NURS 6512 Assessment of Cognition and the Neurologic System
NURS 6512 Assessment of Cognition and the Neurologic System
NURS 6512 Assessment of Cognition and the Neurologic System
Patient Information:
Initials: V.A Age: 47 years
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Sex: Female Race: White
S.
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CC: “Pain in the right wrist.”
HPI:
V.A is a 47-year-old White woman who presents with complaints of pain in the right wrist. She mentions that the wrist pain began two weeks ago. She states that the wrist pain is associated with a tingling sensation and numbness in the thumb, index, and middle fingers, which also began two weeks ago. The pain is associated with activity primarily when she is suing the right hand and is relieved to some degree by rest. The patient states that the wrist pain interferes with her work since she often drops her hair-styling tools. She rates the pain at 3/10.
Current Medications: None.
Allergies: No known allergies.
PMHx: Immunization is current. The last TT- was 18 months ago; the last Influenza shot- was four months ago. The patient has had a history of overweight/obesity since she was 25. No history of other chronic illnesses or surgery.
Soc Hx: V.A is a hairdresser and runs a salon in Brooklyn, NY. She has a diploma in hair and beauty and has worked as a hairdresser for almost 25 years. The patient is married and has two children, 25 and 20. Her hobbies include watching fashion shows and baking. She admits consuming 3-4 beers on weekends but denies using tobacco or illicit substances. The patient takes three meals daily, although she admits to mainly eating fast foods for lunch. She states that she rarely exercises apart from walking to work.
Fam Hx: The patient’s grandfather had DM, and the grandmother died from pancreatic cancer. The children have no chronic conditions.
ROS:
GENERAL: Negative for fatigue, body weakness, hotness of the body, or chills.
CARDIOVASCULAR: Negative for racing heart, skipped heartbeats, chest discomfort, edema, dyspnea on exertion.
RESPIRATORY: Negative for cough, sputum, chest pain, or wheezing.
NEUROLOGICAL: Positive for tingling sensation and numbness in the fingers. Negative for headache, syncope, or dizziness.
MUSCULOSKELETAL: Positive for wrist pain. Negative for muscle pain or joint pain/stiffness.
O.
Physical exam:
Vital signs: BP- 126/84; HR-84; RR- 18; Temp- 98.4F
Wt-192 lbs; Ht-5’45; BMI- 33.0
General: Obese female, calm, and not in distress. She is well-groomed and maintains adequate eye contact. Her speech is clear and goal-directed, and she exhibits a positive attitude.
Cardiovascular: Regular heart rate and rhythm. S1 and S2 were heard with a normal rhythm. No S gallop or systolic murmurs were auscultated.
Respiratory: Smooth respirations with unison chest rise and fall. Breath sounds are heard bilaterally, and lungs are clear.
Neurological: Normal gait, balance, and posture. Sensory abnormalities in the palmar side of the right thumb and index and middle fingers. Positive carpal compression test.
Musculoskeletal: Spine is well-aligned. Muscle strength- 5/5. Joints are non-inflamed and non-enlarged.
Diagnostic results:
Plain X-ray of the Right Wrist and Fingers: Awaits results. The X-ray is vital in visualizing joint defects in the wrist and metacarpophalangeal joints.
A.
Differential Diagnoses
Carpal Tunnel Syndrome (CTS): CTS is characterized by compression of the median nerve when passing
through the carpal tunnel in the wrist. Clinical manifestations of CTS include pain in the hand and wrist accompanied by tingling and numbness (Genova et al., 2020). The pain is typically distributed along the median nerve, the palmar surface of the thumb, index and middle fingers, and the radial half of the ring finger. However, it can involve the entire hand. Usually, affected individuals wake at night with aching or burning pain and a tingling sensation and numbness and shake the hand to relieve the pain and tingling and reinstate the sensation (Genova et al., 2020). CTS is a differential diagnosis based on positive findings of pain, tingling, and numbness in the wrist and thumb, index, and middle fingers, which result in loss of grip when working. In addition, sensory defects in the palmar side of the affected fingers and a positive carpal compression test point to CTS.
Peripheral Neuropathy: Peripheral neuropathy is characterized by dysfunction of one or more peripheral nerves, the section of a nerve distal to the root and plexus. The condition includes various syndromes that manifest with different levels of pain, sensory disturbances, muscle weakness and atrophy, diminished deep tendon reflexes, and vasomotor symptoms, which occur alone or in combination (Castelli et al., 2020). Peripheral neuropathy is a differential diagnosis based on the patient’s symptoms of wrist pain and tingling, and numbness in the right arm fingers.
Arthritis of the Right Wrist: Arthritis of the wrist is caused by the loss of cartilage between wrist bones. It results in wrist joint pain, swelling, and stiffness (Maklad, 2020). The symptoms can be constant if the arthritis is severe. The patient’s history of right wrist pain makes wrist arthritis a differential diagnosis. However, the patient has no wrist swelling or stiffness, making arthritis an unlikely primary diagnosis.
Wrist Tendonitis: Wrist tendonitis is characterized by inflammation of one or more tendons in the wrist. It occurs as a result of micro-tears in a tendon due to sudden or recurring injury (Ferguson et al., 2019). The tendon inflammation usually results in pain, stiffness, swelling, and warmth in the wrist. Wrist tendonitis is a differential diagnosis based on the symptom of wrist pain.
Cervical Radiculopathy: Radiculopathy causes segmental radicular deficits like pain and paresthesias that distribute in a dermatomal pattern. They also cause weakness and atrophy of muscles innervated by the nerve root (Kang et al., 20200. Besides, the pain may be aggravated by movements that convey pressure to the nerve root via the subarachnoid space. The patient’s wrist pain, as well as numbness and tingling sensation on the right-hand fingers, make cervical radiculopathy a differential diagnosis.
NURS 6512 Assessment of Cognition and the Neurologic System References
Castelli, G., Desai, K. M., & Cantone, R. E. (2020). Peripheral Neuropathy: Evaluation and Differential Diagnosis. American family physician, 102(12), 732–739.
Ferguson, R., Riley, N. D., Wijendra, A., Thurley, N., Carr, A. J., & Bjf, D. (2019). Wrist pain: a systematic review of prevalence and risk factors- what is the role of occupation and activity? BMC musculoskeletal disorders, 20(1), 542. https://doi.org/10.1186/s12891-019-2902-8
Genova, A., Dix, O., Saefan, A., Thakur, M., & Hassan, A. (2020). Carpal Tunnel Syndrome: A Review of Literature. Cureus, 12(3), e7333. https://doi.org/10.7759/cureus.7333
Kang, K. C., Lee, H. S., & Lee, J. H. (2020). Cervical Radiculopathy Focus on Characteristics and Differential Diagnosis. Asian spine journal, 14(6), 921–930. https://doi.org/10.31616/asj.2020.0647
Maklad, M. (2020). Wrist arthritis and Carpal Advanced Collapse-Systematic review. International Journal of Orthopaedics, 7(6), 1374-1378.
A 63-year-old woman comes to your office because she’s been forgetting things…a young mother comes in concerned because her baby fails to make eye contact and is unresponsive to touch…a teenager comes in and a parent complains that the teen obsessively washes his hands.
An array of neurological conditions could be causing the above symptoms. When assessing the neurologic system, it is vital to formulate an accurate diagnosis as early as possible to prevent continued damage and deterioration of a patient’s quality of life.
This week, you will explore methods for assessing the cognition and the neurologic system.
Learning Objectives
Students will:
- Evaluate abnormal neurological symptoms
- Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for cognition and the neurologic system
- Assess health conditions based on a head-to-toe physical examination
Learning Resources
Required Readings (click to expand/reduce)
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). St. Louis, MO: Elsevier Mosby.
- Chapter 7, “Mental Status”This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.
- ·Chapter 23, “Neurologic System”The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2019). Advanced health assessment and clinical diagnosis in primary care (6th ed.). St. Louis, MO: Elsevier Mosby.
Credit Line: Advanced Health Assessment and Clinical Diagnosis in Primary Care, 6th Edition by Dains, J.E., Baumann, L. C., & Scheibel, P. Copyright 2019 by Mosby. Reprinted by permission of Mosby via the Copyright Clearance Center.
Chapter 4, “Affective Changes”
Chapter 9, “Confusion in Older Adults”
Chapter 13, “Dizziness”
Chapter 19, “Headache”
Chapter 31, “Sleep Problems”
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Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.
- Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”) (Previously read in Weeks 1, 2, 3, and 5)
Note: Download the Physical Examination Objective Data Checklist to use as you complete the Comprehensive (Head-to-Toe) Physical Assessment assignment.
Note: Download and review the Student Checklists and Key Points to use during your practice neurological examination.
This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful.
Shadow Health Support and Orientation Resources
Use the following resources to guide you through your Shadow Health orientation as well as other support resources:
Document: Shadow Health. (2014). Useful tips and tricks (Version 2) (PDF)
Use this template to complete your Assignment 3 for this week.
Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.
- Chapter 14, “The Neurologic Examination” (pp. 683–765)This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.
- Chapter 15, “Mental Status, Psychiatric, and Social Evaluations” (pp. 766–786)In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.
Mahlknecht, P., Hotter, A., Hussl, A., Esterhammer, R., Schockey, M., & Seppi, K. (2010). Significance of MRI in diagnosis and differential diagnosis of Parkinson’s disease. Neurodegenerative Diseases, 7(5), 300–318.
Required Media (click to expand/reduce)
Neurologic System – Week 9 (16m)
Online media for Seidel’s Guide to Physical Examination
It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 7 and 23 that relate to the assessment of cognition and the neurologic system. Refer to the Week 4 Learning Resources area for access instructions on https://evolve.elsevier.com/
Assignment 1: Case Study Assignment: Assessing Neurological Symptoms
Photo Credit: Getty Images/iStockphoto
Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.
In this Case Study Assignment, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
To Prepare
- By Day 1 of this week, you will be assigned to a specific case study for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
- Also, your Case Study Assignment should be in the Episodic/Focused SOAP Note format rather than the traditional narrative style format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.
With regard to the case study you were assigned:
- Review this week’s Learning Resources, and consider the insights they provide about the case study.
- Consider what history would be necessary to collect from the patient in the case study you were assigned.
- Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
- Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.
The Case Study Assignment
Use the Episodic/Focused SOAP Template and create an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
By Day 6 of Week 9
Submit your Assignment.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “WK9Assgn1+last name+first initial.(extension)” as the name.
- Click the Week 9 Assignment 1 Rubric to review the Grading Criteria for the Assignment.
- Click the Week 9 Assignment 1 link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “WK9Assgn1+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
NURS 6512 Assessment of Cognition and the Neurologic System Grading Criteria
To access your rubric:
Week 9 Assignment 1 Rubric
Check Your Assignment Draft for Authenticity
To check your Assignment draft for authenticity:
Submit your Week 9 Assignment 1 draft and review the originality report.
Submit Your Assignment by Day 6 of Week 9
To participate in this Assignment:
Week 9 Assignment 1
Assignment 2: Lab Assignment: Practice Assessment: Neurological Examination
Short of opening a patient’s cranium or requesting a brain scan, what can an advanced practice nurse do to determine the cause of neurological symptoms? A multitude of techniques can be used to generate a neurological diagnosis.
In preparation for the Comprehensive (Head-to-Toe) Physical Assessment due this week, it is recommended that you practice performing a neurological examination.
Note: This is a practice physical assessment.
To Prepare
- Arrange an appropriate time and setting with a volunteer “patient” to perform a neurological examination.
- Download and review the Neurological Checklist provided in this week’s Learning Resources as well as review Seidel’s Guide to Physical Examination online media.
The Lab Assignment
Complete the following in Shadow Health:
- Neu