NURS 6541: Primary Care of Adolescents and Children | Week 10

For many children and adolescents, sports are one way to build friendships, work in teams, engage in healthy competition, and earn scholarships—Tracy Yatsko was no exception. Tracy played on her high school’s basketball and track teams until suffering from a severe concussion. Initially, her concussion was thought to be mild. However, the dizziness and nausea lingered into the next evening when she collapsed in the locker room after another game. Tracy spent much of the remaining school year at home with migraines, nausea, vomiting, and difficulty concentrating. She was prescribed several different medications, was forced to stop playing sports, and lost many friends (Mishori, 2012). Sports injuries such as concussions are only one of several musculoskeletal and neurologic disorders that impact pediatric patients. Patients with these disorders often require extensive care, and as the advanced practice nurse, it is your role to provide this care, develop treatment strategies, and identify factors that impact adherence to care.

This week you explore musculoskeletal and neurologic disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.

Learning Objectives

By the end of this week, students will:

• Assess pediatric patients for musculoskeletal and neurologic disorders
• Evaluate differential diagnoses for pediatric musculoskeletal and neurologic disorders
• Analyze treatment and management plans for pediatric patients with musculoskeletal and neurologic disorders
• Analyze strategies for educating patients and families on the treatment and management of musculoskeletal and neurologic disorders
• Evaluate the impact of culture on the treatment and management of musculoskeletal and neurologic disorders
• Understand and apply key terms, principles, and concepts related to musculoskeletal and neurologic disorders in pediatric patients

Learning Resources – NURS 6541:Week 10: Evaluation and Management of Musculoskeletal and Neurological Disorders

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings

Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., Blosser, C. G., & Garzon, D. L.  (Eds.). (2017). Pediatric primary care (6th ed.). St. Louis, Missouri: Elsevier.

• • Chapter 28, “Neurologic Disorders” (pp. 660-702)This chapter explores the anatomy and physiology of the nervous system. It also presents assessment and management strategies of degenerative and nondegenerative disorders in children.

• Chapter 37, “Musculoskeletal Disorders” (pp. 983-1041)This chapter examines the anatomy and physiology of the musculoskeletal system. It also explores clinical findings, differential diagnoses, and management of musculoskeletal disorders specific to children including hip, knee, and foot problems.

Marsh, A.M.,  Fraser, D., Marsh, J.P., Serota, J.A., Giordano, B., & Hallas, D. (2013). Management of concussion in the pediatric patient. Journal of Pediatric Health Care, 27(6), 499-504.

American Academy of Pediatrics, Subcommittee on Febrile Seizures. (2011). Febrile seizures: Guideline for the neurodiagnostic evaluation of the child with a simple febrile seizure. Pediatrics, 127(2), 389–394. Retrieved from http://pediatrics.aappublications.org/content/127/2/389.full.pdf+html?sid=e5cbf9c6-b05c-459a-9aff-5a9d83a37a07

This article provides evidence-based recommendations for the diagnosis and evaluation of simple febrile seizures in infants and young children. It also identifies the benefits and limitations of various treatment options for simple febrile seizures.

Discussion: Diagnosis and Management of Musculoskeletal and Neurologic Disorders

Musculoskeletal and neurologic disorders can present complications for pediatric patients from infancy to adolescence. These disorders affect patients physically and emotionally and often impact a patient’s ability to participate in or carry out everyday activities. Patients with these disorders frequently need long-term treatment and care requiring extensive patient management and education plans. Musculoskeletal and neurologic disorders present various symptoms because they affect multiple parts of a patient’s body. Consider treatment, management, and education plans for the patients in the following three case studies.

• Case Study 1: A-F
• Case Study 2: G-M
• Case Study 3: N-T
• Case Study 4: U-Z

Case Study 1:

HPI: Clay is a 7-year-old male who presents in your office with complaints of right thigh pain and a limp. The pain began approximately 1 week ago and has progressively worsened. There is no history of trauma.

PE: Pleasant Caucasian boy, in mild distress. VS and growth pattern stable.
MS: flexion and internal rotation of the right hip and limited abduction of the right hip. Limb lengths are equal.

Case Study 2:

HPI: A 12-year-old girl presents with left knee pain during and after playing soccer. She’s been a member of an elite soccer team for the last 6 years. She has 2 hour practices 3 times a week. Does not recall any injuries.

PMH: asthma, eczema
MS: Anterior/posterior drawer tests negative; negative ballottement; negative edema/erythema; bony tenderness, slight swelling at the left tibial tubercle.

Case Study 3:

HPI: Trevon is an 18-month-old with a 3-day history of upper-respiratory-type symptoms that have progressively worsened over the last 8 hours. Mom states he spiked a fever to 103.2°F this morning and he has become increasingly fussy. He vomited after drinking a cup of juice this afternoon and has refused PO fluids since then.

PE: VS: Temp: 102.5°F;
HEENT: Marked irritability with inconsolable crying, and he cries louder with pupil examination and fights head and neck assessment
ABD: negative abdominal exam
NEURO: You are unable to elicit Kernig’s or Brudzinski’s signs due to patient noncompliance.

Case Study 4:

HPI: Molly is a 12-year-old who comes to your office after hitting her head on the ground during a soccer game. Her mother reports that she did not lose consciousness, but that she seems “loopy” and doesn’t remember what happened immediately following her fall. She was injured when she collided with another player and fell backward, striking her head on the ground. She has no vomiting and denies diplopia but complains of significant headache.

PE: Physical examination is negative except for the presence of slight nystagmus. All other neurologic findings including fundoscopic examination are normal.

To prepare:

• Review “Neurologic Disorders” and “Musculoskeletal Disorders” in the Burns et al. text.
• Review and select one of the three provided case studies. Analyze the patient information.
• Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
• Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
• Consider strategies for educating patients and families on the treatment and management of the musculoskeletal or neurologic disorder.

By Day 3

Post an analysis of your assigned case by responding to the following:

• What additional questions will you ask?
  • Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).
• What additional examinations or diagnostic tests, if any will you conduct?
• What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.
• What is your most likely diagnosis and why?
• How will you treat this child?
  • Provide medication treatment and symptomatic care.
  • Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
• Patient Education, Health Promotion & Anticipatory guidance:
  • Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
  • Include any socio-cultural barriers that might impact the treatment and management plans.
  • Health Promotion:
    • What immunizations should this child have had?
    • Based on the child’s age, when is the next well visit?
    • At the next well visit, what are the next set of immunizations?
    • What additional anticipatory guidance should be provided today?

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days in both of the wayslisted below. Respond to colleagues who selected different case studies than you did.

• Explain how culture might impact the diagnosis, management, and follow-up care of patients with the musculoskeletal and/or neurologic disorders your colleagues discussed.
• Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit! NURS 6541:Week 10: Evaluation and Management of Musculoskeletal and Neurological Disorders

 

 

 

 

ADDITIONAL INFORMATION 

Diagnosis and Management of Musculoskeletal and Neurologic Disorders

Introduction

Musculoskeletal and Neurologic disorders are common, often debilitating conditions that can affect the ability to perform daily tasks. While many of these disorders have an obvious cause, sometimes it takes a more thorough evaluation to determine why you are experiencing symptoms.

Musculoskeletal Disorders

Musculoskeletal disorders are conditions that affect the muscles, bones, tendons and joints of the body. They can be caused by injury or disease.

Musculoskeletal disorders include:

• Joint injuries – these range from simple sprains and strains to more serious sprains and fractures (broken bones).

• Muscle tears – these injuries may occur when you overextend a muscle in an effort to carry out an activity such as walking up stairs. Muscle tears can also happen as a result of falls on uneven ground or when lifting heavy objects incorrectly.

Symptoms include pain at the site where there’s been damage to muscle tissue; stiffness in affected joints; swelling around damaged areas like fingers or toes; lightheadedness due to blood loss from small cuts within blood vessels near injured muscles located under skin surface area like hands/feet etc..

Osteoarthritis

Osteoarthritis is a degenerative joint disease that affects the cartilage (the smooth, flexible tissue that covers the ends of bones) and synovial membrane. The cartilage layer can become thinner, thinner and eventually disappear completely. This causes pain when you move your joints around in everyday activities like walking or climbing stairs.

Symptoms of osteoarthritis include:

• Increased pain with daily motion of affected joints (such as bending over to tie shoes) or when lying down for a long period of time

• Difficulty moving certain parts of the body completely within their normal range because they don’t have enough strength in them anymore

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic, systemic, inflammatory disease that primarily affects the joints. It can also affect other organs of the body, including the lungs and gastrointestinal tract. The disease occurs when your body’s immune system attacks its own tissues.

In rheumatoid arthritis (RA), there are no signs or symptoms until you have severe pain in one or more joints that lasts for at least three months and occurs every day for at least six months of each year; this is called active disease. If you have milder cases—for example, if you notice just occasional pain—this is called reactive arthritis (RA). The reason why RA develops depends on how sensitive your immune system is to certain environmental chemicals called cytokines that are released by cells in response to infections or injury caused by other conditions such as cancer or surgery.*

Cancer-Related Pain

Cancer pain is a complex problem that can be acute or chronic. It may be treated with opioids, but many patients are under-treated. The most common cancers associated with pain include lung cancer and breast cancer, but other types of cancer may also cause pain.

In some cases, cancer-related pain can be controlled through medication or surgery alone; however, if you have uncontrolled symptoms due to your underlying health conditions (like diabetes), multiple surgeries on different parts of your body could lead to complications such as nerve damage and organ failure.

Psychological Aspects of Nonspecific Low Back Pain

The psychological aspects of low back pain are just as important to understand as the physical aspects. Psychological factors can play a role in causing and exacerbating back pain, as well as helping you manage your condition.

• Pain interference: Pain interference describes how much our thoughts and emotions interfere with our ability to deal with physical pain. For example, if you’re carrying groceries out of the house and suddenly feel a sharp pain in your lower back, you may be more likely to think about how sore it feels than concentrate on putting one foot in front of another without hobbling or falling over because of poor balance (a sign that something is wrong). This practice called distraction may actually make things worse by allowing some nerve signals from the brain stem or spinal cord to bypass their usual route through the body; this could cause further damage down below by interfering with messages going up through nerves outside those areas being injured.”

Neurologic Disorders

Neurologic disorders are caused by damage to the brain or spinal cord. The brain and spinal cord are made up of neurons and glial cells, which form a protective barrier around these vital organs.

The skull protects the cerebrum (upper portion) of your head from injury by providing a hard outer shell that contains sensitive areas such as your eyes and ears. It also provides support for your cranium (hard outer part), cerebellum (soft inner part), occipital lobes (back part) and frontal lobes (forehead).

The vertebrae provide protection for your spinal cord as well as other important structures like nerves, arteries and veins that supply oxygenated blood throughout your body

Stroke Rehabilitation

Aphasia and communication disorders

Paralytic stroke is the most common cause of primary aphasia, which can be treated with speech therapy. The patient may need to relearn how to speak, read, write and understand language. Speech therapists help patients communicate through words by using visual cues such as pictures or photographs to teach them how to use their words correctly. Occupational therapists work with patients who have difficulty performing everyday tasks like dressing themselves or bathing themselves because of weakness in their arms from paralysis caused by stroke. Assistive devices and equipment help people with disabilities perform their daily activities more easily: they include walkers (or wheelchairs), hearing aids, eyeglasses/contacts/contrast media etc..

Cerebral Palsy in Adults

Cerebral palsy is a condition that affects the development of movement and coordination in children. It can present at any age, but most commonly occurs between the ages of 2 and 4 years old. The cause of cerebral palsy is unknown, but it’s believed to be due to brain damage due to birth trauma or illness during pregnancy or childbirth.

Symptoms include:

• Limited movement (or no movement) in one or more limbs. Heel-toe gait is common for children with cerebral palsy; when walking on their toes instead of heel-toes, they may drag their feet along the ground rather than lift them up off it. Children who have received surgery may walk with slowness due to weakness in the legs below their knees; this condition sometimes results in limpness called “walker’s limp” (when someone walks flatfooted instead). Movement problems can also affect balance as well as posture—for example, if your child has difficulty walking up stairs without falling backwards down them!

Takeaway:

• Takeaway:

• If you’re experiencing any of these symptoms, see your healthcare provider.

• When it comes to musculoskeletal and neurological disorders, there are many different causes and treatments available. If you are experiencing any of the symptoms listed above, please contact us at [phone number] or visit our website at [website].

Conclusion

The quick takeaway is that all of these issues require specific treatment. The sooner you start looking into the causes and effects, the better your outcomes will be. There are many options available for each condition, including physical therapy, pain management and even surgery if needed.