I need a response to this assignment zero plgiarism three references Initials: J.S    Age: 42     Sex: Male   Race: African American  S. CC:  “I am experiencing lower back pain that radiates to my left leg” HPI :  Mr. Smith is a 42-year-old African American male who reports to the clinic complaining of lower back pain that periodically radiates to his left leg.  The pain started about one month ago.  The character of the pain is shooting and stabbing. It appears to get worse when sitting for an extended period of time, bending over and during strenuous physical activity. The severity of the pain is 8/10 without medications but relieves to about 3/10 after taking Tylenol and getting some rest.   Location: Lower back Onset: 1 month Character: Shooting and Stabbing Associated signs and symptoms: nausea, vomiting, photophobia. Timing: Sitting for extended periods, bending over and strenuous physical activity.  Exacerbating/ relieving factors: Tylenol and rest makes the pain tolerable, but not completely better. Severity: 8/10 pain scale Current Medications :  Metoprolol 100 mg tablet, PO once daily.  Acetaminophen 500 mg tabs, 1-2 PO q 6 hrs, PRN for pain. (not to exceed 3 g in 24 hr). PMHx: Diagnosis: Hypertension Surgical Hx: Laparotomy, 02/2000 Immunizations: Childhood immunizations completed. Tetanus and Flu shots are up-to-date. Soc Hx: Unemployed. Lives alone and never married. Has one brother and both parents are alive. Performs physical exercise regularly at the gym, and uses seat belts all the time when driving. Denies tobacco and alcohol use. Fam Hx : Father has a stroke and heart disease, Mother has hypertension, Brother has diabetes. Maternal and Paternal grandparents died of a stroke 2 years ago. ROS :  BP - 140/90 L arm,  P - 86, T - 98.1 oral,  RR - 18,  Ht. - 5’10”, Wt. - 200 lbs. BMI 28.7 GENERAL:   No weight loss, fever, chills, weakness or fatigue. HEENT:  Eyes:  No visual loss, blurred vision, doubles vision or yellow sclerae.  Ears, Nose, Throat:  No hearing loss, sneezing, congestion, runny nose or sore throat. Skin: No rash or itching. No skin lesions or moles that are new or suspicious.   CARDIOVASCULAR:  No chest pain, chest pressure or chest discomfort. No palpitations or edema. No pleurisy pain, no hx of a heart murmur. No EKG on record. No peripheral edema or claudication. BP controlled with medication.  RESPIRATORY:  No cough, sputum or SOB. No DOE, hemoptysis. Chest X-rays - 3 years ago.  GASTROINTESTINAL:  No anorexia, nausea, vomiting or diarrhea. No abdominal pain or blood. No unintentional weight loss or gain. No change in bowel habits. GENITOURINARY:  No penile discharge or erectile dysfunction. No nocturia, dribbling, or incontinence. NEUROLOGICAL:  No headache, dizziness, syncope, paralysis, ataxia, numbness or tingling in the extremities. No change in bowel or bladder control. No reports of numbness or tingling to the left leg since the onset of lower back pain. MUSCULOSK.

1. I need a response to this assignment
zero plgiarism
three references
Initials: J.S Age: 42 Sex: Male Race: African American
S.
CC:
“I am experiencing lower back pain that radiates to my left leg”
HPI
: Mr. Smith is a 42-year-old African American male who
reports to the clinic complaining of lower back pain that
periodically radiates to his left leg. The pain started about one
month ago. The character of the pain is shooting and stabbing.
It appears to get worse when sitting for an extended period of
time, bending over and during strenuous physical activity. The
severity of the pain is 8/10 without medications but relieves to
about 3/10 after taking Tylenol and getting some rest.
Location: Lower back
Onset: 1 month
Character: Shooting and Stabbing
Associated signs and symptoms: nausea, vomiting, photophobia.
Timing: Sitting for extended periods, bending over and
strenuous physical activity.

2. Exacerbating/ relieving factors: Tylenol and rest makes the pain
tolerable, but not completely better.
Severity: 8/10 pain scale
Current Medications
:
Metoprolol 100 mg tablet, PO once daily.
Acetaminophen 500 mg tabs, 1-2 PO q 6 hrs, PRN for pain. (not
to exceed 3 g in 24 hr).
PMHx:
Diagnosis: Hypertension
Surgical Hx:
Laparotomy, 02/2000
Immunizations:
Childhood immunizations completed. Tetanus and Flu shots are
up-to-date.
Soc Hx:
Unemployed. Lives alone and never married. Has one brother
and both parents are alive. Performs physical exercise regularly
at the gym, and uses seat belts all the time when driving. Denies
tobacco and alcohol use.
Fam Hx
: Father has a stroke and heart disease, Mother has
hypertension, Brother has diabetes. Maternal and Paternal
grandparents died of a stroke 2 years ago.
ROS

3. : BP - 140/90 L arm, P - 86, T - 98.1 oral, RR - 18, Ht. -
5’10”, Wt. - 200 lbs. BMI 28.7
GENERAL: No weight loss, fever, chills, weakness or fatigue.
HEENT: Eyes: No visual loss, blurred vision, doubles vision
or yellow sclerae.
Ears, Nose, Throat: No hearing loss, sneezing, congestion,
runny nose or sore throat.
Skin: No rash or itching. No skin lesions or moles that are new
or suspicious.
CARDIOVASCULAR: No chest pain, chest pressure or chest
discomfort. No palpitations or edema. No pleurisy pain, no hx
of a heart murmur. No EKG on record. No peripheral edema or
claudication. BP controlled with medication.
RESPIRATORY: No cough, sputum or SOB. No DOE,
hemoptysis. Chest X-rays - 3 years ago.
GASTROINTESTINAL: No anorexia, nausea, vomiting or
diarrhea. No abdominal pain or blood. No unintentional weight
loss or gain. No change in bowel habits.
GENITOURINARY: No penile discharge or erectile
dysfunction. No nocturia, dribbling, or incontinence.
NEUROLOGICAL: No headache, dizziness, syncope, paralysis,
ataxia, numbness or tingling in the extremities. No change in
bowel or bladder control. No reports of numbness or tingling to
the left leg since the onset of lower back pain.
MUSCULOSKELETAL: Reports lower back pain that
sometimes radiate to the left leg. No edema noted.

4. HEMATOLOGIC: No hx of Blood transfusions. No anemia,
bleeding or bruising.
LYMPHATICS: No hx of splenectomy. No enlarged lymph
nodes.
PSYCHIATRIC: No hx of depression or anxiety.
ENDOCRINOLOGIC: No reports of sweating, cold or heat
intolerance. No polyuria or polydipsia. No heat or cold
intolerance.
ALLERGIES: NKFA, NKDA
O.
Physical exam
:
General: Alert & Oriented x3. Appears well-nourished but
exhibits a slight limp due to left leg pain.
Cardiovascular: Regular heart rate and rhythm, normal heart
sounds and intact pulses. No murmurs, gallops or pericardial
friction rub.
Pulm/chest: No respiratory distress. Lung Sounds clear to
auscultation in all fields.
Abdomen: Soft, non-tender, Bowel sounds present x4 quadrants.
Musculoskeletal: Decreased mobility with lower back pain.
Limited ROM with lumbar flexion. Gait disturbances, leaning to
the right side on examination. Muscle spasms noted.

5. Hip flexion/ extension and strength against resistance indicates
weakness to left gluteus maximus and L5 nerve root
involvement. No hip or joint instability, knees equal in height
Neurological: Bilateral L3-S1 dermatomes reactive to touch, no
decrease in sensation. Deep tendon reflexes are symmetrical.
Knee jerk reflex positive and symmetrical bilaterally.
Diagnostic results
:
Urinalysis: Negative, Light-yellow urine.
A
.
Differential Diagnoses:
Low back pain & sciatica - Shooting pain in the lower back, that
radiates down to one leg.
Degenerative disc - The gradual deterioration of the disc
between the vertebrae.
Lumbar radiculopathy - Nerve irritation caused by damage to
the discs b/w the vertebrae.
Herniated disk -Signs and symptoms include arm/leg pain,
numbness/tingling, and weakness.
The presenting low back pain symptoms indicate a sciatic nerve
involvement since the pain is radiating down the posterior
aspect of the left leg. The X-rays show lesions most likely at

6. the L-5. Further tests that may be ordered include; Schober test.
This test measures the ability of a patient to flex his lower back.
The patient is asked to touch his toes while keeping the knees
straight. A positive test will be less than 4 cm between the 2
marks indicating decreased lumbar mobility. A Straight Leg
Raise (SLR) test can be used to determine if the patient has true
sciatica. A positive SLR test usually indicates S1 or L5 root
irritation.
A FABER test can be used to rule out Sacroiliac (SI) Joint Pain
and sacroiliitis. It is considered positive if movements
reproduce pain or cannot be completed due to limited range-of-
motion. Nerve testing of the lower extremities can be used to
detect nerve irritation, while disc herniation can be detected
with radiology testing, such as CT scan or MRI scan (McCance
et al., 2014).
According to El Barzouhi et al., (2013), patients with sciatica
frequently experience disabling back pain. Sciatica or lumbar
spine pain with nerve root involvement results in low back pain
and leg pain. The condition generally resolves within a period
of 8 weeks. If the low back pain does not resolve within 8
weeks, then consider using imaging techniques such as; CT scan
or MRI (El Barzouhi et al., 2014).
Diagnostic testing is not usually recommended within the first
four weeks of the onset of low back pain, with no neurological
symptoms, according to national practice guidelines (Dains,
Baumann, & Scheibel, 2012). Evidence shows that unnecessary
or routine imaging (X-ray, MRI, CT scans) for low back pain is
not associated with improved outcomes. Patients who have early
imaging had much greater health care use and costs, but they
did not have better outcomes (AHRQ, 2015).
References

7. Agency for Healthcare Research and Quality (2015). Back pain?
Hold the MRI, new research says. Retrieved from
https://www.ahrq.gov/news/newsletter/e-newsletter/464.html
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., &
Stewart, R. W. (2015). Seidel's guide to physical examination
(8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2012). Advanced
health assessment and clinical diagnosis in primary care (5th
ed.). St.Louis, Missouri: Elsevier.
El Barzouhi, A., Vleggeert-Lankamp, C. L. A. M., van der
Kallen, B. F., Lycklama à Nijeholt, G. J., van den Hout, W. B.,
Koes, B. W., & Peul, W. C. (2014). Back pain’s association
with vertebral end-plate signal changes in sciatica. The Spine
Journal, 14(2), 225–233. https://doi-
org.ezp.waldenulibrary.org/10.1016/j.spinee.2013.08.058
McCance , K. L., Huether, S. E., Brashers, V. L., & Rote, N. S.
(2014). Pathophysiology: The biologic basis for disease in
adults and children (7th ed.). St. Louis, MS: Elsevier.