When you urinate, have you noticed: pain, burning
When you urinate, have you noticed: pain, burning
Discussion Question 1
Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.
The history collection portion of these assignments seems to be the most challenging to me. There are so many questions, and sections, that is difficult to ask all the expected questions. I did fail to ask a few of the questions deemed to be important, according to the experts. The first question, “When you urinate, have you noticed: pain, burning, blood, difficulty starting or stopping, dribbling, incontinence, urgency during day or night or any changes in frequency?” This is an important question because spinal injury can result in issues with bowel or bladder control. These findings are “red flags” according to Goolsby and Grubbs (2015). Loss of bladder or bowel control could indicate the patient is suffering from Cauda Equina syndrome, which is a medical emergency that requires treatment to prevent long-term complications (Ahad, Elsayed, and Tohid, 2015).
The second question I omitted was, “Any other symptoms or concerns we should discuss?” This question is very useful to help patient’s talk about other issues they may be experiencing. During my personal clinical rotation, this question has often revealed a whole new problem the patient is experiencing.
Discussion Question 2
Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client.
My physical exam of this patient was decent, but I was so focused on this patient’s current complaint that omitted some key assessments. I failed to auscultate that patient’s heart sounds, before moving on to something else. Cardiovascular assessment is essential on all patients, and should not be skipped. Many patients have underlying cardiovascular issues, that are only caught during physical examinations (Bickley, 2016).
I did not perform a breast exam on this patient, simply because her last mammogram was normal. This patient’s family history of breast cancer is a good indication for screening (Goolsby & Grubbs, 2015). Situations like these are difficult for me to decide if a portion of an exam should be omitted or not. In the beginning of this class I was doing unnecessary exams during my iHuman exams, so I attempt to be more focuses. This was not a good plan for this patient.
Discussion Question 3
Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.
The patient’s complaints of lower back before and during assessment prompted me to perform the straight leg raise test. Bilateral leg raises were positive for causing increased pain in the patient’s lower back. At this point, I should have assessed the patient for neurological sensory changes, such as touch, pain, temperature, and vibration. I failed to do this during the exam, but this test could reveal impairments in neurological functions (Bickley, 2016)
Discussion Question 4
Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client.
One of the identification issues for this patient that I missed was her smoking history. I later realized that she had been a smoker for 40 years. Smoking can play a huge part in the development in many different types of cancers, as well as other health conditions. This patient has a history of asthma, and was actively having wheezing bilaterally. I didn’t even think to ask her about her smoking history, and I didn’t add asthma to her list of problems.
Discussion Question 5
Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.
When I selected differential diagnoses, I chose radiculopathy, and the system told me that was incorrect. In fact, this patient was experiencing radiculopathy, as her back pain was radiating into her sciatic nerve causing her pain in her right leg. Spinal neoplasm was one that I did not choose because I did not think this patient suddenly experienced acute pain from a tumor, as she was lifting at the time of pain onset. As mentioned above her history of smoking and familial history of cancer, should have been reason enough to suspect a mass or tumor as the cause of her pain (Goolsby & Grubbs, 2015).
Discussion 2
Discussion Question 1
Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.
What are the events surrounding the start of your leg pain?
I did not find it necessary to inquire about the circumstances related to pain in leg again after I had already asked similar questions when the pain had just started. She responded that the beginning of pain was associated with the backache that she obtained together with the injury at work. I realize that further investigation and extra questions could be helpful as her answers hinted at having radiculopathy in her leg. Certain changes in back can lead to pinching or damaging the nerve
