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Critical Thinking Scenario Template – Part 2 Frances Funstead, a 55-year-old Caucasian woman, presents to the occupational health nurse asking for help with her back pain. She works on an assembly line and believes her back pain may be related to her job. Biographie Date: Ms. Funstead, 55-year-old Caucasian woman. Alert and oriented, Asks and answers questions appropriately, Reason for Seeking Health Care: “have pain and stiffness in my lower back. History of Present Health Concern: The client reports that 2 weeks ago she developed low back pain and stiffness that has increased over the past 2-3 days. She describes the pain as dull and achy. Ms. Funstead states that the pain is worse in the morning and with certain movements such as getting in and out of the car, bending over, and changing positions suddenly. She has also noted that the pain increases after standing for long periods of time. Despite taking ibuprofen and resting, the pain continues Client rates pain as 7 on scale of 0-10 prior to taking ibuprofen. An hour after taking ibuprofen, rates pain as 3-4 on scale of 0-10. Ibuprofen, resting and stretching alleviate the pain somewhat, however, the pain never goes away. Client denies paresthesias and bowel/bladder incontinence Personal History: Ms. Funstead denies any recent weight gain. She denies any past problems with joints, muscles, or bones. She reports that her immunizations are up to date. Denies diabetes, sickle cell anemia, SLE. or osteoporosis. Ms. Funstead reports that she is postmenopausal and not taking any estrogen replacement therapy Family History Ms. Funstead denies family history of rheumatoid arthritis, gout, or osteoporosis Lifestyle and Health Practices: Ms. Funstead reports that she tries to walk 30 minutes three times weekly and is usually successful. Client denies issues with weight gain or loss, but does feel as if she needs to lose weight Ms. Funstead’s medications include: Cakium with vitamin D supplement two times daily ibuprofen 400 mg every 8 hours as needed. Client denies use of tobacco or alcohol. She admits to drinking 3-4 cups of coffee each morning and 32 or of diet cola throughout the day. Her 24-hour diet recall includes Breakfast-cereal bar and coffee, lunch-low-calorie frozen meal yogurt apple, diet cola; dinner-chicken noodle soup, salad, fruit smoothie, 8-o glass of 2% milk. Activities in a typical day include Awakens at 5:30 AM and gets ready for work. Works from 7 AM to 3 PM. Walks after work with friends. Goes homes, prepares dinner, does household chores, watches TV; in bed by 10:30 PM Ms. Funstead works at a local factory on an assembly line. She picks up small parts and places them in a motor. She twists from side to side throughout the work day. She has one 15 minute break in the morning 30 minutes for lunch, and one 15-minute break in the afternoon. She stands while at work and is required to wear steel-toed shoes. She denies difficulty performing ADES. She does not require the use of assistive devices for mobility. Cilent devies any change in body image or self-esteem. Physical Examination Findings Inspection: Posture erect. Movement is coordinated and rhythmic. Arms swing in opposition. Able to stand on heels and toes Cervical and lumbar spines are concave. Thoracic Spine is convex Palpation Cervical thoracic, and lumbar spinous processes nontender. Lumbar paravertebral muscles are firm, taut, and tender bilaterally Lumbar spine: Flexion is decreased at 60 degrees; lateral bending is decreased at 25 degrees and guarded bilaterally hyperextension is normal at 30 degrees; rotation decreased at 20 degrees bilaterally and elicit discomfort. Lasegue test straight leg test) is negative. Leg length is equal Cr Range Step 1 – Describe the detailed Focused Physical Assessment of the Musculoskeletal system, Inspection Palpation Range of Motion Step 2 – What worries you? What data is relevant, what is the clinical significance of each data and identify the relevance of the data to the situation? ste Step 3 – What is the priority problem/nursing diagnosis. What are the signs and symptoms/client behaviors commonly seen with this problem? Step 4 – Are all the facts gathered? What other information or questions might the nurse need to gather/ consider as I prepare for this client Step 5 Describe any biased thought or personal beliefs that might prevent you from objectively looking at this situation Step 6. Consider developmental, cultural, and nutritional considerations and risk factors when completing health history and physical assessment on the musculoskeletal system Step 7-Provide patient teaching as regards to the musculoskeletal system + Critical Thinking Scenario Linda Hutchisoa, a 49-year-old Caucasian high school teacher, has had multiple sclerosis (MS) for over 20 years. She has been very tired lately, has had trouble maintaining urinary continence, is experiencing weakness, and describes a pins and needles feeling in her legs. Also, muscle spasms at night are affecting her ability to sleep. She is concerned about an exacerbation of ber MS and arrives at her scheduled appointment to discuss ways to prevent this from happening. Biographical Data: L.H. 49-year-old Caucasian woman. Alert and oriented. Asks and answers questions appropriately. Had been working as an office manager at the local high school, but recently began teaching her first love) language classes (French and German); she is also responsible for teaching two physical education (PE) classes a woek. Reason for Seeking Health Care I have been so tired and weak lately, and have been having trouble with urinary continence and a ‘pins and needles’ feeling in my legs. Leg spasms at night are keeping me awake. I am anxious that I will have an exacerbation of my MS.” History of Present Health Concern: The current symptoms began after she recently changed jobs. “I get so tired by the end of the week. If I rest all weekend, I am OK by Monday morning.” Ms. Hutchison has had MS for 20 years, but has managed to function at a near-normal level for most of that time. “I had one severe exacerbation during my divorce, but I went into remission after about 6 months.” • Personal Health History: Ms Hutchison denies numbness, seizures, or dizziness. She has not noticed a change in sensations of taste or smell, hearing, or vision Client denies difficulty speaking or swallowing. She denies loss of bowel control Client denies recent or remote memory loss. Client denies head injury, meningitis, encephalitis, spinal cord injury, or stroke. Family History: Ms. Hutchison reports that her mother has hypertension and migraine headaches. Her father and two sisters are in excellent health Maternal grandmother has hypertension and obesity. Matemal grandfather died as a result of an automobile accident at age 35. Paternal grandmother has rheumatoid arthritis. Paternal grandfather has coronary artery disease, hypertension, and diabetes type 2. Ms. Hutchinson denies a family history of cerebrovascular disease, epilepsy, brain cancer, or Huntington choren Lifestyle and Health Practices: Takes oxybutynin (Ditropan) as prescribed for MS. Takes multivitamin daily Denies use of tobacco or recreational drugs. Reports drinking two to three glasses of wine every 2 to 3 months Reports wearing a seatbelt at all times. Denis participation in any activities requiring protective headgear. 24-hour diet recall: Breakfast cereal with 2% milk and 1 cup of coffee: lunchplain ham and cheese sandwich I small bag plain potato chips, and an apple, with unsweetened iced tea; dinner petite filet mignon, loaded baked potato, salad, water Denies exposure to lead, insecticides, pollutants, or other chemicals. Denies frequent heavy lifting or repetitive motions. Reports that she is able to perform ADLs independently Denies any change in self-esteem or body image Physical Examination Findings: Alert, thin, middle-aged woman with mildly elevated blood pressure and pulse rate (13692 and 98). According to her chart, Ms. Hutchison’s blood pressure is normally 100/70 CN : Able to correctly identify scents bilaterally . . Step 1 – Describe the detailed focused Physical Assessment of the Neurologic system Discuss the Cranial Nerve Assessment Step 2 – What worries you? What data is relevant, what is the clinical significance of each data and identify the relevance of the data to the situation? Step 3 -What is the priority problem/nursing diagnosis. What are the signs and symptoms/client behaviors commonly seen with this problem? Step 4 – Are all the facts gathered? What other information or questions might the nurse need to gather/ consider as I prepare for this client Step 5 Describe any biased thought or personal beliefs that might prevent you from objectively looking at this situation Step 6 – Consider developmental, cultural and nutritional considerations and risk factors when completing health history and physical assessment on the neurologic system Step 7 -Provide patient teaching as regards to the neurologic system
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