Week 5 Discussion Musculoskeletal Discussion

Sample Answer

Week 5 Discussion

Musculoskeletal disorders comprise a crucial public health concern for most populations. Nurses and other healthcare providers utilize evidence-based interventions to optimize outcomes and minimize disease burden to the affected populations. Therefore, the purpose of this paper is to examine Mr. Payne’s case study. The analysis focuses on his history, physical examination and diagnostics, differential diagnoses, and the selected plan of care.

Mr. Payne’s History

Mr. Payne is a 45-year-old patient that comes to the hospital with complaints of low back pain. The history that would be pertinent for his health problem include that related to the low back pain. The patient is a truck driver who reports low, sharp, stabling back pain for the last two weeks. He reports that the pain started after he picked a box.

The pain initially responded to analgesics but worsened after he played softball with his daughter. The pain was severe that he had difficulties getting out of bed this morning. The other significant pertinent history is his part medical history, which shows that he has a history of diabetes, which is well controlled and hyperlipidemia and hypertension that are controlled. His current history of medication use is also crucial since it will guide the selection of best treatments to optimize outcomes.

History about the factors that relieve or aggravate the symptoms is also important. The patient reports that sitting or standing for long periods worsens the pain while lying supine relieves it. The character of the pain such as radiating down the left leg to the ankle is important in guiding the development of an accurate diagnosis. Pain rating is also crucial in enabling the nurse to understand its severity and appropriate interventions.

Physical Exam and Diagnostic Tools

Physical examination is important for the determination of the client’s problem. Healthcare providers use physical examination data to validate the client’s concern. Several physical examinations should be performed for Mr. Payne. One of them is inspection. Inspection is necessary to assess the patient’s posture, symmetry and contour of the spine.

This would help rule out kyphosis, scoliosis, and lordosis. A reflex test should also performed on the patient. The aim is to identify if the client has full range of motion, pain with movement, normal gait, and can do deep knee bends as well as response to different stimuli. Back examination should also performed. The focus should be on the presence of tenderness, pain, and abnormal curvatures.

The muscle tone of both lower extremities should be assessed to determine if reduced or normal. Sensory tests of the lower extremities are also crucial to help note any abnormal findings that predispose the patient to harm. Physical examination of the abdomen should also be performed when the patient was in supine position for abdominal bruit and passive straight leg raise. Palpation for abdominal and pelvic tenderness should also performed to rule out any gastrointestinal issues (Kang et al., 2020). Some of the diagnostic investigations that may be performed to develop accurate diagnosis include spinal CT scan to rule out causes such as disc compression and malignancies.

Differential Diagnoses

The client’s primary diagnosis is disc herniation. Disc herniation is a common musculoskeletal problem that develops from the displacement of the nucleus pulposus from the intervertebral space. Patients often describe the character of pain in herniated disc as stinging or burning. The pain often has the character of radiating to the lower extremities. The extreme cases of herniated discs are associated with changes in sensation and weaknesses.

Spinal cord dysfunction may develop if the herniation involves the compression of the spinal cord nerves. The additional symptoms of disc herniation include difficulty in walking due to pain, loss of bowel or bladder control, lower back pain with Velsava manuuever, and muscle spasms (Benzakour et al., 2019). Mr. Payne has most of these symptoms, making disc herniation the primary diagnosis.

The second diagnosis that should be considered for the patient is osteophytes. Osteophytes refer to non-inflammatory process that arises from the degeneration of the intervertebral disc. Degeneration leads to the development of spondylosis and osteophytes. The resulting symptoms from osteophytes include pain of the upper and lower limbs, lower back pain, numbness and tingling.

The third diagnosis to consider is discal cyst. A discal cyst is a less common lesion that is associated with radicular and lumbar pai. It develops from the resorption of the preexisting disc herniation, which increases the risk of disc prolapse (Kang et al., 2020). The accompanying symptoms associated with discal cyst include lower back pain, upper and lower extremity pain, and difficulty in walking or sitting secondary to pain.

Plan of Care

Disc herniation resolve on its own after some period. However, treatments for symptom management should be prescribed. Analgesics such as ibuprofen and muscle relaxants should be prescribed to help Mr. Payne manage the symptoms. In addition, it is important for the patient to be on strict bed rest to relieve pressure from the herniated disc.

The bed rest will also enhance the recovery process. A referral to a physical therapist is also recommended to help Mr. Payne on the different exercises and activities he can engage to promote recovery process (Yamada et al., 2022). Patient education focuses on the importance of avoiding lifting heavy weights, engaging in moderate activities, and avoiding alcohol abuse. Patient’s follow-up should be done after two weeks to determine his response to treatment.

Conclusion

In summary, this paper has explored Mr. Payne’s case study. His primary diagnosis is disc herniation. The secondary diagnoses should be ruled out. The use of analgesics, muscle relaxants, strict bed rest, and referral to physical therapy are appropriate treatments for him.

References

• Benzakour, T., Igoumenou, V., Mavrogenis, A. F., & Benzakour, A. (2019). Current concepts for lumbar disc herniation. International Orthopaedics, 43(4), 841–851. https //doi.org/10.1007/s00264-018-4247-6
  
• Kang, K.-C., Lee, H. S., & Lee, J.-H. (2020). Cervical Radiculopathy Focus on Characteristics and Differential Diagnosis. Asian Spine Journal, 14(6), 921–930. https //doi.org/10.31616/asj.2020.0647
  
• Yamada, K., Iwasaki, N., & Sudo, H. (2022). Biomaterials and Cell-Based Regenerative Therapies for Intervertebral Disc Degeneration with a Focus on Biological and Biomechanical Functional Repair Targeting Treatments for Disc Herniation. Cells, 11(4), Article 4. https //doi.org/10.3390/cells11040602