Summary NR511 / NR 511 Final Exam Study Guide |Week 5 - 7| (Latest 2021): Differential Diagnosis & Primary Care Practicum - Chamberlain
Summary NR511 / NR 511 Final Exam Study Guide |Week 5 - 7| (Latest 2021): Differential Diagnosis & Primary Care Practicum - Chamberlain

NR-511 Differential Diagnosis & Primary Care Practicum


NR511 – Final Exam Study Guide

Week 5 & Week 6 & Week 7

Topics:

o Common M/S disorders

o Common spine disorders

o Metabolic disorders

o Endocrine disorders

o Wounds, lacerations & bites

o Common hematological disorders

o Common male GU disorders

o Testicular disorders

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1. Signs and

symptoms and

management of

musculoskeletal

sprains/strains/dislocations

Signs and symptoms and management of musculoskeletal sprains/strains/dislocations

Sprains: stretching or tearing of ligaments that occurs when a joint is forced beyond its normal

anatomical range

 First degree- stretching of ligamentous fibers

 Second degree- partial tear of part of the ligament with pain and swelling

 Third degree- complete ligamentous separation

Sprain- sudden injury or fall that caused acute pain and swelling that got worse over a few

hours, redness and bruising, active and passive ROM decreased. Radiography to rule out fx.

Strain: muscle injury caused by excessive tensile stress placed on a muscle that results in

stiffness and decreased function

 -effects muscle or tendon that connects a muscle to a bone, complain of “pulled

muscle,” severe cases cause inflammation, swelling, weakness and loss of function-surgery may

be needed

Management: PRICE (protect, rest, ice, compression, elevation), limitation of activity, physical

therapy, NSAIDS, referral to ortho

Dislocation- complete separation of 2 bones that form a joint

 Very painful and cause immobility, need immediate medical attention

 Referral to orthopedics for possible surgery or reduction with application of cast or

splint.

four cardinal signs of inflammation (erythema, warmth, pain, or swelling) -SPEW

2. Signs and symptoms and

management of spinal

Cervical Spondylosis- neck stiffness, mild aching discomfort with activity. Pain and limited ROM

occur with lateral rotation and lateral flexion of the neck toward the affected side. Weakness

shoulder abduction- C5. Bicep weakness- C6. Tricep weakness-C7.Myelopathy- leg weakness,

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disorders (spondylosis,

stenosis, etc.)

gait disturbance, balance problems, difficulty performing fine motor tasks, loss of bowel and

bladder. Treatment- cervical traction, PT, pain relievers. Surgery for Myelopathy.

Low back pain-Tenderness and decreased range of motion. Positive straight leg test. TreatmentNSAIDS, muscle relaxants, opioids, surgical, self-care, spinal manipulation

Stenosis-pseudoclaudication causing radicular pain in the calves, buttocks, and upper thighs of

one or both legs. Symptoms progress from a proximal to distal direction. Walking or prolonged

standing causes pain and weakness in buttocks and legs. Stooping over helps relieve pain.

Positive Romberg. Reflexes diminished. With bowel or bladder symptoms, sphincter tone may

be decreased

Management- surgical decompression. NSAIDS, folic acid, vitamin b12. PT-flexing the

spine.Bicycling.

Intermittent use of NSAIDs may be helpful, as well as folic acid or vitamin B12 supplementation

in some cases depending on results of laboratory tests.

Management revolves around physical therapy or an exercise program that focuses on flexing

the spine. Flexion of the spine increases intraspinal volume. Bicycling is one exercise that is

done with the spine in flexion. Improving abdominal muscle tone lifts the pelvis anteriorly and

flexes the lumbar spine. Reduction of intra-abdominal fat is critical to achieving the objective.

Thus, weight loss may be pivotal. Lumbar flexion exercises increase spinal canal volume.

Examples include exercise on all fours, arching the back, or in the fetal position. Exercises that

extend the spine should be avoided (swayback).

3. Recognition and

immediate management of

cauda equina syndrome

Immediate management of cauda equina syndrome. (P. 829)

Cauda equina syndrome is a medical EMERGENCY and requires immediate decompression.

If Cauda equina is confirmed, surgical lumbar decompression is necessary to halt neurological

deterioration unless surgery is contraindicated for other medical reasons.

*Rational on Davis Edge question: Low back pain accompanied by acute onset of urinary

retention or overflow incontinence, loss of anal sphincter tone or fecal incontinence, loss of

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sensation in the buttocks and perineum, and motor weakness in the lower extremities is a red

flag for cauda equina syndrome or severe neurologic compromise. Perianal numbness.

Cauda equina compression is characterized by bilateral lower extremity weakness, anesthesia,

or paresthesia of the perineum and buttocks (saddle anesthesia). There may or may not be

bowel or bladder incontinence or bladder retention. When there is neurologic deficit affecting

the bowel or bladder, these changes may not be reversed with surgical decompression,

4. Maneuvers and

expected findings with

joint pain (knee, shoulder,

wrist, etc.)

Neck pain-Spurling’s.

Shoulder pain-Apley scratch test(reaching the scapula). Internal and external flexion. Internal

and external abduction. Pain with abduction= early supraspinatus tendinitis and subacromial

bursitis=early rotator cuff injuries. Wrist and hand-allen’s test= radial and ulnar arteries.

Phalens test=median nerve compression.

Tinel’s sign assess for compression neuropathy – tapping over nerve.

Finkelsteins test- de Quervains disease. Thumb between finger and point.

Knee Pain= Mcmurray, apprehension sign, bulge sign, inspect/palpate to assess effusion.

Lachman, drawer sign – ACL,

Thumb test - PCL

MCL, LCL test are valgus and varus

Tennis elbow cup coffee cup sign

CTS-NSAIDs not effective

Achillies rupture – Thompson test

5. Initial assessment of

FOOSH injury in correlation

to anatomical location of

radial head bone Lisa

Callahan

FOOSH - Falling On an Out Stretched Hand. After falling on an outstretched hand patients

present after trauma with pain and swelling in the distal forearm or wrist. Numbness may be

present if the medial nerve is affected. The mechanism of injury will often provide important

clues to the diagnosis. The examination begins with gentle palpation to locate the area of point

tenderness and includes a thorough neurovascular assessment. A radiograph of the wrist

(including an oblique view) may be necessary to rule out fracture. Common fractures are the

Colles fracture of the distal radius and the navicular (scaphoid) fracture of the anatomical

snuffbox. It is not unusual to have a navicular fracture missed on radiography, so an orthopedic

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