Discuss diagnosis and management of musculoskeletal and neurologic disorders
NURS 6541:Week 10: Discussion: Diagnosis and Management of Musculoskeletal and Neurologic Disorders
NURS 6541:Week 10: Discussion: Diagnosis and Management of Musculoskeletal and Neurologic Disorders
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. Discussion: Diagnosis and Management of Musculoskeletal and Neurologic Disorders
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: Discussion: Diagnosis and Management of Musculoskeletal and Neurologic 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
Discuss diagnosis and management of musculoskeletal and neurologic disorders
Introduction
Musculoskeletal and neurologic disorders are common in older adults. They can cause pain, stiffness, and limited mobility. In addition to these symptoms, musculoskeletal problems can lead to falls and other injuries. Discuss the diagnosis and management of musculoskeletal and neurologic disorders with your doctor or nurse practitioner so you can better manage this type of health issue
Introduction
Musculoskeletal and neurologic disorders are among the most common reasons for visits to primary care physicians. These conditions can be frustrating, expensive and potentially debilitating. They also present a major opportunity for misdiagnosis if they are not recognized early on.
This article will discuss diagnosis of musculoskeletal disorders in general, including those affecting the spine, neck or head; joints; muscles; tendons; ligaments and menisci (cushions between bones). It will also cover management options such as physical therapy interventions that may help relieve symptoms or prevent further damage from occurring.
Osteoarthritis
Osteoarthritis is a degenerative disease of the cartilage that occurs when the smooth tissue that covers your bones wears down and becomes damaged. The most common form of osteoarthritis is called rheumatoid arthritis, which affects about 2 million Americans.
Symptoms include:
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Pain in joints that may be worse at night or on changing positions (such as getting out of bed)
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Joint stiffness or popping sounds when you move your limb, especially if accompanied by pain
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Swelling around joints and crepitus (grating noises) caused by friction between joint surfaces
Rheumatoid arthritis
Rheumatoid arthritis (RA) is an autoimmune disease that causes damage to the joints. It’s characterized by inflammation in your body and can affect any joint, including your hands, wrists, elbows and knees.
Rheumatoid arthritis is caused by an overactive immune system that attacks its own tissues instead of foreign invaders like bacteria or viruses. This process causes the body to produce antibodies that attack healthy tissue around your joints causing pain and swelling.
The symptoms of RA vary depending on which joints are affected; however they may include:
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Painful swelling around the affected joint(s)
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Pain when trying to move into certain positions or using certain movements
Gout
Gout is a form of arthritis that occurs when uric acid crystals accumulate in the joint space. The most common form of gout is monosodium urate (MSU), which can crystallize as high-molecular-weight and low-molecular-weight forms. In people with MSU gout, there are purplish lines on the fingers, toes and nails; these lines usually fade over time but may continue to be present for years after an episode has passed.
The causes of gout are not well understood but include genetic factors combined with excess alcohol consumption and/or lack of physical activity (that can lead to weight gain). Other risk factors include:
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Having a family history of gout or another disorder known to be associated with increased uric acid levels
Lumbar radiculopathy
Lumbar radiculopathy is a neurological condition that results from inflammation of the nerve roots in the lower back. The pain can be severe and prolonged, with symptoms ranging from a dull ache to sharp pains. Causes of lumbar radiculopathy include (but are not limited to):
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Lumbar disc herniation, which involves the degeneration of one or more discs between your spine and pelvis. This may cause pressure on your nerves, leading to pain from these nerves being compressed by their surrounding tissues.*
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* Bulging disks may also contribute to this condition; however, it’s less common than lumbar disc herniation.*
Treatment for lumbar radiculopathy includes anti-inflammatory medications such as ibuprofen and naproxen sodium over-the-counter medicines such as acetaminophen/paracetamol combination drugs like Tylenol 3® caplets (or generic equivalent), Neurontin® tablets (or generic equivalent), Lyrica® tablets (or generic equivalent). Other treatment options include physical therapy sessions along with prescription painkillers such as Vicodin®, Norco®, Percocet®, codeine phosphate/hydrocodone bitartrate combination tablets
Low back pain
Low back pain is common, and can be caused by many things. It’s a complex problem that requires a variety of treatment options.
For some people, low back pain limits their ability to do activities they enjoy or make them feel uncomfortable in their own skin. For others, it means they can’t perform daily tasks like getting out of bed or reaching for something on the floor without experiencing significant pain that lasts at least three days each week for six months or more (the “chronic” definition).
Carpal tunnel syndrome
Carpal tunnel syndrome is a condition that affects the wrist and hand. It can cause numbness, tingling, or pain in the fingers and thumb. The most common symptoms are pain and weakness in your hands.
Carpal tunnel syndrome is caused by pressure on the median nerve in the wrist (the large nerve running from your forearm to your hand). This pressure may be caused by:
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A damaged joint (such as arthritis)
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Tight muscle around this joint (such as tendonitis)
Discuss diagnosis and management of musculoskeletal and neurologic disorders
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Diagnosis of Musculoskeletal and Neurologic Disorders
A diagnosis is the identification of an underlying cause for a disease or condition. It can be made by a healthcare provider after reviewing symptoms, performing tests, and speaking with the patient. A clinical diagnosis is one that has been made based on the patient’s history, physical examination findings, lab tests (if indicated), imaging studies (such as X-rays), and other diagnostic procedures performed on or near his or her body such as electrocardiography (ECG) or brain imaging studies such as magnetic resonance imaging (MRI).
Conclusion
We hope that this article has been helpful in providing you with an overview of diagnosis and management of musculoskeletal and neurologic disorders. Remember that if you suspect a problem, the first step is to see a doctor who can help with tests such as x-rays and MRIs.
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