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[ANSWERED] Patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache

Patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache

Case Study Analysis

An understanding of the neurological and musculoskeletal systems is a critically important component of disease and disorder diagnosis and treatment. This importance is magnified by the impact that that these two systems can have on each other. A variety of factors and circumstances affecting the emergence and severity of issues in one system can also have a role in the performance of the other.

Effective analysis often requires an understanding that goes beyond these systems and their mutual impact. For example, patient characteristics such as, racial and ethnic variables can play a role.

An understanding of the symptoms of alterations in neurological and musculoskeletal systems is a critical step in diagnosis and treatment. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment.

In your Case Study Analysis related to the scenario provided, explain the following:

  • Both the neurological and musculoskeletal pathophysiologic processes that would account for the patient presenting these symptoms.
  • Any racial/ethnic variables that may impact physiological functioning.
  • How these processes interact to affect the patient.

Case Study Scenario

Patient is a 24-year-old female administrative assistant who comes to the emergency department with a chief complaint of severe right-sided headache. She states that this is the sixth time in the last 2 months she has had this headache. She says the headaches last 2–3 days and have impacted her ability to concentrate at work. She complains of nausea and has vomited three times in the last 3 hours. She states, “the light hurts my eyes.” She rates her pain as a 10/10 at this time. Ibuprofen and acetaminophen ease her symptoms somewhat but do not totally relieve them. No other current complaints.

Rubric Detail

Select Grid View or List View to change the rubric’s layout.

Name: NURS_6501_Module5_Case Study_Assignment_Rubric

  • Grid View
  • List View
  Excellent Good Fair Poor
Develop a 1- to 2-page case study analysis, examining the patient symptoms presented in the case study. Be sure to address the following:

Explain both the neurological and musculoskeletal pathophysiologic processes of why the patient presents these symptoms.

28 (28%) – 30 (30%)

The response accurately and thoroughly describes the patient symptoms.

The response includes accurate, clear, and detailed explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation.

25 (25%) – 27 (27%)

The response describes the patient symptoms.

The response includes accurate, explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by evidence and/or research, as appropriate, to support the explanation.

23 (23%) – 24 (24%)

The response describes the patient symptoms in a manner that is vague or inaccurate.

The response includes explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms and is supported by explanations that are vague or based on inappropriate evidence/research.

0 (0%) – 22 (22%)

The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing.

The response does not include explanations of both the neurological and musculoskeletal pathophysiologic processes of patients who present these symptoms, or the explanations are vague or based on inappropriate evidence/research.

Explain how the highlighted processes interact to affect the patient. 28 (28%) – 30 (30%)

The response includes an accurate, complete, detailed, and specific explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation.

25 (25%) – 27 (27%)

The response includes an accurate explanation of how the highlighted processes interact to affect the patient and is supported by evidence and/or research, as appropriate, to support the explanation.

23 (23%) – 24 (24%)

The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate evidence/research.

0 (0%) – 22 (22%)

The response includes a vague or inaccurate explanation of how the highlighted processes interact to affect the patient, with explanations that are based on inappropriate or missing evidence/research.

Explain any racial/ethnic variables that may impact physiological functioning. 23 (23%) – 25 (25%)

The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation.

20 (20%) – 22 (22%)

The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning and is supported by evidence and/or research, as appropriate, to support the explanation.

18 (18%) – 19 (19%)

The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations that are based on inappropriate evidence/research.

0 (0%) – 17 (17%)

The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research.

Written Expression and Formatting – Paragraph Development and Organization:
Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.
5 (5%) – 5 (5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity.

A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.

4 (4%) – 4 (4%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time.

The purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.

3.5 (3.5%) – 3.5 (3.5%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time.

The purpose, introduction, and conclusion of the assignment are vague or off topic.

0 (0%) – 3 (3%)

Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time.

No purpose statement, introduction, or conclusion were provided.

Written Expression and Formatting – English Writing Standards:
Correct grammar, mechanics, and proper punctuation
5 (5%) – 5 (5%)

Uses correct grammar, spelling, and punctuation with no errors.

4 (4%) – 4 (4%)

Contains a few (1 or 2) grammar, spelling, and punctuation errors.

3.5 (3.5%) – 3.5 (3.5%)

Contains several (3 or 4) grammar, spelling, and punctuation errors.

0 (0%) – 3 (3%)

Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding.

Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list. 5 (5%) – 5 (5%)

Uses correct APA format with no errors.

4 (4%) – 4 (4%)

Contains a few (1 or 2) APA format errors.

3 (3%) – 3 (3%)

Contains several (3 or 4) APA format errors.

0 (0%) – 3 (3%)

Contains many (≥ 5) APA format errors.

Total Points: 100

Name: NURS_6501_Module5_Case Study_Assignment_Rubric

Expert Answer and Explanation

Case Study Analysis

Prior to treating a patient, a provider has to be aware of the patient’s health problems, and the underlying reasons for the symptoms which the patient exhibits. This underscores the reason for the clinical assessment which involves performing diagnosis tests, and asking a series of questions focused on getting to understand the patient’s needs. Patient assessment can also help a provider gauge the patient’s risk of developing a particular clinical condition. When assessing a patient, a provider may look at aspects such as the ethnicity or race of the patient because racial or ethnic characteristics can impact an individual’s risk of developing certain diseases. To properly examine a patient, a clinician has to take into consideration the relationship between the neurologic functioning and the musculoskeletal system. This knowledge is necessary because it can help them understand the kind of intervention that can help promote the recovery of the patient (Weatherall, 2015). It is important to examine the neurological and musculoskeletal pathophysiological processes for a 24-year old patient who experiences headache.

Neurological and Musculoskeletal Pathophysiologic Processes

Based on the clinical manifestations stated in the study, the patient seems to have migraine, and one can attribute this to the changes in the patient’s neurological as well as musculoskeletal pathophysiological processes. The condition occurs due to altering of the central neuronal processing. This occurs when the brain stem nuclei is activated accompanied by releasing of the neuropeptides. The release of these materials create a feeling of painful inflammation. This pain occurs in the cranial vessels, and can be felt on the right side of the head. The low level of brain’s serotonin contributes to this inflammation (Burstein, Noseda, & Borsook, 2015). The limited supply of this material causes the swelling of the blood vessels. This creates a feeling of pain on the right side of the head. The decline in the level of material can nauseated feeling, and this explains the reason why the 24-year old patient is nauseated and has vomited (Deen et al., 2018).

Racial or Ethnic Variable that can affect the Physiological Functioning

The prevalence of the migraines varies across various racial and ethnic populations. Native Americans experience higher rates compared to the general population. The prevalence for this group is 19.2%, and 11.3% for the Asians. One can attribute this difference to the difference in the genetic build across different races. They have a large genetic component, and the rate of depletion of the serotonin level differ from one individual to another depending on their racial or ethnic background. Because the prevalence is higher among the Native Americans, one can conclude that this group is likely to experience a decline in the serotonin levels in their brains, and therefore the reason for the high prevalence rates of headache (Pressman et al., 2016).

Interaction of the Processes

The neurologic and musculoskeletal pathophysiologic processes interact to cause headaches which last more than 24 hours. The serotonin is an active chemical that helps the nerve cells to communicate. When the supply of this chemical dwindles, the communication across the nerve cells becomes hampered, and this triggers the muscles on the blood vessels to contract. This ultimately results to narrowing of the blood vessels including the vessels on the right side of the head. These processes end up causing the inflammation which cause headache (Gasparini, Smith, & Griffiths, 2017).

Conclusion

In overview, the serotonin plays a key role in the pathophysiology of the headache, and a decrease in the amount of this chemical can result to a serious migraine. Due to the lack of the chemical, the central neuronal processing is altered, and this explains the reason why headache occurs. However, the rate of occurrence of the headache in individuals may differ when one considers people across different ethnic groups.

References

Burstein, R., Noseda, R., & Borsook, D. (2015). Migraine: multiple processes, complex pathophysiology. The Journal of neuroscience : the official journal of the Society for Neuroscience35(17), 6619–6629.Doi: https://doi.org/10.1523/JNEUROSCI.0373-15.2015.

Deen, M., Hansen, H. D., Hougaard, A., Nørgaard, M., Eiberg, H., Lehel, S., Ashina, M., & Knudsen, G. M. (2018). High brain serotonin levels in migraine between attacks: A 5-HT4 receptor binding PET study. NeuroImage. Clinical18, 97–102.Doi: https://doi.org/10.1016/j.nicl.2018.01.016.

Gasparini, C. F., Smith, R. A., & Griffiths, L. R. (2017). Genetic and biochemical changes of the serotonergic system in migraine pathobiology. The journal of headache and pain18(1), 20. Doi:https://doi.org/10.1186/s10194-016-0711-0.

Pressman, A., Jacobson, A., Eguilos, R., Gelfand, A., Huynh, C., Hamilton, L., Avins, A., Bakshi, N., & Merikangas, K. (2016). Prevalence of migraine in a diverse community–electronic methods for migraine ascertainment in a large integrated health plan. Cephalalgia : an international journal of headache36(4), 325–334.Doi: https://doi.org/10.1177/0333102415590242.

Weatherall, M. W. (2015). The diagnosis and treatment of chronic migraine. Therapeutic advances in chronic disease6(3), 115–123.Doi: https://doi.org/10.1177/2040622315579627.

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