Hip Pain Case Studies

Hip Pain Case Studies
This is a 38–year–old male with a 3/14/2014 date of injury. He sustained the injury while performing his regular job duties. He was backing up while
carrying a bucket of fire–proofing material, when he tripped and fell over some stacked plywood.
DIAGNOSIS: Radiculopathy, lumbar region; other dorsalgia, unspecified inflammatory spondylopathy, lumbar region
12/18/15 Progress Report indicated that the patient presents with back pain radiating down his right leg; lower backache and right hip pain. The pain is
10/10–scale level without medications and 9/10–scale level with medications. His quality of sleep is poor. His activity level has remained the same.
Current medications include Lidocaine 5 % patch, Cymbalta 30 mg and Vimovo Dr 500–20 mg. ... Show more content on Helpwriting.net ...
The patient presents with chronic low back pain recalcitrant to activity modification, physical therapy, and medication. The patient has low back pain
that radiates down his leg. The exam revealed Trigger point and twitch response on palpation at the lumbar para–spinal muscles on right. Sensations
were decreased to light touch over L4 lower extremity dermatome on the right side. Per ODG, Radiculopathy is not an indication (however, if a
patient has MPS plus radiculopathy a TPI may be given to treat the MPS). In this case the patient clearly has radiculopathy and MPS; a TPI may be
given to treat his MPS. Medical necessity of TPI has been established. Recommend
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Identifying The Components Of A Client 's Health History
1.2.Identify the components included in a client's health history. Biographic Data–The client's demographic data, should include the name, address,
age, sex, marital status, occupation, religion, health care financing, and primary care provider. Chief Complaint–The reason for the visit should be
obtained and documented in the client's own words. History of Present Illness–Gather more information about the present illness by asking questions
such as: When did the symptoms start? Did it occur suddenly or gradually increased over time? How often does the problem occur? What is the
intensity of the pain? Can you rate it from 0 to 10? How much sputum, vomit, or discharge came up or out? What color was it? Was it watery, thick, or
bloody?... Show more content on Helpwriting.net ...
Moreover, diseases that require particular attention includes: heart disease, cancer, diabetes, hypertension, obesity, allergies, arthritis, tuberculosis,
bleeding, alcoholism, and mental health disorders. Lifestyles–Ask the client about their personal habits such as the amount of tobacco, alcohol,
caffeine, or recreational drugs consumed. Also, obtain their normal daily diets, special diets, or ethnic food patterns; and the amount of meals and
snacks per day. Likewise, who cooks and do the shopping? In addition, ask about the client's sleep pattern. What time do you go to bed/ what time do
you wake up? Any you having any problems sleeping? Have you tried anything to correct this problem? Furthermore, ask about the daily living
activities. Are you having any problems performing basic activities such as eating, grooming, dressing, elimination, or locomotion? Are you having any
problems with preparing foods, shopping, transportation, housekeeping, laundry, or the ability to use the telephone, handle finances, or manage your
medication. Finally, ask the client do you exercise and how well do you tolerate the activity? Do you have any other hobbies? Social Data–Ask the
client who helps them during times of stress? What effects have your illnesses had on the family and are there any family problems affecting your
illness? Do you have any religion or beliefs that could affect your health or recovery? Moreover, find out about the client's education. What is

Medical Case Study: Mr. Smith's Vital Signs
Mr. Smith is a 60–year–old male complaining of weakness, increased tiredness, and headache lasting a few days. He has self–treated with over the
counter medications with no improvement. The patient history includes diagnosis of prostate cancer for 5 years. After collecting his current complaint
and medical history, the provider will need to conduct a physical examination on Mr. Smith. The exam will include taking his vital signs, auscultation,
percussion and palpation. Each area of the examination has a specific purpose. During the vital sign portion, the provider will take Mr. Smith's heart
rate, blood pressure, breathing rate and temperature. The provider will then compare them to his previous vital sign history. Although there is a normal
... Show more content on Helpwriting.net ...
Smith came in with the same complaint as before, but is now stating he is also having shortness of breath. His vitals were taken and there was an
additional concern. Mr. Smith's blood pressure was taken manually with a blood pressure cuff and stethoscope and determined his blood pressure
was currently at 160/100 mmHg. The 160 or top number is the systolic blood pressure which is the amount of pressure being pushed through the
arteries to the rest of the body while the heart is beating. The 100 or the bottom number is the diastolic blood pressure which is the amount of
pressure in the arteries while the heart is at rest. The normal range for an adult is 120/80 mmHg. Mr. Smith had an MRI completed at it revealed
metastasis of prostate cancer to osseous tissue. He also had an abdominal CT and it showed an obstruction of the intestine due to nodular enlargement
of the adrenal glands. He was again admitted to the hospital and had additional labs ordered. He had to repeat the complete blood count and blood and
urine potassium check, a blood glucose test, and an adrenal stress test to include serum aldosterone, 24 hour urinary aldosterone, renin,
adrenocorticotopic hormone(ACTH) and cortisol

Comprehensive Medical Report Essay
Data: 06/03/09 Identifying Data: Name: J. Smith Sex: female Age: 44 Occupation: community college administration assistant Reliability: good CC:
bilateral shoulder stiffness, right elbow pain HPI: Ms. Smith presents to the office with bilateral shoulder stiffness and lateral elbow pain in right arm.
The patient has been suffering shoulder stiffness for over 2 years. The symptom developed gradually after she started using her computer more at her
work place; she had to hold her telephone between her shoulder and head while typing information on computer. The pain in right elbow stated about 8
months ago with gradual onset. The patient does not recall any trauma to the shoulder and elbow. She has been diagnosed as tennis... Show more content
on Helpwriting.net ...
oots for HPB in April 2009 Cancer prevention: annual OBGYN checkup including mammogram, no abnormality detected on last checkup in February
2009 Vision screening: regular screening every 6 months, no abnormality detected on last checkup in February 2009 Dental care: regular screening
every 6 months, no abnormality detected on last checkup in February 2009 ROS: General: no history of weight change, fever or chills, weakness,
fatigue, or change in appetite; occasional difficulty falling asleep, mostly associated with stress from work Integument: N/A Hematopoietic: N/A Eyes:
N/A Ears: N/A Nose/throat/sinuses: N/A Mouth: N/A Pulmonary: N/A Breasts: N/A Cardiovascular: N/A Gastrointestinal: occasional heartburn and
bloating, especially after consumption of Indian foods; no history of nausea, vomiting, bowel changes, melena, hematochezia, dysphagia, jaundice,
abdominal pain reported Urinary: N/A Geniral/Reproductive: N/A Menses: 26–27 days of cycle duration, 3 days of actual bleeding and 1–2 days of
spotting afterword, moderate flow of bright red blood, no clots; mild increase in appetite 2–3 days prior to periods, no other PMS symptoms; no history
of dysmenorrhea or abnormal bleeding; no menopausal symptoms Endocrine: N/A Musculoskeletal: bilateral shoulder stiffness and lateral elbow pain
in right arm (see HIP) Neuro: rarely experiences headache; no history of syncope,

Work Related Trauma Case Study
DOI: 7/2/2010. The patient is a 57–year old female claims examiner who sustained a work–related cumulative trauma injury to multiple body parts that
include head/cervical spine, shoulders, arms knees, and left hip. As per progress report dated 7/11/16, the patient reports neck and low back pain. IT
was noted that the pain is associated with left lower extremity numbness, tingling, and weakness. The patient has tried and failed multiple
anti–inflammatories, which causes gastrointestinal upset, except for Celebrex. Her psychiatrist, Dr. Nehoryan has recommended her current regimen
including Cymbalta and Restoril intermittently for sleep. It was mentioned that the patient had a fall in early 2/2016 due to left lower extremity
numbness and is continuing ... Show more content on Helpwriting.net ...
Conservative treatment notes included aquatic physical therapy, acupuncture, narcotic pain medications, Transcutaneous electrical nerve stimulation
(TENS or TNS), psychologist, and hypnosis. The patient also has tried and failed multiple over–the counter and prescription remedies for her opioid
induced constipation including diet modification, stool softeners, and laxatives including Miralax, Senokot, Metamucil. Ducalax. It was noted that
Movantik is being provided to help her with this situation. As per interval changes, the patient complains of ongoing neck and left upper extremity
pain, and an increase in low back and left lower extremity pain. Patient states that she fell at home 2 weeks ago. She states that she injured her right
arm and it has been swollen for 2 weeks. The pain score is 10 without medications and 2 with medications. The medications prescribed are keeping the
patient functional, allowing for increased mobility, and tolerance of activities of daily living, and home exercises. Current medications incldue
Nucynta, Percocet, Restoril as necessary for insomnia, Cymbalta, Neurontin, Cselebrex, Robaxin, Prilosec, Singulair, Vagifem, and

Informatic Cancer Case Write Up
DOI: 9/18/2000. Patient is a 59–year–old female technician who sustained a work–related injury due to being jostled and jolted in the back of a golf
cart which ran over a pothole. As per OMNI, she was diagnosed with post cervical protrusions, facet syndromes with headaches, lumbar facet syndrome
and status post right shoulder repair/resection.
Urine drug screen obtained on 05/02/16 showed positive for hydrocodone, norhydrocodone, Zolpidem, gabapentin, meprobamate and caffeine.
Per the medical report dated 07/18/16, patient is being seen for her lower backache, rated 7/10 with medications and 10/10 without medications. Current
medications include Ambien 10mg; Maxalt–MLT 10mg; Norco 10/325mg; Evzio 0.4mg; orphenadrine 100 mg and gabapentin 600 mg.... Show more
content on Helpwriting.net ...
Quality of sleep is fair. Activity level has remained the same.
On examination of the cervical spine, there is tenderness and tight muscle band is noted on both the sides of the paravertebral muscles. There is pain
with extension and palpation of right facets.
Inspection of the right shoulder joint reveals atrophy. Movements are restricted with flexion to 90 degrees limited by pain and abduction to 75 degrees
limited by pain. Hawkin's test, Neer's test, Shoulder crossover test, Empty Cans test, Lift–off test, and Apprehension test is positive. On palpation,
tenderness is noted in the acromioclavicular joint and subdeltoid

Chronic Acalculous Cholecystitis
When a patient comes with abdominal pain, it can be due to different causes. The pain may be visceral, somatoparietal or referred pain as an
indicator of a wide variety of systemic and local causes. Visceral pain is from abdominal distention or stretching of the muscle fibers, carried by
sympathetic nerve fibers, presents as dull, poorly localized pain in the mid areas of the abdomen. Somatic pain occurs once the parietal peritoneum is
inflamed or irritated, and passed by sensory fibers. Somatic pain is better defined and more localized, high intensity, and also associated with
tenderness and spasm of the localized muscle groups.
Differential diagnosis
Chronic Acalculous Cholecystitis: Here Ms. G presented with right upper abdominal pain, ... Show more content on Helpwriting.net ...
G: Ms. G appears ill–looking, uncomfortable and clutching her abdomen, as she is experiencing pain, she rated her pain as eight on the scale of 0 to
10 as 10 being the worse pain. The pain of Ms. G is in her upper abdomen and radiating to her upper right back and right scapular tip consistent with
Collins sign. The pain initially stated as achy but changed to colicky in nature and became more constant. The pain started after she ate and vomited
few times before arrival. Percussion of Ms. G's abdomen is significant for tenderness to palpation towards her upper right quadrant a positive murphy's
sign, without rebound tenderness. Bowel sounds are normal. Ms. G's clinical presentation is consistent with Cholecystitis. The pain for Cholecystitis
usually starts within an hour post food; it can last from one to five hours and increases steadily over ten to twenty minutes along with Collins sign, and
the pain doesn't relieve after vomiting.
Diagnostic tests
CBC with differential
Leukocytosis with a left sided shift is the common abnormality in Cholecystitis. A high white blood cell count suggests inflammation, an abscess,
gangrene, or a perforated gallbladder.
Gall bladder ultrasound
Gall bladder ultrasound typically helps in establishing the diagnosis of Cholecystitis. A sonographic Murphy's sign, (when the ultrasound probes the
ultrasound patient will have pain) is a useful diagnostic

Medical Case Report: 48 Year-Old Patient
DOI: 6/20/2008. Patient is a 48–year–old male foreman who incurred a work–related injury on 6/20/2008 when he was struck from behind while at
stopped on red light.
MRI of the lumbar spine without contrast dated 5/22/14 revealed degenerative disc disease at L3–4 through L5–S1; large central and right paracentral
disc herniation and extruded disc at L4–5; there is severe stenosis of the right neural foramen at L4–5 entrapping the right L4 nerve; and severe right
and left neural foraminal stenosis at L5–S1 entrapping the right and left L5 nerves.
As per office notes dated 4/21/16, the patient complains of neck pain on the left side, radiating to the left shoulder and between shoulder blades. The
pain is constant (90–100% of the time). It is sharp and throbbing. The pain becomes worse with ... Show more content on Helpwriting.net ...
The pain is better with rest. The upper neck pain is radiating around the skull and triggering frequent headaches, low back pain is radiating to the right
posterolateral thigh and calf wrapping around and including dorsum of the right foot and middle toes. The patient also has left wrist pain. Current
medications include Menthoderm, Flexeril, Naproxen, hydrocodone–acetaminophen, Bactrim, bupropion "Sr", and Ventolin "Hfa". Physical
examination revealed that the patient's gait has a left–sided antalgic gait. He does not use assistive devices. Cervical spine examination revealed
asymmetry or abnormal curvature noted on inspection. There is also tenderness and trigger point (a twitch response was obtained along with radiating
pain on palpation) is noted on both sides. Lumbar spine examination revealed loss of normal lordosis with straightening of the lumbar spine. Lumbar
range of motion is has limited flexion of 60 degrees and limited extension of 10 degrees. The range of motion is limited by pain.

Patient Case 35: 35 Year Old Regular Employee
DOI: 01/14/2011. Patient is a 35–year old male Spanish, regular employee who sustained a work–related injury while bending over to pick up air hose
off floor. Per OMNI, patient was diagnosed with Right Knee Strain. MRI of the right knee dated 02/03/2011 revealed menisci, cruciate ligaments, and
collateral ligaments, small acute impaction injury with full–thickness cartilage defect in medial femoral condyle, small displaced osteochondral lesion
of the inferior medial trochlea, mild diffuse patellar tendinosis, and moderate joint effusion without loose intra–articular chondral or osteochondral
body. As per office notes dated 3/24/16, the patient is an obese patient who suffers from ongoing knee and lower backpain which indicates her for
aquatic

Carotid Artery Essay
The pathological changes of the carotid artery can affect the brain and on another hand the hemodynamic changes at the heart, aorta and brain can be
detected at carotid artery. For example, if the narrowing of the carotid arteries becomes severe enough to block blood flow, or a piece of
atherosclerotic plaque breaks off and obstructs blood flow to the brain, a stroke may develop. Therefore, this is a strong rationale to consider that
cardiovascular event may ultimately be more closely related to carotid artery rather than brachial artery [5]. Carotid arteries, the major vessels
supplying the brain are directly connected to aorta closer than peripheral arteries such as brachial and radial artery (Figure 1). Currently research is
more focused on non–invasive determination of pressure waveform measured at carotid artery [12].
The pulse examination of the human artery has been practiced in assessing health since the history of Traditional Chinese Medicine in the 6th
century BC [13]. Pulse palpation is an important part of the vascular physical examination. The pulse can be palpated in any place that allows an
artery to be compressed against a bone, such as carotid artery at the neck, brachial artery on the inside of the elbow, radial artery at the wrist and
femoral artery at the ... Show more content on Helpwriting.net ...
The technique of non–invasive pulse wave analysis, as described here, depends on different principles and type of the pulse wave. Pulse wave analysis
in clinical practice is commonly used by the hand–held tonometry probe. It is simple to use, a non–invasive and accurate method using a small strain
gauge sensor detects the force on the artery wall [2]. The principal of applanation tonometry is a partial compression of a pulsating carotid artery
against muscle and vertebral body of the neck and its pulse wave spreading in the skin impacts the

Physical Therapy : Spine ( Lumbar / Cervical Thoracic )
1.Physical Therapy 3X6 – Spine (Lumbar/Cervical/Thoracic) Regarding Physical Therapy 3X6–Spine (Lumbar/Cervical/Thoracic); CA MTUS
supports an initial course of physical therapy with objective functional deficits and functional goals. The claimant has basically whole body pain with
limitations in range of motion and tenderness in most all body parts. Medical necessity has been established. However, initial 6 visits are given.
Additional requests should include functional improvement, discussion of functional goals and patient's progress in meeting these goals. Recommend
modified certification of PT 2X3 Spine (Lumbar/Cervical/Thoracic). 2. MRI – Spine (Lumbar/Cervical/Thoracic) Regarding MRI–Spine (Lumbar
/Cervical/Thoracic); the... Show more content on Helpwriting.net ...
However, plain films were not obtained. There is no clear rationale for the indication of shoulder MRI with unequivocal objective findings and absence
of plain films. In addition, there is no focal neurological deficit on the exam. There are no sensory or motor deficits noted. Medical necessity has not
been established. Recommend non–certification. 4. MRI – right wrist Regarding MRI right wrist; CA MTUS criteria for hand/wrist MRI include
normal radiographs and acute hand or wrist trauma or chronic wrist pain with a suspicion for a specific pathology. However, as noted above, no plain
films were obtained. There is no documentation or indication of an acute trauma to the wrist. Recommend non–certification. 5. MRI – Left knee
Regarding MRI left knee; CA MTUS recommends MRI for an unstable knee with documented episodes of locking, popping, giving way, recurrent
effusion, clear signs of a bucket handle tear, or to determine extent of ACL tear preoperatively. In addition, ODG criteria include acute trauma to the
knee, significant trauma, suspect posterior knee dislocation; nontraumatic knee pain and initial plain radiographs either nondiagnostic or suggesting
internal derangement. This is a chronic injury patient. There is no documentation of any acute injury to the knees. In addition, there is no
documentation of locking, giving away, recurrent effusion, or signs of a bucket handle tear

Esi Right Shoulder Pain Case Study
Reason for visit: s/p ESI Right Shoulder Pain.
Vital Signs –
S: TM missed 3 days of her ESI visit, related holidays, but she did continue with ice and plan of care as instructed at home. The TM reports her pain
is 4/10, and the pain is described as aching type pain; the pain is intermittent. TM is currently taking Ibuprofen 800 mg tab, 1 tab 2 times a day and
Acetaminophen 500 mg tab 2 tabs as needed for shoulder pain to manage her pain and it does help to decrease her pain to 2–3/10. TM denies any loss
of ROM or sensation of the right arm; denies any tingling or numbness.
O: Inspection of the right shoulder, no redness or edema noted; palpation of the right shoulder there was no warmth noted; on deep palpation TM
reports in some tenderness

Symptoms And Symptoms Of Diabetes Type 2
The patient that I will do a full head to toe assessment is a 55 year old who has just been diagnosed with diabetes type 2, she also has a history of
sinus infections, allergies, and smoking
Skin: The client's skin is even in color, unblemished and no presence of any foul odor. She has a goodskin turgor, and skin's temperature is within
normal limit. There is good oxygen, circulation, and nutrition with no tissue damage. Patient has concern about being lights skin, but no melanoma
noted to skin. Palms, sole of the feet, and lips show no signs of cyanosis. No erythema or redness noted to skin.
Hair: The hair of the client is thin, dry and brittle, hair is evenly distributed and has a variable amount of body hair. There is no signs of... Show more
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When palpating the head, the skull is round anteriorly and posteriorly, no masses or indentions noted
Skull: When palpating the head, the skull is round anteriorly and posteriorly and posteriorly, no masses or indentions noted
Face: The face of the client appeared even and has unbroken evenness and with no presence of a mass or large nodules.
Eyes and Vision Eyes and Vision
Eyebrows: on inspection the eyebrows are even, no missing hair and symmetrical to both sides. When patient raise the eyebrows, they show movement
equally when lowered. No courseness of the hair or failure to extend beyound the temperal canthus
Eyelashes: Eyelashes seemed similarly distributed, with no missing hair through out
Eyelids: when ask the patient to blink the eyelids, they blink at the same time. Also inspected the invlountary movement of the eyelid, which was
normal, no discoloration or disharges noted to the eyelid. No drooping noted to eyelid
Eyes o During the assessment of the eye, visual accuity tested by reading material outloud, No problem noted, Inpecting the eye they both looks white
in color, no edema or discharges noted to the eyes, conjunctiva smooth, pink and shiny and appear normal, no excessive tears to lacramal gland when
palpate the lacramal gland, no tenderness noted. Cornea is transparent, no dryness noted, the iris are visible. When the cornea is touched the patient
blinks.When

Symptoms And Treatment Of Injury Essay
This is a 52–year–old female with a 4/1/2002 date of injury. A specific mechanism of injury has not been described.
DIAGNOSIS: Cervicalgia, Contracture right shoulder, long term (current) use of opiate analgesic.
01/25/16 Progress Report indicated that the patient has continued pain in the cervical spine, which radiates down to the right arm above the elbow.
There is some aching at the cubital tunnel with no distal numbness in the forearm and hand. She takes OTC ibuprofen to reduce pain. She presented
with a pain of 2/10–level. The ongoing neck pain is located diffusely. It is described as burning. ROS was positive for insomnia, anxiety and
depression. The exam revealed cervical spine tenderness. There is decreased ROM on flexion, extension, rotation and left lateral bending. Right & Left
Shoulder: there was tenderness to palpation at the subacromial space and pain with restricted ROM on abduction. Lumbar: there was tenderness to
palpation over the facet joint. The ROM was decreased on flexion, extension and lateral bending. Treatment Plan: continue Ibuprofen; recommend MRI;
and Electro diagnostic studies of the right upper extremity. Follow–up is on 04/18/16.
10/26/15 UDT Report was negative for all drugs, including amphetamines, barbiturates, benzodiazepine, cocaine metabolite, methadone, and Opiates.
10/26/15 UDT Report described that the patient has neck pain located centrally. It is described as aching and is constant. The symptom is ongoing. The
pain is rated

Snellen Case Studies
Eyes The eyes and eyebrows are symmetrical. There is even hair distribution among the eyelashes. She is able to close her eyelids completely. Upon
inspection, the conjunctiva is clear over the sclera and pink in the lower lid area. The sclera is white. The eyes are not sunken in (enophthalmos) nor
protruding (exophthalmos). The patient's eyes are glossy, and the pupils are 4 mm in diameter at resting. The pupils are round, equal, and symmetrical.
Both pupils react to light both direct and consensual. Both pupils demonstrate accommodation. A Snellen chart was not available to test acuity. The
patient does report wearing contacts and needing to use glasses. She states her last eye exam was November 2017. Testing of the extraocular fields was
There are 5 flat brown macules noted on her back: one on the lower left border of the right scapula 2 mm in diameter, one near the right shoulder
2mm in diameter, one midline between the shoulder blades 3 mm in diameter, one near the left shoulder 1mm in diameter, and one higher near the
neck area 2 mm in diameter. All macules are symmetrical. The posterior chest is symmetrical with symmetric muscle development and tone. Chest
expansion was assessed posteriorly with adequate symmetrical equal expansion noted. Tactile fremitus was assessed posteriorly with symmetrical
vibrations noted in all ten areas. Auscultation of the posterior chest reveals clear lung sounds in all 18 areas. The patient does not complain of pain
or tenderness with palpation of the costovertebral angle. She does not complain of pain or tenderness with palpation of the scapula or of the spinal
column down to the lumbar region. The spine was unable to be fully assessed due to doctor's orders of bedrest. The patient has a normal AP diameter
1:2. Upon inspection of the anterior chest the skin is appropriate for ethnic background with pinkish undertones. There is effortless rise and fall of the
chest with respirations. Respiratory rate is 18 breaths per minute and are effortless and unlabored. There are no pulsations noted over the five key
landmarks (aortic, pulmonic, tricuspid, erb's point, and mitral). The patient

Bp Psychology Case Study
Bozena Czekalski
John is a 16 year old African American male. He presents for a pre–participation physical exam for football. He has been in good health since his last
PE 1 year ago. He lives with his mom and 12 year old sister. He will be a sophomore in high school this fall.
PMH: Last tetanus at 11 years of age Last Menactra 11 years of age
PSH: none
Nutrition/exercise: No breakfast, Lunch – fast food from school cafeteria, Dinner – what mom cooks – meat/potatoes; Snacks – chips, milk
Home: Lives with mom & sister – good relationship
Education: 11th grade, plays football, gets C's in most classes. Wants to be a pro football player
Activities: Plays soccer and runs track
Drugs/Drinking: Tried marijuana 3 X this summer with ... Show more content on Helpwriting.net ...
al., 2013, p. 114).
What guidance do you offer for John's mother?
Johns is an inexperienced adolescent in negotiation and he may often argue a point to excess. Arguing is a normal behavior for teenagers that reflect
their use of more abstract thinking skills.
Discuss the need for clear rules, expectations and consequences before trouble has occurred.
Discuss the need of parents to be involved in John's life to be there to answer questions and concerns when they arise.
Discuss the importance of being involved in John's school (meet his teachers and stay in touch with them to help John succeed).
Continue involving John in family activities, even if he is not interested.
Encourage to keep promises made to teenagers (that will help with establishing trust, respect and being a role model).
Be a role model.
Continue to supervise John's

Lh Detection
The systematic review is aimed to determine what methods have been used to identify the presence of LH in diabetes patients treated with insulin. The
result of this review reveals that there is little research evidence to support the formulation of recommendations regarding the method of detection of
LH. Forty–three papers (original articles and conference abstract) were included in the review. Three detection methods for LH are in current use
namely visual inspection, palpation and ultrasound. Fourteen papers presented use of ultrasound to detect LH and found the prevalence of
LH in the range 14.5–86.5%, compared to thirty–one papers using palpation. The prevalence identified by palpation ranged from 14.5% to 54.9%. The
variation in ... Show more content on Helpwriting.net ...
However, the current use of ultrasound to detect LH uncovers the need for further research, to build up a scientific foundation for such methods.
Strengths and Limitations of the study
This is the first systematic review focusing on LH in diabetes people treated with insulin. A specific search strategy was design and and a rigorous
approach to the literature search and critical appraisal was followed. It included all published full papers and conference abstracts found in the four
major databases in medical and nursing science, with no limitations on time of publication nor language. It also included cases from both type I and
type 2 diabetes. It covered different study designs and encompassed research in five continents. The review includes patients using pump, syringe or
pen.
The major limitation was the inadequate information due to limited published articles about LH related to diabetes. Furthermore, the quality of most
papers was moderate to low. Forty percent of material was conference abstracts and case studies, reducing the information content and overall quality.
Removing low quality studies would have caused an incomplete description of

Abdomen Case Study Essay
The sequencing that I will be using to assess the abdomen would be inspection, auscultation, percussion, and palpation. I would inspect the abdomen
for the shape of the abdomen, skin masses and abnormalities. Inspection will give me clues whether I should percuss or palpate the abdomen. Then, I
would auscultate the abdomen for altered bowel sounds. It is important to auscultate the abdomen first. Percussion and palpation tends to intensify
peristalsis which can result to false interpretation of bowel sounds (Jarvis, 2012). When I proceed to the patient's abdominal examination, it is
important to know the anatomy of the abdomen where each organ is located. I would percuss M.M's abdomen and check for abnormal fluid and
masses. According to Jarvis (2012), flank dullness upon percussion may indicate fluid in the abdomen or ascites. I would do palpation last if not
contraindicated. Palpation is used for detection of masses and tenderness, but because of the pain that palpation may trigger, it should be done in a
careful manner. In M.M's case, I would still... Show more content on Helpwriting.net ...
I would listen for abdominal bowel sounds to listen for air or fluid activity eliminating bowel obstruction in my assessment. It is common for
someone who has a ascites to have a normal bowel sounds, but diminished bowel sound over the ascitic area (Jarvis, 2012). I would do percussion to
a patient who have ascites and listen for dull sound. I would do a light palpation of the abdomen if the patient tolerates. It is important that I check his
mental status, because the buildup of toxins in the brain is common to someone who has a history of alcohol abuse. I would watch the patient for
hepatic encephalopathy. Since the liver is unable to remove toxins from the blood and accumulates in the blood resulting in confusion or decreased
mental function. I would also look for signs of ascites, because liver failure can cause fluid buildup and

Bilateral Hip Flexion Report
Hip ROM
Bilateral hip flexion, internal rotation and external rotation ROM was measured using goniometric methods as defined by Norkin and White.24
Bilateral hip internal and external rotation were goniometrically measured in sitting (Figure 3 & 4), while hip flexion was measured with the patient in
supine (Figure 5).
Manual Muscle Testing Bilateral LE muscle strength was determined using the manual muscle test (MMT) "break test." In sitting, the patient was
requested to perform bilateral hip flexion, internal and external rotation, knee flexion and extension, and ankle dorsiflexion against graded manual
resistance applied by the examiner.27 To assess bilateral planterflexion, the patient was asked to stand on one leg at a time and raise herself onto her
toes with only fingertips touching the mat table.27 ... Show more content on Helpwriting.net ...
The psychometrics of each special test has been summarized in Table 2.
The straight leg raise (SLR) test was administered to confirm the diagnosis and symptoms.28–30 The SLR was performed in supine position as
described by Cook et al.30 The patient was instructed to individually lift each straight leg up as high as she could. Once the patient reported her
symptoms, a goniometric measurement at the hip was taken. This was completed bilaterally. Additionally, the standard SLR revealed a positive result
for crossed SLR (XSLR) in which the patient experienced symptoms in the contralateral leg with the SLR

Sij Dysfunction Reflection
Examining patients with suspected SIJ dysfunction, I first begin with the examination with the lumbar segments to evaluate any instability or
dysfunctions. I would check first CPR stenosis, then Zygapophyseal joint problems using Revel's criteria, especially absence of pain by cough
/sneezing; no pain when the patient is rising from body flexion to extension position, and no pain by extension rotation criteria's would rule out facet
problems.
Tests like Slump, PA springing test, SLR, Crossed SLR, passive lumbar extension and prone spine instability tests, active lumbar repeated movements
test would help me to rule out the LS pathologies. Next step, I would skip pelvic and move to the hip segment to clear intra–articular and extra–articular
Altogether using cluster of findings including provocation testing, pain location, palpation, strength testing, and mobility testing would help me to
diagnose of painful SIJ pathology.
There are new tests and measures in the monolith that I will definitely like to add to my evaluation for SIJ. The integrate mobility tests; stork test,
lumbo–pelvis rhythm, sacral and Ilium motion evaluations, I did not use in the past. Measuring spine, Ilium, sacrum, hip motion and movement
patterns trough palpation and observation, I believe, would add value on my evaluation. Also, McGill's endurance tests (core ratio) are new for me to
use with PGP patients. But I can see the correlation pelvic pain and the strength level of the abdominals.
Overall, it is difficult to evaluate and diagnose pelvic joint dysfunction. The problem is that there is no accepted reference standard for SIJ movement
dysfunction. The anatomy of functional pelvic–girdle, load transfer system, and structural relationship and the pattern of intra pelvic motion during
stance and swing phase are important in evaluation a SIJ patient as their pain and

Neck: A Case Study
Head was inspected for size, shape, position and symmetry. Scalp noted clean and well maintain, no dryness, or lesions were noted. No sign of hair
loss were observed. Facial structure were symmetrical, no skin discoloration, rashes, swollen or lesion were noted. No involuntary movement of the
face were perceived. Neck was inspected, good symmetry were noticed, and no scar or lesions were perceived. No large lymph nodes or mass
detected during palpation, patient denies pain or tenderness. Thyroid gland was not visible, during palpation no mass or nodule were identified. No
bruit was perceived during auscultation of the thyroid lobes. Trachea was noted to be in the midline, no deviation was noted. Visual acuity, visual field,
extraocular movement,

Carotid Palpation
Introduction
Most endurance trained athletes and participants in a group exercise class monitor their exercise intensity through palpation of the carotid or radial
artery. Heart rate (HR) is used as an indictor of exercise intensity because of the linear relation between HR and oxygen consumption (Cotton & Dill,
1935). The researchers of this study have decided to use pule rate palpation to monitor exercise intensity because the procedure is described in many
textbooks and it is common in various exercise settings (American Collage of Sports Medicine, 2000). However most chronic exercisers have a
rapid recovery of HR following the cessation of exercise, and therefore carotid or radial palpation could underestimate exercise HR. Also, endurance
trained individuals have a greater arterial baroreflex sensitivity and are more responsive to carotid palpation. Therefore, the palpation of the carotid
artery may unload arterial baroreceptors and elicit feedback reductions in HR (Heidorn & McNamera, 1956). The primary aim of this study was to
determine the accuracy of carotid and radial palpation in estimating exercise HR and the effect of carotid palpation HR in chronic exercisers. The
secondary aim was to determine the association between the magnitude of reductions in HR ... Show more content on Helpwriting.net ...
However for the results to be more meaningful and valid, a certified fitness trainer should have taken the pulse rates. One study looked at the ability of
certified fitness trainers and participants to accurately palpate post–exercise HR. The post–exercise HR obtained by the trainers was 134 +/– 38 bpm
and the participants obtained 140 +/– 25 bpm (Garner & Wagner, 2013). Having trainers obtain pulse rates could avoid any bias from the participants;
in other words, the researchers would know that the pulse rates are accurate and not falsified or

Symptoms And Treatment Of Medical Records
This is a 56–year–old female with a 1–11–2015 date of injury, when he tripped over some cables and fell.
01/08/16 DWC Form RFA for Acupuncture; X–Rays C/S, T/S, Bilateral shoulders; Referrals FCE, Ortho surgeon, pain management; medical records
are requested; and re–evaluate.
01/08/16 Progress Report noted that the patient sustained an initial injury in June 2014, due to a cumulative trauma. She sustained a new injury in
January 2015 as well. She sustained an injury to her neck, right shoulder, right arm, and right knee. She had X–rays and MRI post injury. Her right
knee swelled, but improved right after she received treatment for her right shoulder and right knee. She received PT and chiropractic treatment twice a
week, medications and surgery to her right shoulder in May 2015. She has received no treatment for her neck or left shoulder. She has not received
acupuncture. The patient presented today with complaints of occasional, mild to moderate, throbbing neck pain, stiffness and cramping. The physical
exam of the cervical spine revealed positive tenderness to palpation of the cervical paravertebral muscles and bilateral trapezii. There is also a muscle
spasm of the cervical paravertebral muscles. The cervical ROM is decreased and painful. Shoulder depression causes pain. The exam of the thoracic
spine showed tenderness to palpation of the thoracic paravertebral muscles, right trapezius, T1–T2 spinous process, T2–T3 spinous process, right
Rhomboid and right lateral

A Case Study Of The Diagnosis Of Managed Care
The patient is a 54–year–old individual who sustained an injury on 03/07/17 due to a fall.
The recent diagnoses included a sprain/strain of the cervical, thoracic, and lumbar spine, a sprain/strain of the right shoulder, rule out rotator cuff tear, a
sprain/strain of the right elbow, rule out cubital tunnel syndrome, a sprain/strain of the right wrist, rule out carpal tunnel syndrome, De Quervain's
disease, and a sprain/strain of the right hand, knee, ankle, and foot.
Treatments rendered to date included medications.
The most current medication regimen included Cyclobenzaprine and Acetaminophen. Her past medical history was significant for pre–diabetes,
hypertension, and high cholesterol.
Medical records reviewed included Doctor's ... Show more content on Helpwriting.net ...
The Soto–Hall's test was positive. Her thoracic spine examination documented tenderness to palpation in the spinous processes of the thoracic spine.
Lumbar spine examination revealed tenderness to palpation in the paralumbar muscles associated with spasm. The lumbar spine range of motion
revealed a flexion of 45В°, an extension of 20В°, and lateral bending of 20В°, with pain in all planes. Bechterew's test was positive for low back pain.
Her right shoulder examination documented tenderness to palpation in the upper trapezius and rotator cuff muscles. The Drop arm test was
questionably positive. Her right shoulder range of motion revealed a flexion of 160 degrees, an extension of 40В°, abduction of 160В°, adduction
of 50В°, external rotation of 80В° and internal rotation of 80В°, with pain in all planes. Her right elbow examination revealed tenderness to
palpation. Her range of motion revealed flexion of 140В°, extension of 0В°, forearm supination of 70В°, with pain in all planes. The tennis elbow
test was questionably positive. Tinel's sign was also positive. Her right wrist examination revealed tenderness to palpation. Right wrist range of
motion revealed a palmar flexion of 50В°, dorsiflexion of 50В°, as well as radial and ulnar deviation of 20В°,with pain in all planes. The Tinel's sign
was questionably positive and the Finkelstein's

Work Related Injury: A Case Study
DOI: 2/12/2014. The patient is a 67–year–old female janitor who sustained a work–related injury to her bilateral feet, lower extremities, hands, and
wrists due to constant walking and cleaning.
Per AME dated 04/14/2016, the patient had reached Maximum Medical Improvement and was noted to be Permanent and Stationary.
Based on the progress report dated 09/13/16, the patient reports unchanged intermittent moderate left foot pain. Patient also notes of intermittent
moderate low back pain and left hand pain, that bothers her most. The patient went to a foot specialist last week, who administered an injection that
increased pain and seems to have not taken effect yet.
Examination of the left hand reveals diffuse tenderness to palpation. Grip

Fundamental Case Study Essay examples
1. Mr. Dunner is admitted to his room accompanied by his wife. Before the nurse can begin the admission assessment, Mr. Dunner states that he needs
to "throw up." The nurse helps him sit up and provides an emesis basin.
Mr. Dunner vomits into the emesis basin and then remains sitting on the side of the bed, stating he may need to "throw up" again.Which assessment
should the nurse complete first?
A. Auscultate the bowel sounds.
Another assessment should be completed before assessing the client's bowel sounds.
B. Palpate for abdominal distention.
Another assessment should be completed before assessing for distention.
C. Correct Observe the color of the emesis.
Since the client is vomiting, the nurse should first observe the color ... Show more content on Helpwriting.net ...
H. When does the client develop his intolerance to spicy foods.
Other information is more useful in assessing the client's inability to eat spicy foods.
After completing the client interview, where Calvin reports that he gets severe indigestion and heartburn after eating Mexican foods, the nurse is ready
to begin the physical assessment of the abdomen.
5. The nurse prepares Calvin for the physical assessment of the abdomen. Before assisting him to a supine position, what action should the nurse take?
A. Correct Encourage the client to empty his bladder.
Emptying the bladder will help promote relaxation of the abdominal wall.
B. Ask the client to breathe deeply several times.
Breathing exercises may help relax the abdominal wall but should be done just prior to and during the examination, not prior to client positioning.
C. Darken the room lights and lower the thermostat.
A brightly lit room aids the nurse in accurate assessment. A chilled environment can increase muscle tension.
D. Instruct the client to place his hands over his head.
Placing the hands over the head can cause the abdominal muscles to tense.
After completing the preparations, the nurse assists Calvin to a supine position on the bed.
6. To assess the symmetry of the abdomen, what action should the nurse take?
E. Note pattern of hair growth.
The pattern of hair growth does not provide information related to the

What Are The Four Basic Techniques In Physical Assessment
16. Demonstrate the four basic techniques utilized in the pysical assessment. The four basic techniques utilized in the physical assessment are
inspection, palpation, percussion, and ascultation. To begin the techniques I will first wash my hands, and then make the patient as comfortable as
possible. Then I will start by inspecting the patient. I will observe the patient's state of consciousness by having the patient repeat their name and date
of birth along with telling me where they are at, and what the date is. If there are any abnoramalities their, I will document them. Next I will observe
their overall state of health, look for any signs of physical distress. I will then look for any lacerations, bruises, visible lumps or bumps, or things such
as moles and birth marks, and body symmetry. Again, if anything is abnormal I will document my findings. Also when inspecting the patient I will
document any oders and note their nature and source. If everything is not in the normal limits the assessment will be... Show more content on
Helpwriting.net ...
Before administering any medication to a patient I check to see if I have the right patient by checking their bracelet, and have them repeat their name
and date of birth, then compare the name on the medication to the information on the bracelet, and to what the patient has stated and verify any
allergies. Once I have the right patient, I will verify that I have the right medication. First, I will check the medication order, and if something is
unclear then I would ask the prescribing physician to clarify the order. The next thing I must do is triple check the medication label. The triple check
involves checking the label when you retreive the medication, prepare the medication, and before administering the medication. A side note to include
here is that a nurse must never administer medication that was prepared by another

Work Related Injury Case Summary
DOI: 9/30/1997. The patient is a 50–year–old female reservation clerk who sustained a work–related injury to her back and bilateral lower extremities
when she tripped and fell.
Based on the medical report dated 03/29/16 by Dr. Riley, the patient complains of increased pain to both heels, left greater than the right. She states that
the pain is most severe with the 1st step in the morning or after periods of rest. She is requesting new custom orthotics, as her existing pair have
become very worn. They are more than 2 years old. Additionally, she sustained a trip and fall Injury on 2/2 with her knee "giving out." Two days
prior to this visit, patient is with pain and swelling to the left great toe joint. She is unclear if the injury occurred with the fall, or in the process of ...
Show more content on Helpwriting.net ...
There is a soft tissue mass to the left lateral ankle overlying the sinus tarsi, consider with lipoma.
There is collapse of the medial arch with calcaneal valgus with weight bearing. The IW functions in end range pronation throughout midstance of gait.
There is tenderness upon palpation to the posterior plantar aspect of the left heel at the insertion of the calcaneus. There is mild pain with deep
palpation to the right foot in the same location. She has pain with dorsiflexion and plantar flexion of the dorsal aspect of the left 1st
metatarsophalangeal joint. There is no pain with active dorsiflexion and plantar flexion with resistance.
Current medications include Tylenol #3, Voltaren, Norco and Zoloft.
Of note, anteroposterior and lateral views of the left foot taken on this visit reveal no evidence of fracture or dislocation. There is mild periarticular
osteophyte formation, however, no Joint space narrowing is noted.
Assessments are 1st metatarsophalangeal left foot joint sprain, plantar fasciitis, left greater than the right and symptomatic lipoma of the left

Anatomy: Abdominal Assessment
Abdominal Assessment: Abdominal assement is a method to provide a comprehensive information about the safe and accurate functioning of
abdomen. Components: There are certain componenets that are essential to be examined these include; inspection of shape, skin and umbilicus,
palpation to check for any tenderness, rigidity or masses, Auscultation to assess the bowel sounds and bruits and percussion. Inspection: The first
component is inspection. To perform onpection the patient should be exposed from the xiphoid process till the pubic symphysis. After proper
exposure first check the shape of the abdomen from different angles. The normal shape of abdomen is scaphoid. Note any change of shape. Check for
any abnormal depression, or scar or mass

Cholecystitis Case Study Essay
Presenting symptom:
A 28–year old Caucasian female patient is presenting with a new breast lump found on self–examination at home. The patient describes this breast
lump located in the left upper quadrant of her breast and states that it is approximately the size of a pea and is hard.
The physical examination would include a thorough breast examination. The patient should be covered for decency and exposing one breast at a time
should be done. Breasts are divided into four quadrants based on horizontal and vertical lines crossing at the nipple (Bickley, 2013). Palpation of lymph
nodes in the lateral, central, subscapular, pectoral, supraclavicular and infraclavicular areas should be palpated to determine any further lumps. A
thorough health ... Show more content on Helpwriting.net ...
Patients may be more apt to take breast cancer seriously and do monthly examinations knowing that they have a BRCA mutation. This may help to
save lives and prevent future health declines associated with breast cancer. There are also many cultural considerations with breast cancer. For
example, Latinas are usually diagnosed with breast cancer in advanced stages (Kingsley, 2010). This may be because it can be taboo to talk about
cancers or perhaps those born to poor economic status do not have access to adequate health care screenings. However, Latinas have a lower incidence
of breast cancer compared to Caucasians (Kingsley, 2010). No matter the race, age, ethnicity, culture or religion breast cancer is a serious illness and
getting immediate medical attention may just save someone's

What A Postnatal Abdominal Palpation Is Important For A...
This essay will first describe partnership and how a midwife working in the continuity of care model develops and maintains it. Secondly, this essay
will describe what a postnatal abdominal palpation is, why it is done and what the outcomes may be. It will also describe the anatomy and physiology
of a uterus and involution. Lastly, a description of how the assessment is conducted and how during this partnership and cultural safety is maintained
by the midwife.
The partnership between a woman and her midwife is the key to a successful birth experience. This partnership is a professional friendship that allows
midwives to get to know women and their bodies.
This model identifies midwifery partnership as a relationship of 'sharing' between the women and the midwife, involving trust, shared control and
responsibility and shared meaning through mutual understanding. It is the sharing relationship which constitutes midwifery and it is one which spans
the life experience of pregnancy and childbirth. (Guilliland, K., & Pairman, S, 2010, p. 7).
This partnership is formed throughout the continuity of care Model. According to Leap & Pairman (2010) "The development of this partnership
relationship relies on midwives being able to work in continuity–of–care models so that mutual trust and understanding between midwives and women
can evolve over time"(p. 338). The continuity of care model that lead maternity carers work with, is where midwives support woman from the day they
find out

Effects Of Musculoskeletal Palpation On Athletic Training...
To evaluate injuries, musculoskeletal palpation is taught in many athletic training programs. Oftentimes, the focus is on accuracy of surface anatomy
landmarks instead of the ability to discriminate qualitative information such as, tissue tone, spasm, or pain response from the soft tissue. Palpation is a
large foundation for evaluation and intervention, a need to further the development of this skill exists. Due to this the integration of tasks to improve
palpation skills throughout athletic training curriculum may help improve student confidence, accuracy and precision while performing patient
evaluation and manual medicine interventions. Recent research has proven that stereognosis drills can improve student's palpation skills and provide
advanced training to better refine palpation skills. Below, the definition of stereognosis will be defined, as well as, altering techniques to perform these
drills. 1
The use of manual medicine has become increasingly popular in the profession of athletic training. This occurs because athletic trainers are seeking
new ways to rehabilitate their patients. Typically, these techniques require theathletic trainer to palpate superficial and deep structures of the body with
great accuracy and discrimination. Ironically, many athletic trainers and students report difficulty with their personal abilities to feel and discriminate
the local soft tissue. Stereognosis is a concept first introduced by Hoffman, as an individual's ability to

Essay on Reflective Nursing Case Study
Case Study One
In this case study I will use Gibbs (1988) model of reflection to write a personal account of an abdominal examination carried out in general practice
under the supervision of my mentor, utilising the skills taught during the module thus far.
What happened
During morning routine sick parade I was presented with a 21 year old male soldier experiencing severe acute, non specific, abdominal pain. Under the
supervision of the medical officer (MO) I proceeded to carry out a full assessment and abdominal examination, using Byrne and Long's (1976) model to
structure the consultation. I requested the patients' consent before conducting the examination, as is essential before commencement of any medical
procedure, be it a ... Show more content on Helpwriting.net ...
Thus allowing me to form a differential diagnosis and rule out certain causes, such as; constipation, and indigestion. Subsequently, thephysical
examination enabled me to confirm a diagnosis of acute abdomen. As the patient was not experiencing any worrying (red flag) symptoms associated
with abdominal emergencies, such as; appendicitis or pancreatitis. However, I did forget certain aspects of the physical examination and had to be
prompted by the MO. Although with more practice such incidence would be reduced.
Analysis
I was happy that I managed to rule out any distinct causes of the abdominal pain by performing the examination to collect data, analyse it, and use the
results to make an appropriate decision (Schon, 1984). However, had I performed the examination without assistance I may not have gained all the
information required to confirm diagnosis, as I did forget some aspects.
Conclusion
The MO seemed happy with my diagnosis and care plan, though he did highlight the importance of practicing the physical examination skills in order
to become a more competent practitioner. Overall I feel gaining knowledge and skills in translating a patients' history and physical examination results,
has enabled me to become more confident in making a diagnosis and has improved my decision making skills.
Action Plan
In order to become a more capable and effective practitioner I must continue to

Accuvein Finder
Inserting an IV into a patient can be a painful experience, especially if the individual has veins that are hard to visualize or palpate. Some reasons for
difficulty inserting IV catheters include obesity, veins that roll or blow easily, dark pigmented skin, and dehydration. With the help of modern
technology, devices called Accuvein finders have made it a less painful process for patients. The author will discuss how these devices have compared
to palpation and inspection on hospitalized patients in the last five years. This paper will focus on three articles that tested the Accuvein finders and
the results of each. Accuvein is a device that uses infrared light to illuminate veins (Aulagnier et al., 2014). It has been a preferred method over
ultrasound because of its portability and easy training. There are different brands of the vein illuminating devices, such as Vein Locator Universal,
which is used at Sharn Anesthesia in Tampa (Aulagnier et al., 2014). AccuVein has shown promise in pediatric patients and illuminates the hemoglobin
of the veins (Aulagnier et al., 2014).... Show more content on Helpwriting.net ...
The attempt was done to lessen cannulation times in emergency situations. Nurses performed IV cannulation in both groups using a tourniquet with up
to three attempts. The results revealed that AccuVein surprisingly was not more successful than inspection and palpation. The study conducted
included 266 patients and revealed that patients moved more when the operator used AccuVein, therefore making cannulation difficult. (Aulagnier et
al., 2014). The study also revealed that although not by much, IV cannulation was quicker than using the AccuVein device. The research team believes
while the device illuminates an image of the veins, it is hard to determine if it can be used for cannulation without

Evaluation Of The Standardized Patient Experience
Reflective Evaluation
The standardized patient experience was useful and interesting for me because I became more confident and active during nursing practice after that
practice exam. This practical exam helped me recall my professional experience from year 2012 and 2013 when I worked as a nurse in my country.
After that practice exam, I knew how staff nurses deal and communicate with patients from a different culture and spoke different language. My
specialization is nursing education, but I wanted to take more practical classes during the course or study to obtain first hard experience and confidence
in dealing with patients.
I had the opportunity to elicit a comprehensive health history by using skillful interviewing techniques. However, I was nervous and panicky because I
thought the time will be not adequate to complete the practical exam. I applied my skills and experience during health history section, but the problem
was I did not deal with any real patient during nursing practical about two years ago. After I introduced myself to the patients, I started to ask and write
patient name, age, and chief complaint. Then, I started to ask patients about subjective data which included a history of present illness, past medical
history, family history, and personal and social history. I did an appropriate job with subjective data. I did not ask patients about sexual history during
subjective data based on their situation and age. Also, according to my previous experience

Head to Toe Essay
The head to toe physical assessment is the first step of the nursing process and is a systemic approach of collecting objective (physical) and subjective
(mental) data on the patient that will help the nurse formulate nursing diagnoses and plan patient care. It is also used to confirm or question data that
was stated in the pt. previous history stated in the charts and to evaluate the effectiveness of the nursing interventions that were carried out on the
patient. The main focus of the head–to–toe assessment is to focus on what the patient is currently presenting with; the patient's responses to actual or
potential problems.
In preparing for the assessment, it is important to explain the purpose of the assessment, explaining why it is ... Show more content on Helpwriting.net
...
The head to toe physical assessment is to be performed in less than 10 minutes using a stethescope, pen light, your hands, and observational skills. It
comprises of four different techniques: IPPA inspection, palpation,percussion, and auscultation. This sequence, in apparent order, is used for al
systems except for the abdominal assessment, which requires auscultation before palpation and percussion. Inspection is visually examining the person,
focusing on one area of the body at a time. Palpation is using touch, feeling for texture, size, consistency, and location of body parts. Auscultation is
listening for sounds within the body, mainly listening the lungs, heart, as well as the abdomen with the use of a stethoscope. Percussion is tapping an
area of the body with the fingers and is usually a special assessment skill that the RN or physician uses, not a practical student nurse.
The nurse must initially evaluate the patient's charts for any bacterial precautions and fall risks. As the nurse walks into the patient's room, the nurse
begins by making sure the environment is clean and safe. The nurse would do this by gathering equipment, washing hands thoroughly, and wear gloves.
The nurse is then to greet the patient, introducing self, then let them know exactly what you came to do. The nurse should first ask the patient for his
or her name, birthdate, location of where the patient is currently at, and the reason as to what

Identifying The Components Of A Client 's Health History
2.Identify the components included in a client's health history. Biographic Data–The client's demographic data, should include the name, address, age,
sex, marital status, occupation, religion, health care financing, and their primary care provider. Chief Complaint–The reason for the visit should be
obtained and documented in the client's own words. History of Present Illness–Gather more information about the present illness by asking questions
such as: When did the symptoms start? Did it occur suddenly or gradually or increased over time? How often does the problem occur? What is the
intensity of the pain? Can you rate it from 0 to 10? How much sputum, vomit, or discharge came up or out? What color was it? Was it watery, thick, or
Moreover, diseases that require particular attention includes: heart disease, cancer, diabetes, hypertension, obesity, allergies, arthritis, tuberculosis,
bleeding, alcoholism, and mental health disorders. Lifestyles–Ask the client about their personal habits such as the amount of tobacco, alcohol,
caffeine, or recreational drugs consumed. Also, obtain their normal daily diets, special diets, or ethnic food patterns; and the amount of meals and
snacks per day. Likewise, who cooks and do the shopping? In addition, ask about the client's sleep pattern. What time do you go to bed/ what time do
you wake up? Any you having any problems sleeping? Have you tried anything to correct this problem? Furthermore, ask about the daily living
activities. Are you having any problems performing basic activities such as eating, grooming, dressing, elimination, or locomotion? Are you having any
problems with preparing foods, shopping, transportation, housekeeping, laundry, or the ability to use the telephone, handle finances, or manage your
medication. Finally, ask the client do you exercise and how well do you tolerate the activity? Do you have any other hobbies? Social Data–Ask the
client who helps them during times of stress? What effects have your illnesses had on the family and are there any family problems affecting your
illness? Do you have any religion or beliefs that could affect your health or recovery? Moreover, find out about the client's education.

Importance And Importance Of Physical Examination
1build a relationship with your doctor
2.1 Significance in personal life:
It is very useful in our personal life as physical examination includes all the basic assessment which can give you an idea about your own health. It is
also very beneficial in terms of assessing your family members when they are in need or sick. This examination also helps you to maintain your and
your family's health in terms of your growth and development which includes BMI, Nutritional guidance etc.
2.2 Significance in Social Context:
Importance of Physical examination in society plays a great role in health promotion. Healthy life is always been a motive of health promotion and In
every society there are institutions which are focusing of health promotion. Many ... Show more content on Helpwriting.net ...
In many cases I observe that people are getting their checkup of physical examination done in every 6 months which is a good thing, they are very
much interested in healthy life style and are ready to maintain their health status.
2.3 Application in current Job:
As we are in nursing profession and working in clinical setting all the day, we encounter many patients and we used to do physical examination every
shift as per our hospital policy and we report document in their file the observations and then doctors revisit, so the continuity of care must be provided.
This again helps us in building competency in our assessment skill which will be beneficial for us and for the patients.
2.4 Current Research:
Many researches have been done on the importance of physical assessment and it also shows that regular physical examination helps in decreasing
morbidity and mortality rates. It also helps the health care workers to detect the diagnosis earlier and to treat them with promptness. Early identification
of Cancers are also been treated effectively and increase patients prognosis.
Concept 3: Assessment of Integumentary System
Introduction:
Integumentary system comprises of the skin and its appendages which includes hairs, scales, feathers, hooves, and nails.
Significance of the Integumentary

Trigger Point Of Muscle Demographics
Trigger points, also known as trigger sites or muscle knots, are described as hyperirritable spots in skeletal muscle that are associated with palpable
nodules in taut bands of muscle fiber. These very localized areas in muscle tissues and/or their tendinous attachments are often felt as taut bands when
palpated, which elicits pain. A trigger point is a very circumscribed region in which relatively few motor units seem to be contracting. So it is
localized spot of tenderness in a nodule of a palpable taut band of contractured muscle fibers The exact nature of a trigger point is not known. It has
been suggested that certain nerve endings in the muscle tissues may become sensitized by algogenic substances that create a localized zone of
hypersensitivity

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