Muscoloskeletal System
How did the iHuman Virtual Patient Encounter case help strengthen your understanding of the chosen body system?
What additional study techniques will you incorporate to strengthen your understanding of the chosen body system?
MUSCOLOSKELETAL SYSTEM
This is the management plan and issues with this weeks patient
Diagnosis: Anterior wedged-shaped fracture of L4
Diagnostic Tests:X-Ray of spine – Interpretation: Anterior wedged-shaped fracture of L4 (Alsoof et al., 2022)Bone scan total body – Interpretation: Normal (Alsoof et al., 2022) Lumbar spine MRI – Interpretation: Anterior wedged-shaped fracture of L4 (Alsoof et al., 2022)Thoracic spine MRI – Interpretation: Normal (Alsoof et al., 2022)
Medications/Treatments
Continue the following medications:
Lisinopril 20 mg dailyHydrochlorothiazide 25 mg dailySimvastatin 40 mg daily
New Medications:
Rx: Calcium Citrate (Citracal) tablet315 mg calcium and 200 IU Vit D (Hollier, 2021)
Sig: 1 tablet PO twice daily for bone strength
Disp: 90 tabletsRefill: 2
Rx: Ibuprofen (Advil) 600 mg tablets (Hollier, 2021)
Sig: 1 tablet every 6 hours for pain managementDisp: 90 tablets
Refill: 0
Consults/Referrals:Orthopedic referral for evaluation and management or possible surgery (Donnelly III et al., 2022).Referral for physical and occupational therapy. (Hollier, 2021)Neuro and Neurosurgeon when appropriate Donnelly III et al., 2022).
Client Education:Educate on diagnosis and diagnostic test findings.Provide treatment option including pharmacotherapeutic pain management and possible surgery.Importance of consult with ortho and back brace for support/stabilization of spine (Hollier, 2021).Weight bearing exercises when indicated avoiding bending forward.Avoid taking NSAIDs like Ibuprofen with an empty stomach.Introduce intake of calcium and Vitamin D, discussing its purpose (Hollier, 2021).Encourage adequate rest and resuming activities as tolerated (Hollier, 2021).Apply ice/heat packs for 20 to 30 minutes several times per day (Hollier, 2021)Encourage patient to immediately report sings of weakness, numbness, tingling, bladder/bowel incontinence or difficulty urinating (Hollier, 2021).Educate patient that she should seek emergency medical care if she develops weakness, numbness, tingling, and/or loss of bowel and/or bladder.Monitor BP daily and report elevated readings.
Follow-up:Contact office if condition worsens. If stable, return to office within 1 – 2 weeks (Hollier, 2021).Report to nearest emergency room if bladder/bowel incontinence or difficulty urinating or if respiratory difficulties develop (Hollier, 2021).Office follow up recommended after Ortho consult.If pain persists after 3 -6 weeks, x-ray will be repeated (Hollier, 2021).
References
Alsoof, D., Anderson, G., McDonald, C. L., Basques, B., Kuris, E., & Daniels, A. H. (2022). Diagnosis and management of vertebral compression fracture. The American Journal of Medicine, 135(7), 815–821. https://doi.org/10.1016/j.amjmed.2022.02.035
Donnally III, C, J., DePompeo, C. M., & Varacallo, M. (2022). Vertebral compression fractures. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK448171/
Hollier, A. (2021). Fractures. In Clinical guidelines in primary care (4th ed., pp.620-621). Essay, Advanced Practice Education Associates.
Hollier, A. (2021). Low Back Pain. In Clinical guidelines in primary care (4th ed., pp.632-633). Essay, Advanced Practice Education Associates.
Hollier, A. (2021). Osteoporosis. In Clinical guidelines in primary care (4th ed., pp.643-648). Essay, Advanced Practice Education Associates.
Hollier, A. (2021). Pain Management in Orthopedics. In Clinical guidelines in primary care (4th ed., pp.648-652). Essay, Advanced Practice Education Associates.
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