week 8 responses
Assessment
CC- “Dull ache in both knees, and sometimes a clicking in the knees.”
HPI: The patient is a 15 yo Caucasian male presenting to the clinic with report of dull pain, which he reports to be a 5/10, in both knees. There is also a click in one or both knees and a catching sensation under the patella. The patient reports difficulty walking and concentrating when the pain and the sounds occur. The symptoms usually express themselves after walking long distances or sometimes standing too long before sitting down, which usually occur in the daytime. The patient takes either 650 mg Tylenol or 500 mg ibuprofen for the pain, depending on which is available. He feels that Tylenol and ibuprofen dull the pain but do not totally alleviate the pain.
Current Medications: Ibuprofen 500 mg and Tylenol 650 mg PRN.
Allergies: NKA
Past medical hx (PMH): No previous medical history to report,
Past surgical hx (PSH)- Patient reports a history of torn rotator cuff.
Soc hx: Patient does not use tobacco products, alcohol, or illicit drugs. He is the starting 140-pound wrestler on his high school team. He lives with his biological parents and has a younger sister (12 yo). He occasionally works for local farmers doing jobs such as bailing hay, mowing, and feeding livestock. He enjoys going to the local mall with his friends to hang out and skate in the parking lot.
Immunizations- COVID vaccination (Moderna) 10.23/2021, current flu shots.
Fam hx: Father: 38 yo with a history of Osgood-Schlatter disease; Mother: 36 yo with no previous medical history; Sister: 12 yo with no previous medical history; Maternal grandmother obesity, HTN; Maternal grandfather HTN, obesity, knee replacement age 58; Paternal grandmother died of cancer age 63; Paternal grandfather HTN.
ROS:
General: Patient reports no fatigue, cough, fever, or chills. Denies problems sleeping. He has not had any recent weight loss or appetite change.
HEENT: Patient denies headaches, dizziness, or confusion. Patient denies problems hearing, tinnitus, or discharge. Patient denies issues with vision or itching, dryness, or pain in the eye. Patient denies epistaxis, pain, or trouble breathing through his nose. Patient denies soreness in throat, difficulty swallowing, or problems talking. Patient has no pain in the mouth, problems chewing, or changes in taste. Patient denies neck pain, stiffness, or limited ROM.
Cardiovascular: Denies palpitations, chest pain, SOB, or irregular heartbeat.
Respiratory: Patient denies cough, difficulty breathing, SOB, or dyspnea upon exertion.
Gastrointestinal: Denies N/V. No changes in bowel movement.
Musculoskeletal: Expresses normal ROM.
Psychiatric: Patient has no history or present diagnosis of psychiatric disorders. Denies depression, anxiety, SI or HI.
Physical exam:
Vital Signs:
Blood pressure: 118/76
spO2: 100% room air
HR: 62 bpm
Resp. rate: 14
Temp.: 36.8 Celsius
HEENT- Patient does not have headaches or altered sensorium. Eyes are clear, moist conjunctiva, no diplopia, does not wear glasses. Ears equilateral, no hearing loss, tinnitus, or abnormalities. Mouth has no lesions, gum abnormalities, tooth decay, or bleeding. Throat is pink, no swelling, and no pain reported.
Respiratory- No crackles, rhonchi, or stridor heard during auscultation. Even, unlabored breathing.
Cardiovascular- No murmurs, rubs, gallups, or abnormal heart rhythm detected during auscultation.
Gastrointestinal- Normal bowel sounds heard in all quadrants during auscultation. Kidneys and spleen not palpable.
Skin- No lesions, wounds, or lacerations found during assessment. Warm, dry, and intact.
Musculoskeletal- No swelling, pain, or stiffness in the joints. Normal ROM.
Neurological- No neuropathy and neuro checks are normal. Alert and oriented X4. Speaks well.
Diagnostic tests- valgus and varus test (medial and lateral ligament), posterior drawer test (posterior crucial ligament), Lachman test (anterior crucial ligament, anterior drawer test (anterior crucial ligament), pivot shift test (anterior crucial ligament), McMurray test (menisci), arthrometric testing, x-ray, and CT scan.
A .
Meniscal injury- damage to the knee cartilage that provide cushion between the tibia from the femur. Pain, swelling, and locking of the knee joint are hallmarks of this injury. Usually resolved by rest, ice, pain relievers and sometimes surgery (Kraus et al., 2012).
Medial collateral ligament injury- damage to the ligament locate on the inner side of the knee that usually sounds like a pop. Swelling, pain, and a feeling that the knee may “give way” are hallmarks of this injury. Usually resolved by rest, ice, compression, and elevation (RICE) (Hoetzel et al., 2014).
Anterior crucial ligament injury- tissue that connects the femur to the tibia at the knee. Pain and swelling usually followed by inability to move normally or make sudden twists or turns. If it is a full tear surgical intervention is imminent, otherwise physical therapy may be an option (Kraus et al., 2012).
Osgood-Schlatter disease- affects children with growth spurts, especially active children playing sports. There is usually a painful lump below the kneecap that usually resolves on its own (Jones et al., 2000).
Sinding-Larsen-Johansson syndrome- swelling and irritation of the growth plate at the bottom of the knee characterized by swelling, tenderness around the kneecap, or pain that increases with activity or squatting. Usually treated with ice, OTC medication, or physical therapy (Hoetzel et al., 2014).
P.
This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.
References
Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., & Stewart, R.W. (2019). Head and neck: Key
points. In Seidel’s guide to physical examination: An interprofessional approach (9th ed.).
St. Louis, MO: Elsevier Mosby.
Hoetzel, J., Preiss, A., Heitmann, M.A., & Frosch, K.H. (2014). Knee injuries in children and
adolescents. European Journal of Trauma and Emergency Surgery, 40(1), 23-36.
Jones, D., Louw, Q., & Grimmer, K., (2000). Recreational and sporting injury to the adolescent
knee and ankle: Prevalence and causes. Australian Journal of Physiotherapy, 46(3),
179-88.
Kraus, T., Svehlik, M., Singer, G., Schalamon, J., Zwick, E., & Linhart, W. (2012). The
epidemiology of knee injuries in children and adolescents. Archives of orthopaedic and
trauma surgery, 132(6), 773-779.
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