb and index and middle fingers. Positive carpal compression test.

Musculoskeletal: Spine is well-aligned. Muscle strength- 5/5. Joints are non-inflamed and non-enlarged.

Diagnostic results:

Plain X-ray of the Right Wrist and Fingers: Awaits results. The X-ray is vital in visualizing joint defects in the wrist and metacarpophalangeal joints.

 A.

Differential Diagnoses

Carpal Tunnel Syndrome (CTS): CTS is characterized by compression of the median nerve when passing through the carpal tunnel in the wrist. Clinical manifestations of CTS include pain in the hand and wrist accompanied by tingling and numbness (Genova et al., 2020). The pain is typically distributed along the median nerve, the palmar surface of the thumb, index and middle fingers, and the radial half of the ring finger. However, it can involve the entire hand. Usually, affected individuals wake at night with aching or burning pain and a tingling sensation and numbness and shake the hand to relieve the pain and tingling and reinstate the sensation (Genova et al., 2020). CTS is a differential diagnosis based on positive findings of pain, tingling, and numbness in the wrist and thumb, index, and middle fingers, which result in loss of grip when working. In addition, sensory defects in the palmar side of the affected fingers and a positive carpal compression test point to CTS.

Peripheral Neuropathy: Peripheral neuropathy is characterized by dysfunction of one or more peripheral nerves, the section of a nerve distal to the root and plexus. The condition includes various syndromes that manifest with different levels of pain, sensory disturbances, muscle weakness and atrophy, diminished deep tendon reflexes, and vasomotor symptoms, which occur alone or in combination (Castelli et al., 2020). Peripheral neuropathy is a differential diagnosis based on the patient’s symptoms of wrist pain and tingling, and numbness in the right arm fingers.

Arthritis of the Right Wrist: Arthritis of the wrist is caused by the loss of cartilage between wrist bones. It results in wrist joint pain, swelling, and stiffness (Maklad, 2020). The symptoms can be constant if the arthritis is severe. The patient’s history of right wrist pain makes wrist arthritis a differential diagnosis. However, the patient has no wrist swelling or stiffness, making arthritis an unlikely primary diagnosis.

Wrist Tendonitis: Wrist tendonitis is characterized by inflammation of one or more tendons in the wrist. It occurs as a result of micro-tears in a tendon due to sudden or recurring injury (Ferguson et al., 2019). The tendon inflammation usually results in pain, stiffness, swelling, and warmth in the wrist. Wrist tendonitis is a differential diagnosis based on the symptom of wrist pain.

Cervical Radiculopathy: Radiculopathy causes segmental radicular deficits like pain and paresthesias that distribute in a dermatomal pattern. They also cause weakness and atrophy of muscles innervated by the nerve root (Kang et al., 20200. Besides, the pain may be aggravated by movements that convey pressure to the nerve root via the subarachnoid space. The patient’s wrist pain, as well as numbness and tingling sensation on the right-hand fingers, make cervical radiculopathy a differential diagnosis.

References

Castelli, G., Desai, K. M., & Cantone, R. E. (2020). Peripheral Neuropathy: Evaluation and Differential Diagnosis. American family physician, 102(12), 732–739.

Ferguson, R., Riley, N. D., Wijendra, A., Thurley, N., Carr, A. J., & Bjf, D. (2019). Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity? BMC musculoskeletal disorders, 20(1), 542. https://doi.org/10.1186/s12891-019-2902-8

Genova, A., Dix, O., Saefan, A., Thakur, M., & Hassan, A. (2020). Carpal Tunnel Syndrome: A Review of Literature. Cureus, 12(3), e7333. https://doi.org/10.7759/cureus.7333

Kang, K. C., Lee, H. S., & Lee, J. H. (2020). Cervical Radiculopathy Focus on Characteristics and Differential Diagnosis. Asian spine journal, 14(6), 921–930. https://doi.org/10.31616/asj.2020.0647

Maklad, M. (2020). Wrist arthritis and Carpal Advanced Collapse-Systematic review. International Journal of Orthopaedics, 7(6), 1374-1378.

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Assignment: Assessing Neurological Symptoms

Photo Credit: Getty Images/iStockphoto
Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.
In this Case Study Assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
To Prepare
• By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
• Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style 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.
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 exams 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.
The Case Study Assignment
Use the Episodic/Focused SOAP Template and create 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.

Case Study #2
47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools

Learning Resources

Required Readings (click to expand/reduce)

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 7, “Mental Status”

This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.

• ·Chapter 23, “Neurologic System”

The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.
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 4, “Affective Changes”
This chapter outlines how to identify the potential cause of affective changes in a patient. The authors provide a suggested approach to the evaluation of this type of change, and they include specific tools that can be used as part of the diagnosis.

Chapter 9, “Confusion in Older Adults”
This chapter focuses on causes of confusion in older adults, with an emphasis on dementia. The authors include suggested questions for taking a focused history as well as what to look for in a physical examination.

Chapter 13, “Dizziness”
Dizziness can be a symptom of many underlying conditions. This chapter outlines the questions to ask a patient in taking a focused history and different tests to use in a physical examination.

Chapter 19, “Headache”
The focus of this chapter is the identification of the causes of headaches. The first step is to ensure that the headache is not a life-threatening condition. The authors give suggestions for taking a thorough history and performing a physical exam.

Chapter 31, “Sleep Problems”
In this chapter, the authors highlight the main causes of sleep problems. They also provide possible questions to use in taking the patient’s history, things to look for when performing a physical exam, and possible laboratory and diagnostic studies that might be useful in making the diagnosis.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
• Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”) (Previously read in Weeks 1, 2, 3, and 5)
Note: Download the Physical Examination Objective Data Checklist to use as you complete the Comprehensive (Head-to-Toe) Physical Assessment assignment.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical examination objective data checklist. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Mosby’s Guide to Physical Examination, 7th Edition by Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. Copyright 2011 by Elsevier. Reprinted by permission of Elsevier via the Copyright Clearance Center.

Note: Download and review the Student Checklists and Key Points to use during your practice neurological examination.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Neurologic 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). Neurologic 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.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Mental status: 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.

Kim, H., Lee, S., Ku, B. D., Ham, S. G., & Park, W. (2019). Associated factors for cognitive impairment in the rural highly elderly. Brain and Behavior, 9(5), e01203. https://doi.org/10.1002/brb3.1203

Lee, K., Puga, F., Pickering, C. E., Masoud, S. S., & White, C. L. (2019). Transitioning into the caregiver role following a diagnosis of Alzheimer’s disease or related dementia: A scoping review. International Journal of Nursing Studies, 96, 119–131. https://doi.org/10.1016/j.ijnurstu.2019.02.007

O’Caoimh, R., & Molloy, D. W. (2019). Comparing the diagnostic accuracy of two cognitive screening instruments in different dementia subtypes and clinical depression. Diagnostics, 9(3), 93. https://doi.org/10.3390/diagnostics9030093

Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:

Shadow Health. (2021). Welcome to your introduction to Shadow Health. https://link.shadowhealth.com/Student-Orientation-Video

Shadow Health. (n.d.). Shadow Health help desk. Retrieved from https://support.shadowhealth.com/hc/en-us

Shadow Health. (2021). Walden University quick start guide: NURS 6512 NP students. https://link.shadowhealth.com/Walden-NURS-6512-Student-Guide

Document: DCE (Shadow Health) Documentation Template for Comprehensive (Head-to-Toe) Physical Assessment (Word document)
Use this template to complete your Assignment 3 for this week.

Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2020). DeGowin’s diagnostic examination (11th ed.). New York, NY: McGraw Hill Medical.
• Chapter 14, “The Neurologic Examination”

This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.
• Chapter 15, “Mental Status, Psychiatric, and Social Evaluations”

In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.

Required Media (click to expand/reduce)

Neurologic System – Week 9 (16m)
Accessible player

Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 7 and 23 that relate to the assessment of cognition and the neurologic system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/

RUBRIC:

Excellent Good Fair Poor
Using the Episodic/Focused SOAP Template:
· Create documentation or an episodic/focused note in SOAP format about the patient in the case study to which you were assigned.

· Provide evidence from the literature to support diagnostic tests that would be appropriate for your case. 45 (45%) – 50 (50%)
The response clearly, accurately, and thoroughly follows the SOAP format to document the patient in the assigned case study. The response thoroughly and accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study. 39 (39%) – 44 (44%)
The response accurately follows the SOAP format to document the patient in the assigned case study. The response accurately provides detailed evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study. 33 (33%) – 38 (38%)
The response follows the SOAP format to document the patient in the assigned case study, with some vagueness and inaccuracy. The response provides evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study, with some vagueness or inaccuracy in the evidence selected. 0 (0%) – 32 (32%)
The response incompletely and inaccurately follows the SOAP format to document the patient in the assigned case study. The response provides incomplete, inaccurate, and/or missing evidence from the literature to support diagnostic tests that would be appropriate for the patient in the assigned case study.
· List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each. 30 (30%) – 35 (35%)
The response lists five distinctly different and detailed possible conditions for a differential diagnosis of the patient in the assigned case study and provides a thorough, accurate, and detailed justification for each of the five conditions selected. 24 (24%) – 29 (29%)
The response lists four to five different possible conditions for a differential diagnosis of the patient in the assigned case study and provides an accurate justification for each of the five conditions selected. 18 (18%) – 23 (23%)
The response lists three to four possible conditions for a differential diagnosis of the patient in the assigned case study, with some vagueness and/or some inaccuracy in the conditions and/or justification for each. 0 (0%) – 17 (17%)
The response lists three or fewer, or is missing, possible conditions for a differential diagnosis of the patient in the assigned case study, with inaccurate or missing justification for each condition selected.
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. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. 3 (3%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. 0 (0%) – 2 (2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards:
Correct grammar, mechanics, and proper punctuation 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. 3 (3%) – 3 (3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. 0 (0%) – 2 (2%)
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 heads, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)
Uses correct APA format with no errors. 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. 3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors. 0 (0%) – 2 (2%)
Contains many (≥ 5) APA format errors.