Neurological & Male Genitourinary Disorders Responses
Neurological & Male Genitourinary Disorders.Peers Responses
Below you will find 3 different discussion posts in the attached document, to which you will give answers
Your post should be at least 200 words for each responses, formatted and cited in current APA style with support from at least 1 academic sources. Bibliography used should be from 2016-2021
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. All replies must be constructive and use literature where possible.
PLEASE USE THIS BIBLIOGRAPHY and any other that you find
Physical Examination Part IV
Rhoads, J., Demler, T. L., & Dlugasch, L. (2021).
Neurological & Male Genitourinary Disorders.Peers Responses. Maria First Peer post (I need 2 responses for this post). Case Study 2 Subjective Data After reviewing the patient’s history, both atrial fibrillation and hypertension places this patient at risk for TIA which is a Transient Ischemic Attack. Since the patient has history of atrial fibrillation and hypertension, it is important for the Advance Practice Nurse Practitioner to review all medications, including anticoagulants, OTC, herbals, and illicit drug use. It is important to also ask the patient has there been a pattern with the headaches and speech that is becoming more frequent, escalating symptoms, or was it just a one-time occurrence. Ask patient about precipitating factors and state of consciousness after the event. Ask patient about family history of stroke, hyperlipidemia, or stroke. Objective Data Some other objective findings the Advance Practice Nurse Practitioner would focus on is examining the nervous system. It is important to assess LOC, ability to interact, language, difficulty swallowing, tremors, spasticity, and memory skills. Observe the client’s gait and posture when completing the neurological examination. Cranial nerve testing, examining motor strength, sensory testing is also important to assess. Diagnostic exams Some labs that the Advance Practice Nurse Practitioner should order is emergent labs like glucose, serum chemistry profile including creatinine, coagulation and hypercoaguablity testing (PT/INR, PTT, etc.) CBC. Also order ESR, Cardiac Enzymes, and a lipid profile. AN MRI or CT scan will be ordered within 24 hours of symptoms onset. Carotid Doppler ultrasonography, cardiac imaging to evaluate cardioembolic sources. Differential diagnoses Transient Ischemic Attack: Patient has four predisposing factors of hypertension, African American, age older than 40 years, and Atrial fibrillation. Patient had a neurological event (speech difficulty) secondary to a temporary reduction of blood flow to the brain from a partially occluded vessel or related to an acute thromboembolic event. (Cash, Glass, & Mullen, 2021). Ischemic Stroke: The patient has atrial fibrillation which increase the chances of this patient to produce clots. If a clot breaks off, enters the bloodstream and lodges in an artery leading to the brain, a stroke results. About 15–20 percent of people who have strokes have this heart arrhythmia. This clot risk is why patients with this condition are put on *blood thinners. Migraine with brainstem aura: Sometimes symptoms of migraine can mimic a stroke. A migraine causes pain and sensory disturbances, but the changes inside the brain are usually temporary. (Kirchmann, Thomsen, & Olesen, 2006). According American Migraine Foundation (n.d). “In addition, people with migraine with brainstem aura get brainstem aura symptoms such as: Dysarthria (slurred speech), Vertigo (feeling of movement/spinning of self or environment), Tinnitus (ringing in ears), Hypacusis (impaired hearing), Diplopia (double vision), Ataxia (Unsteady/Uncoordinated movements), and Decreased level of consciousness”. Education The Advance Practice Nurse Practitioner has to explain to the client that she needs to return to the clinic or emergency department immediately if symptoms occur. Adjustments maybe made to their anticoagulant medication and a statin maybe prescribed. It is important to explain to the patient that a TIA is a warning sign of a future stroke. It is important to for the patient to exercise at least 30 minutes daily three to four times a week. It is important for the patient to eat a low-fat, low-cholesterol, and low-sodium diet. Second Peer Post. Case # 1. (I need 1 responses for this post) What other subjective data would you obtain? Allergies would be obtained: What causes them? Action occurs? Immunizations, Any medical history, Any sexual history, Inherited factors, Diet and Nutrition, Substance use, and daily life activities, any symptom: onset, location, duration, characteristics, aggravating/alleviating factors, related symptoms and treatment tried. How many times do you get up in the night to go urinate? How long does the burning last? How long have you been experiencing these symptoms? How long has the prostate been warm and swollen and painful? On a scale of one to ten ? What aggravates the prostate? What alleviates the prostate pain? Are you taking any pain medication? How much? And The frequency? When did you begin having symptoms? How severe are your symptoms? Have your symptoms been continuous, or do they come and go? Were you recently diagnosed with a urinary tract infection? Have you had frequent urinary tract infections in the past? Have you had a recent injury to your groin? What, if anything, seems to improve your symptoms?(Wein, 2018) What other objective findings would you look for? I would look for BMI, any blood work or radiology exams performed recently. Ask about lower back pain, pain in the rectum, or feeling of heaviness behind the scrotum? Check for any drainage from the penis or rectum? Check for bleeding? Check for any bruising or discoloration in groin area? What diagnostic exams do you want to order? Urine tests to check for infection, Blood test to check for signs of infection and prostate problems, post – prostatic massage to test secretions, and imaging tests, CT scan of the prostate, and Ultrasound of the prostate. Cystoscopy is used to diagnose, monitor and treat conditions affecting the bladder and urethra.(Investigate causes of signs and symptoms, Diagnose bladder diseases and conditions, treat bladder diseases and conditions, and diagnose an enlarged prostate). Risks: pain, bleeding, and infection. Name three differential diagnoses based on this patient presenting symptoms? Prostatitis UTI Benign prostatic hyperplasia (BPH) Give rationales for your each differential diagnosis Prostatitis due to warm swollen prostate gland UTI due to fever and chills BPH due to nocturia and dysuria(Pontari, 2016) What teachings will you provide? Hot bath, hot water bottles, or heating pad can help ease the pain Sitting on a donut pillow or inflatable cushion may help Avoid irritating foods such as spicy or acidic foods, and caffeinated, fizzy or alcoholic drinks Bicycle riding may need to be avoided if it makes the pain worse In rare cases surgery on either the urethra or prostate may be necessary Alternative medications Biofeedback Acupuncture Herbal remedies and supplements(Wein, 2018). Case # 3. ( I need 1 responses for this post) What Other Subjective Data would you Obtain? The nurse should inquire about the symptoms’ onset to determine if the headache is insidious, acute, subacute, or chronic. She should also find out the duration of the headache to help in getting a diagnosis. Headache can either be unchanging, increasing, worsening, or stops at some time. These characteristics should be explored to find out the course of the headache. Other associated symptoms with headache are vertigo, convulsions, weakness, and paralysis (Chinthapalli et al., 2018). Headache can occur in different parts of the head; therefore, the exact location of the pain should be enquired. The headache can radiate along the dermatomes; hence enquiring about this radiation is important. Headache may have different characteristics, including pounding, stabbing, light like and stinging. All these characteristics should be asked to help get a diagnosis. Review of more systems to find out other affected systems (Chinthapalli et al., 2018). Find out from the patient If there is a family history of headaches. What Other Objective Findings would you Look For? General findings such as pallor, cyanosis, dehydration should have been assessed. The nurse should assess the optic nerve to rule out glaucoma or pressure to the optic nerve. The pupils should be inspected for Horner syndrome, conjunctival injection, and a die-type pupil (Chinthapalli et al., 2018). Hemiparetic deficits should also be assessed to rule out complicated migraines. The mental status should also be assessed to rule out a mental problem. What Diagnostic Exams do you Want to Order? Headache can be unspecific; medical conditions such as high blood glucose levels, issues with the thyroid, and infections can cause headaches; therefore, blood chemistry and urinalysis should be done. A CT scan can be done, which entails X-rays to produce an image of the brain and detect problems (Noseda et al., 2016). Another option to consider, if a CT scan is not conclusive, is an MRI. An MRI uses magnets, radio waves, and a computer to produce an image of the brain and detect problems. If a sinus problem is suspected, a Sinus X-ray can be done. An eye examination can be essential to rule out glaucoma and pressures on the nerve. A Spinal tap can be done to rule out infection of the brain meninges (Chinthapalli et al., 2018). Name 3 Differential Diagnoses Based on this Patient Presenting Symptoms? Migraine Glaucoma Meningitis (Chinthapalli et al., 2018). Give Rationales for each Differential Diagnosis. Migraines cause severe headaches that can be due to many factors. These factors include hormonal imbalances, environmental factors such as light, food, and stress. Photophobia is a major symptom of migraine (Chinthapalli et al., 2018). Glaucoma is an eye condition characterized by loss of peripheral vision. Patients with glaucoma experience circles that are rainbow-colored around lights which leads to photophobia. They also experience a severe headache (Noseda et al., 2016). Meningitis is the inflammation of the brain meninges, and it can be caused by either bacteria, viral, or even fungus. Meningitis is associated with a severe headache. It also interferes with the normal neurological processes that may lead to photophobia (Noseda et al., 2018). What Teachings will you Provide? The patient should avoid factors that trigger headaches, such as lack of sleep, light, stress, and fatigue. The patient should document the number of times they experience the headache, as it helps to follow the course of the illness. The patient should also stop using any medications that trigger headaches (Chinthapalli et al., 2018). The patient should also do some exercises to reduce the occurrence of the illness. Submission Instructions: Your post should be at least 200 words for each responses, formatted and cited in current APA style with support from at least 1 academic sources. Bibliography used should be from 2016-2021 You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. All replies must be constructive and use literature where possible. PLEASE USE THIS BIBLIOGRAPHY and any other that you find Physical Examination Part IV Rhoads, J., Demler, T. L., & Dlugasch, L. (2021). Chapters 15-16
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