Please respond to discussion below using current APA edition and 2 scholarly references. Must be 150 words. Similarly to the first clinical week, the second clinical week was successful without significant challenges. As a result of my previous clinical rotations, during which I gained invaluable knowledge and skills regarding patient assessments and disease diagnosis, I assessed more patients independently and interacted more effectively with my preceptor as we discussed patient treatment plans together. Due to the interprofessional team collaboration, it was easy to handle complicated cases and develop patient-centered treatment plans.
Nursing Scenario
A 65-year-old white male presented to the clinic complaining of lower back pain. On examination of the patient’s back, the left side was more tender and asymmetrical. The patient informed the clinician that he had fallen at home but never sought medical intervention. He sought medical attention after pulling heavy luggage at the airport. A lumber X-ray showed a compression fracture of L3-L4. The patient is prescribed medications Baclofen 10 mg TID for three days and Ibuprofen 600 mg every 6 hours for pain management. The patient was recommended to consult an orthopedic surgeon and not lift anything heavier than 5 pounds to prevent further back injury.
Patient Assessment, A Plan of Care, and Differential Analysis
A comprehensive history and physical examination are required to determine the primary diagnosis of lower back pain. In this patient’s case, the history included questions about the mechanism of injury, quality of pain, and past and current treatments. The nurse practitioner performed a straight leg raise test, whereby the patient was requested to lie supine while maintaining one leg straight by activating the quadriceps (Harper & Klineberg, 2019). The nurse practitioner performed a slow, progressive elevation of the leg. As soon as the leg was below 45 degrees with the radiation below the knee, the patient felt pain and paresthesia. The test was critical to diagnosing L3 and L4 radiculopathies. Based on these findings and the X-ray results, which showed a compression fracture of L3-L4, the primary diagnosis was lumbar disc herniation. When the patient was assessed, his back was asymmetrical on the left side, with a bruise, which could have been caused by strain and stress when he fell on the dominant side.
Differential diagnoses included in this assessment were mechanical back pain, vertebral compression fractures, and spondylolisthesis (Rickers et al., 2021). The rationale behind these differential diagnoses was pertinent positives in each condition, including lower back pain, tenderness, radicular pain, and pain exacerbation when straining. However, a pertinent symptom that ruled out these conditions was back asymmetry on the left side. Since these persistent disabling symptoms are still present, he was referred to an orthopedic surgeon.
Health Promotion Intervention
Health promotion interventions included adequate rest to prevent muscle strain, physical rehabilitation, and therapies to ease pain, such as massage, ultrasound, and transcutaneous electrical nerve stimulation (Rickers et al., 2021). The patient was also educated on stretching, posture, and proper body mechanics, such as avoiding bending forward or twisting.
Lessons from the Clinical Experience
This week was successful because it helped me gain more insight and experience caring for geriatric patients. My clinical experience taught me several important lessons about referring patients to specialty doctors and collaborating with other interprofessional team members.
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