Assessing Neurological Symptoms Case Studies Discussion

Assessing Neurological Symptoms Case Studies Discussion

Assessing Neurological Symptoms Case Studies Discussion

Patient Information:

Initials: H.F.                Age: 47 Years             Sex: Female                Race: Caucasian

S.

CC (chief complaint): “I am experiencing pain in my right wrist”

HPI: H.F., a 47-year-old Caucasian female with obesity, sought medical attention at the clinic due to her primary concern of experiencing pain in her right wrist, accompanied by sensations of numbness and tingling in the index, middle finger, and thumb. The patient has provided an account of experiencing these symptoms approximately fourteen days prior. Nevertheless, she expresses apprehension regarding the discomfort, as it causes her to inadvertently release her hairstyling implements.

Location: Right wrist

Onset: two weeks ago

Character: Numbness and pain in her right wrist

Associated signs and symptoms: Thumb, middle, and index finger tingling

Timing: the whole day

Exacerbating/ relieving factors: Worse while doing tasks with the wrist joint. When the wrist is stationary, the discomfort is reduced.

Severity: 6/10

Current Medications:

• Ibuprofen at a dosage of 400mg taken orally as needed,
• Hydrochlorothiazide at a dosage of 25mg taken orally every morning
• Amlodipine at a dosage of 10mg taken orally once daily.

Allergies: Allergic to sulfur. No environmental or food allergies.

PMHx: The patient exhibits obesity and has a documented history of hypertension.

• Immunization status: The patient has received all necessary vaccinations, including Tdap in October 2020, the Influenza Vaccine during the current season, and completed the COVID-19 Vaccines with Boosters in 2021.
• Surgeries: without any prior surgical history
• Hospitalization: There is no record of any hospitalizations.

Soc Hx: The patient is a hairdresser who works five blocks from her house in a neighborhood spa. She claims to have a history of sometimes consuming alcohol while smoking cigarettes. She does not, however, admit to using marijuana or any other illegal substance. She presently lives as a family with her husband and three kids. During her free time, she enjoys singing and reading. She exercises by taking the dog for a 30-minute walk every evening. She affirms that she eats a healthy diet and sleeps well for around 8 hours each night.

Fam Hx: The patient has two siblings, the younger of whom has just received an asthma diagnosis while the other is well. Both of her parents are still living; the mother has a history of T2DM and HTN, while the father has a history of HTN and esophagostomy. She is unaware of the medical history of her grandparents.

ROS:

GENERAL: denies any symptoms of heat or cold sensitivity, reduced appetite, sluggishness, chills, fever, or recent weight changes.

HEENT: Head: denies experiencing seizures, headaches, or dizziness. Eye: denies any discomfort, discharge, vision disturbances, photophobia, or blurriness. Ear: denies discharge, tinnitus, discomfort, or hearing loss. Nose: denies having sneeze fits, sinus pain, a runny nose, or nose bleeding. Throat: denies pain, swallowing issues, or voice hoarseness.

SKIN: denies rash or itching.

CARDIOVASCULAR: denies having orthopnea, arrhythmias, elevated blood pressure, or palpitations.

RESPIRATORY: denies having a cough, producing phlegm, having breathing problems, or breathing quickly.

GASTROINTESTINAL: denies experiencing vomiting, heartburn, heartburn pain, discomfort, or abdominal distention.

GENITOURINARY: denies having hematuria, vaginal discharge, incontinence, dysuria, oliguria, frequent urination, or burning pain.

NEUROLOGICAL: denies experiencing ataxia, a headache, paralysis, syncope, or abnormalities in bowel or bladder control. reports tingling and numbness in the middle, index, and thumb fingers.

MUSCULOSKELETAL: a right wrist ache is reported. denies muscular pain, joint stiffness, or joint swelling. demonstrates the complete range of motion in other joints.

HEMATOLOGIC: denies bleeding issues, easy bruising, or anemia.

LYMPHATICS: denies splenectomy or lymphadenopathy.

PSYCHIATRIC: denies experiencing hallucinations or other psychological symptoms such as anxiety, sadness, or thoughts of homicide or suicide.

ENDOCRINOLOGIC: denies a tendency to sweat excessively, polyuria, polydipsia, or sensitivity to heat and cold.

ALLERGIES: Sulfur allergy is reported.

O.

Physical exam: Vital signs: BP- 138/86 mmHg, PR-86, RR-19, Temp- 98.9, SpO2-98% on room air, Ht- 5’9”, Wt- 210 lbs., BMI-31.01

GENERAL: a female who is obese and adequately attired. Clear speaking, the patient is focused and aware X4. The patient responds to inquiries adequately and is not visibly distressed.

HEENT: Head: normal-sized, trauma-free, and without scars. Eye: Sclera and conjunctiva are clear. No significant redness, discharge, or tearing. Ear: Typical pinna with an unobstructed tympanic membrane. It is normal for the external auditory canal. Nose: nasal mucous membrane that is wet. No sinuses or discomfort to the touch. Throat: pink, wet mucous membrane in the mouth. The tonsils and posterior pharynx are not erythematous, and the uvula is in the middle.

MUSCULOSKELETAL: Gait and musculoskeletal development are normal. displays a healthy body posture without any joint or bone swelling or abnormalities. Right thumb abduction shows weakness, with a 3/5 poor strength. Positive Hoffmann-Tinel and Phalen indicators. All the muscles of the other limb are strong and their tendon reflexes are normal.

NEUROLOGICAL: Aware and well-grounded in time, location, and people. quite helpful throughout the assessment. All of the cranial nerves are mostly unharmed. demonstrates typical reactions. The right hand’s middle finger, thumb, and index finger all feel numb and tingly.

Diagnostic results: The complete blood count (CBC) reveals a white blood cell count (WBC) of 8.9. Additionally, a comprehensive metabolic panel (CMP) including differentials is performed.  The glucose level is measured at 125, while the HgbA1c level is recorded as 4.5%, indicating the need to exclude any potential presence or occurrence. Neuropathy associated with type 2 diabetes mellitus (T2DM). The concentration of C-reactive protein in the sample is 4.2 mg/L (Attal & Didier Bouhassira, 2023).

Diagnostic Tests:

• An X-ray examination of the right wrist was conducted to assess the presence of arthritic changes (Genova et al., 2020).
• Test for bone density to rule out osteoporosis.
• nerve conduction analysis.
• Manual: Tinel sign and Durkans Test (Zhang et al., 2020).

A.

Differential Diagnoses:

1. Carpal tunnel syndrome (CTS): This condition is characterized by symptoms such as tingling and numbness in the fingers, which occur due to compression of the median nerve within the carpal tunnel (Malakootian et al., 2022). This condition is commonly regarded as an occupational disease characterized by repetitive wrist and finger extension and flexion. However, certain cases of CTS may have an unknown cause, and the risk of developing CTS can be influenced by various factors, including genetic and acquired factors. A nerve conduction study is a precise diagnostic tool used to identify both normal and abnormal values of nerve function. Diagnostic laboratory results can also be utilized for the identification of increased levels of inflammatory markers. The patient exhibits multiple risk factors for developing this disease, including occupational factors and obesity.
2. Peripheral neuropathy: This condition is linked to hand numbness. The patient’s gender, familial history, and weight contribute to their increased risk of developing type 2 diabetes mellitus (T2DM) (Selvarajah et al., 2019). Peripheral neuropathy is a frequently observed symptom associated with T2DM, characterized by a gradual onset. A two-point discrimination test was conducted, revealing decreased sensitivity in the patient’s right arm. The patient reports no decrease in sensation in the lower extremities. If the patient experiences altered symptoms and exhibits new-onset neuropathy in the lower extremities, I will contemplate reevaluating the A1C levels and potentially diagnose diabetic peripheral neuropathy based on diagnostic assessments. Diabetic individuals exhibit significant declines in hand and finger dexterity relative to their healthy counterparts.
3. Wartenberg’s syndrome: This condition presents as paresthesia or pain occurring along the radial aspect of the forearm, with symptoms radiating toward the thumb and middle fingers. The pain arises due to the compression of the superficial radial nerve. Potential external factors may include the presence of a wristwatch or objects exerting pressure on the nerve (Kuschner & Berihun, 2021). The technique of palpation in the vicinity of the radial nerve region is employed to detect potential masses located both superficially and deeply. The utilization of the Tinel’s sign aids in the confirmation of this particular diagnosis.
4. Lupus: This is an autoimmune disease characterized by immune system dysfunction, resulting in inflammation, a high body temperature, joint pain, malaise, and rash. DNA methylation is a specific and reliable biomarker for the diagnosis of lupus, exhibiting cell-type specificity (Fanouriakis et al., 2020). DNA methylation is more prominent in patients with active disease compared to those in remission. The lupus band test (LBT) is a direct immunofluorescent approach conducted through skin biopsy. It is particularly valuable in cases where clinical and laboratory data are inconclusive for diagnosing lupus.
5. Type 2 Diabetes Mellitus (T2DM): The patient is at a heightened risk of developing T2DM. In the event of a gradual increase in the patient’s HbA1c, it is recommended to implement a prediabetes protocol involving lifestyle modifications such as dietary changes, exercise, and regular monitoring of HbA1c levels. Diabetic peripheral neuropathy (DNP) is characterized by progressive metabolic and inflammatory alterations that result in impaired daily functioning and reduced independence (Wu et al., 2021). Fasting lipid levels should be included in laboratory tests to assess cholesterol levels and provide education on cholesterol, triglycerides, LDL, and HDL levels.

 

 

References

Attal, N., & Didier Bouhassira. (2023). Neuropathic Pain. https://doi.org/10.1093/med/9780197616345.001.0001

Fanouriakis, A., Tziolos, N., Bertsias, G., & Boumpas, D. T. (2020). Update Οn the Diagnosis and Management of Systemic Lupus Erythematosus. Annals of the Rheumatic Diseases, 80(1), annrheumdis-2020-218272. https://doi.org/10.1136/annrheumdis-2020-218272

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

Kuschner, S. H., & Berihun, H. (2021). Robert Wartenberg Syndrome and Sign: A Review Article. The Open Orthopaedics Journal, 15(1), 13–16. https://doi.org/10.2174/1874325002115010013

Malakootian, M., Soveizi, M., Gholipour, A., & Oveisee, M. (2022). Pathophysiology, Diagnosis, Treatment, and Genetics of Carpal Tunnel Syndrome: A Review. Cellular and Molecular Neurobiology. https://doi.org/10.1007/s10571-022-01297-2

Selvarajah, D., Kar, D., Khunti, K., Davies, M. J., Scott, A. R., Walker, J., & Tesfaye, S. (2019). Diabetic peripheral neuropathy: advances in diagnosis and strategies for screening and early intervention. The Lancet Diabetes & Endocrinology, 7(12), 938–948. https://doi.org/10.1016/s2213-8587(19)30081-6

Wu, B., Niu, Z., & Hu, F. (2021). Study on Risk Factors of Peripheral Neuropathy in Type 2 Diabetes Mellitus and Establishment of Prediction Model. Diabetes & Metabolism Journal, 45(4), 526–538. https://doi.org/10.4093/dmj.2020.0100

Zhang, D., Chruscielski, C., Blazar, P., & Earp, B. (2020). Accuracy of Provocative Tests for Carpal Tunnel Syndrome. Journal of Hand Surgery Global Online, 2(3), 121–125. https://doi.org/10.1016/j.jhsg.2020.03.002

ORDER NOW FOR AN ORIGINAL PAPER ASSIGNMENT: Assessing Neurological Symptoms Case Studies Discussion

Question Description

I don’t understand this Health & Medical question and need help to study.

Discussion: Assessing Neurological Symptoms

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 Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

Case 1: Headaches

A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

Case 2: Numbness and Pain

A 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.

Case 3: Drooping of Face

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

To prepare:

pick any case study:

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.

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in 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.

template attached

episodic_focus

You must proofread your paper. But do not strictly rely on your computer’s spell-checker and grammar-checker; failure to do so indicates a lack of effort on your part and you can expect your grade to suffer accordingly. Papers with numerous misspelled words and grammatical mistakes will be penalized. Read over your paper – in silence and then aloud – before handing it in and make corrections as necessary. Often it is advantageous to have a friend proofread your paper for obvious errors. Handwritten corrections are preferable to uncorrected mistakes.

Use a standard 10 to 12 point (10 to 12 characters per inch) typeface. Smaller or compressed type and papers with small margins or single-spacing are hard to read. It is better to let your essay run over the recommended number of pages than to try to compress it into fewer pages.

Likewise, large type, large margins, large indentations, triple-spacing, increased leading (space between lines), increased kerning (space between letters), and any other such attempts at “padding” to increase the length of a paper are unacceptable, wasteful of trees, and will not fool your professor.

The paper must be neatly formatted, double-spaced with a one-inch margin on the top, bottom, and sides of each page. When submitting hard copy, be sure to use white paper and print out using dark ink. If it is hard to read your essay, it will also be hard to follow your argument.

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Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, include a minimum of one scholarly source, and be at least 250 words.
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One or two sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words.
I encourage you to incorporate the readings from the week (as applicable) into your responses.

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Your initial responses to the mandatory DQ do not count toward participation and are graded separately.
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I highly recommend using the APA Publication Manual, 6th edition.

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I discourage overutilization of direct quotes in DQs and assignments at the Masters’ level and deduct points accordingly.
As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content.
It is best to paraphrase content and cite your source.

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For assignments that need to be submitted to LopesWrite, please be sure you have received your report and Similarity Index (SI) percentage BEFORE you do a “final submit” to me.
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The university’s policy on late assignments is 10% penalty PER DAY LATE. This also applies to late DQ replies.
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If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect.
I do not accept assignments that are two or more weeks late unless we have worked out an extension.
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Communication

Communication is so very important. There are multiple ways to communicate with me:
Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class.
Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours.