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Part 1 Case 3 A 45-year-old Hispanic female, Ms. Rodriguez, presents to the clin
Part 1 Case 3 A 45-year-old Hispanic female, Ms. Rodriguez, presents to the clinic complaining of sudden onset headache. She states this headache is different from her previous migraine headaches. The headache pain is described as a 10 on a scale of 0–10 with 10 being the worst pain. The pain is nonradiating, and she has mild photophobia. She did not get relief with sumatriptan (Imitrex), which previously provided relief for her migraines. She feels nauseous and states she vomited twice. Physical examination findings are as follows: Vital signs: temperature 98.8°F; pulse 88 beats per minute; respirations 20 per minute; blood pressure 150/95 mmHg; pulse oximeter 100% on room air. General appearance: alert, in mild discomfort due to pain. Head, Eyes, Ears, Nose, and Throat: normocephalic, atraumatic; pupils equal, round, reactive to light and accommodation; sclera nonicteric; extraocular movements intact; no nystagmus; optic disc margins are sharp with no evidence of papilledema or hemorrhaging noted. Lungs: clear to auscultation bilaterally. Cardiac: regular rate and rhythm; S1, S2 with no murmur. Abdomen: soft, depressible, nontender, no organomegaly. Neuro: cranial nerves II–XII intact; muscle strength 5/5; deep tendon reflexes 2+ and symmetrical throughout; no pronator drift; negative Romberg sign; coordination intact; gait steady. Answer the following questions or provide responses based on Part 3. 1. What is your differential diagnosis? 2. What are your risk factors for meningitis? Subarachnoid hemorrhage (SAH)? 3. What imaging would you like to do? 4. Discuss the difference between a headache that presents gradually as compared to a headache that presents suddenly. 5. What other history to you want to obtain from this patient? 6. What clinical findings would you anticipate with meningitis? 7. What clinical findings would you anticipate with SAH? Part 2 case 1 Case 1 A 35-year-old, healthy White male is complaining of right-sided, low back pain for 1 day. The pain began suddenly after lifting a box weighting 35 lbs. at work. The pain radiates down the back of his leg to his right ankle. He has tried ibuprofen and ice without relief. His pain is an 8 out of 10 (with 0 being no pain and 10 being the worst pain). He denies bowel or bladder dysfunction, paresthesia, motor weakness, or fever. Past medical/surgical history: no major medical illnesses; no surgical history; no previous hospitalizations. Social history: has smoked 1 pack of cigarettes a day for 15 years. Medications: none. Allergies: no known drug allergies. Vital signs: temperature 98.7°F; pulse 90 beats per minute; respirations 18 per minute; blood pressure 126/78 mmHg; pulse oximeter 100%. Physical examination revealed a well-nourished adult male without any acute distress. Significant right paraspinal tenderness at L4–L5 was present with no midline tenderness. Straight leg raise was positive at 30° to the right lower extremity. Straight leg raise was negative to the left lower extremity. The remainder of musculoskeletal examination was unremarkable (e.g., deep tendon reflexes, strength, and sensation). Other systems examinations were unremarkable (e.g., heart, lungs, etc.). Answer the following questions based on the Case 1. 1. What are your differential diagnoses? What are subjective and objective findings consistent with the various differentials for low back pain? 2. Would you consider imaging for this patient? If so, what imaging would be recommended and why? 3. What are the red flags of low back pain? 4. What are treatment strategies for this patient? What education would be provided to the patient? 5. When should you refer this patient to a specialist? Part 3 Post your major takeaway from this week’s content (3sentences) by the due date. Using reference below (Chapter 11 or 12) Dlugasch, L. & Story, L. (2019). Applied pathophysiology for the advanced practice nurse (1st ed.). Jones & Bartlett. ISBN: 9781284150452
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