Assignment: NURS 6512 Assessing Neurological Symptoms

Walden University Assignment: NURS 6512 Assessing Neurological Symptoms-Step-By-Step Guide

This guide will demonstrate how to complete the Walden University Assignment: NURS 6512 Assessing Neurological Symptoms assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for Assignment: NURS 6512 Assessing Neurological Symptoms

Whether one passes or fails an academic assignment such as the Walden University Assignment: NURS 6512 Assessing Neurological Symptoms depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for Assignment: NURS 6512 Assessing Neurological Symptoms

The introduction for the Walden University Assignment: NURS 6512 Assessing Neurological Symptoms is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for Assignment: NURS 6512 Assessing Neurological Symptoms

After the introduction, move into the main part of the Assignment: NURS 6512 Assessing Neurological Symptoms assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for Assignment: NURS 6512 Assessing Neurological Symptoms

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for Assignment: NURS 6512 Assessing Neurological Symptoms

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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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.

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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.

Sample Answer for Assignment NURS 6512 Assessing Neurological Symptoms

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.

Patient Information:

A.Y, 20 year-old African American male

CC “I have been experiencing intermittent headaches that diffuse all over the head with greatest intensity and pressure above the eyes.”

HPI: The patient came with complaints of intermittent headaches for the last one week. The headaches diffuse all over the head with greatest intensity and pressure above the eyes and spreads through the nose, cheekbones, and jaw. The client reports that analgesics such as acetaminophen provide him with relieve that is not long lasting. The associated symptoms include nausea and photophobia. The severity of pain as reported by the patient was 8/10.

Current Medications: The patient has been using acetaminophen 1 gm TDS for the last four days.

Allergies: The client denied any food, drug, or environmental allergy.

PMHx: The client’s immunization history is up to date.

Soc Hx: The client is a college student undertaking a degree in information technology. He does not smoke or take alcohol. He engages in active physical activity, as he is a member of the university basketball team. His social support comprises of his family members and friends.

Fam Hx: The client denied any chronic illnesses in the family.

ROS:

GENERAL: The patient appeared well-groomed for the occasion without any signs of malaise or weight loss. He denied fever and chills.

HEENT: Eyes: The client denied visual loss, blurred vision, double vision or yellow sclerae. He reported photophobia during the episodes of intermittent headaches.

Ears, Nose, Throat: He denied hearing loss, sneezing, congestion, runny nose or sore throat.

SKIN: He denied rash, scars, or itching.

CARDIOVASCULAR: He denied chest pain, chest pressure, chest discomfort, palpitations or edema.

RESPIRATORY: He denied shortness of breath, difficulty in breathing, cough or sputum.

GASTROINTESTINAL: Denies anorexia, vomiting or diarrhea. He also denied abdominal pain or blood. He reported nausea during episodes of intermittent headaches.

GENITOURINARY: He denied burning on urination, increased urinary frequency, or changes in smell and color of urine.

NEUROLOGICAL: The patient reports intermittent headaches, denies syncope, dizziness, paralysis, numbness, and tingling of the extremities. He also denied changes in bladder and bwel control.

MUSCULOSKELETAL: The patient denied muscle, back pain, joint pain or stiffness.

HEMATOLOGIC: He denied anemia, bleeding or bruising.

LYMPHATICS: He denied enlarged nodes with absence of a history of splenectomy.

PSYCHIATRIC: He denied history of depression or anxiety.

ENDOCRINOLOGIC: He denied history of sweating, cold or heat intolerance. He also denied polyuria or polydipsia.

ALLERGIES: He denied history of asthma, hives, eczema or rhinitis.

Physical exam:

General: The patient appears well groomed, with lack of evidence of weight loss and fatigue

Vitals: Temp 36.7, BP 122/76 P-80, RR 20, SPO2 96,

Head: normocephalic, with no lesions, evidence of trauma, with symmetric facial features. The maxillary and frontal sinuses are tender on palpation.

Ears: The ears are symmetric with absence of ear drainage, loss of balance, and grey tympanic membranes

Eyes: the eyes are symmetric, without jaundice and bleeding. Normal visual acuity

Nose: Absence of nasal flaring, discharge, and septum deviation

Throat: Absence of tonsillitis

Neck: symmetric trachea noted with absence of neck rigidity, swelling, and gross abnormalities of the thyroid

Cardiovascular: presence of S1 and S2, with absence of peripheral edema and advantageous sounds

Gastrointestinal: Absence of abdominal swelling, scars, with normal bowel movements.

Respiratory: Lung sounds clear with absence of advantageous sounds

Neurological: Client is oriented to self, place, time, and events. Pupil reactive to light and equal in size with equal grip in both hands and symmetrical facial features. The self-reported headache is rated at 8/10. There is the presence of intermittent headache, photophobia, and nausea.

Diagnostic results: One of the recommended diagnostic investigations that should be performed for the client is nasal scrapping. Nasal scraping should be performed to obtain a sample for test for esinophils. Radiological investigations are also recommended in case of severe symptoms. The investigations include a head CT scan to detect any abnormalities such as tissue involvement, inflammation of the meninges, and tumors. A MRI may also be done to determine the presence of any abnormality in the brain tissue and soft tissue pathology. Bacterial sinusitis may also be diagnosed by performing sinus aspiration (Iskandar & Triayudi, 2020).

Differential Diagnoses

Sinusitis: The first differential diagnosis for the client in this case study is sinusitis. Sinusitis is a condition characterized by the inflammation of the nasal cavities. The symptoms often last for a period of less than a month. Patients with sinusitis experience symptoms that include frontal headaches with feelings of fullness. Patients also experience other accompanying symptoms that include nausea, vomiting, photophobia, and nasal drainage. The physical assessment findings may reveal tenderness of the sinuses (Iskandar & Triayudi, 2020). The patient in the case study has symptoms that align with this diagnosis, hence, it being the primary diagnosis.

Migraine headache: migraine headache is the secondary diagnosis for the patient in this case study. Patients with migraine headache experience severe, throbbing headache. The accompanying symptoms include photophobia, phonophobia, nausea, and vomiting (Ha & Gonzalez, 2019). This is however a least diagnosis because of the patient experiencing feelings of fullness and involvement of the sinuses.

Allergic rhinitis: The other possible diagnosis for the client is allergic rhinitis. Patients with allergic rhinitis experience symptoms that include headaches, nasal drainage, coughing, sneezing, and pressure on the cheeks and nose (Scadding et al., 2017). Allergic rhinitis is however the least likely diagnosis due to the absence of a history of allergic reaction by the client.

Facial pain syndrome: Facial pain syndrome is the other potential diagnosis for the client in the case study. Facial pain syndrome is attributed to pain affecting the trigeminal nerve. The symptoms associated with it include pain on touching the face, speaking, chewing or brushing teeth (Benoliel & Gaul, 2017). Facial pain syndrome is however the least likely diagnosis due to the absence of pain upon stimulation of the facial muscles.

Acute bacterial pharyngitis: Acute bacterial pharyngitis is the last potential diagnosis for the client. Acute bacterial pharyngitis is attributed to step bacterial infection. Patients experience symptoms that include difficulty in swallowing, headache, chills, and malaise. The patient however does not experience difficulty in swallowing, fever, and chills, hence, acute bacterial pharyngitis not being the primary differential (Harberger & Graber, 2021).

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

Benoliel, R., & Gaul, C. (2017). Persistent idiopathic facial pain. Cephalalgia, 37(7), 680–691. https://doi.org/10.1177/0333102417706349

Ha, H., & Gonzalez, A. (2019). Migraine Headache Prophylaxis. American Family Physician, 99(1), 17–24.

Harberger, S., & Graber, M. (2021). Bacterial Pharyngitis. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK559007/

Iskandar, A., & Triayudi, A. (2020). Early Diagnosis of Sinusitis Using Expert System Methods: Early Diagnosis of Sinusitis Using Expert System Methods. Jurnal Mantik, 4(2), 1231–1236. https://doi.org/10.35335/mantik.Vol4.2020.927.pp1231-1236

Scadding, G. K., Kariyawasam, H. H., Scadding, G., Mirakian, R., Buckley, R. J., Dixon, T., Durham, S. R., Farooque, S., Jones, N., Leech, S., Nasser, S. M., Powell, R., Roberts, G., Rotiroti, G., Simpson, A., Smith, H., & Clark, A. T. (2017). BSACI guideline for the diagnosis and management of allergic and non-allergic rhinitis (Revised Edition 2017; First edition 2007). Clinical & Experimental Allergy, 47(7), 856–889. https://doi.org/10.1111/cea.12953

Sample Answer 2 for Assignment NURS 6512 Assessing Neurological Symptoms

Patient Information:

Initials: N.T, Age: 46 years, Sex: Female, Race: White

CC ” I have pain in both ankles”

HPI: N.T. is a forty-six-year-old white female patient who reported to the facility for a check. She complains of pain in both her ankles, even though she expresses more concern with the right ankle. The patient was playing soccer during the weekend when she heard a pop sound, which led to uncomfortable pain. The patient also experienced swelling following the pop sound. Consequently she is also unable to bear her weight. The pain is throbbing and more concentrated on the right ankle. She also rates the pain while resting. The pain is also radiating up the right lower extremity.

Current Medications: The patient is not using any medication currently.

Allergies: There are no records of allergies to food, medication, or environment.

PMHx: The patient indicated that she took her full dose of COVID-19. All other immunizations and annual flu tests are up to date.

Soc Hx: The patient is currently a single parent with three children. She works in the hotel industry. She likes playing soccer, which she does mostly during weekends but also occasionally in the evenings. She denies the previous or current use of alcohol. She also denies smoking or use of other illegal drugs.

Fam Hx: The patient’s parents are still alive; the father is eighty years old, and the mother is seventy-seven years old. The father is living with diabetes and hypertension while the mother has been treated for depression before and is currently living with osteoporosis. She has one elder brother and a younger sister and both are fairly healthy with no major health concerns.

ROS:

GENERAL: No fatigue, weakness, chills, fever, and weight loss.

HEENT: The patient’s head is normal; No visual loss, blurred vision, or double vision. She also denies reduced hearing, sneezing, congestion, sore throat, or even runny nose.

SKIN: No signs of rash, itching, or bruising.

CARDIOVASCULAR: No chest discomfort, chest pain, or pressure. Denies palpitations or edema.

RESPIRATORY: The patient denies any shortness of breath, sputum, or cough.

GASTROINTESTINAL: The patient denies anorexia, nausea, vomiting, or abdominal pain.

GENITOURINARY: No burning or pain during urination. She denies pregnancy. NEUROLOGICAL: She denies headache, dizziness, paralysis, ataxia, or numbness.

MUSCULOSKELETAL: She reports bilateral ankle pain. The pain is more concentrated on the right ankle as compared to the left ankle. She also reports swelling in the right ankle and is unable to bear her weight.

HEMATOLOGIC: No anemia or bleeding.

LYMPHATICS: No history of splenectomy; denies enlarged nodes.

PSYCHIATRIC: No history of headache or mental illness.

ENDOCRINOLOGIC: No Polydipsia or polyuria.

ALLERGIES: No known allergies, either to food, medication, or environment

Physical exam:

Vital signs: BP: 116/75, Temp: 97.0, RR: 18, HR: 76, Height: 6.2, Weight: 141 lbs

General: The patient is well-dressed and groomed. She is alert and oriented. She appears concerned regarding her ankle pain which started after hearing a pop sound when playing soccer during the weekend.

HEENT: The head is atraumatic and Normocephalic. No ear pain or discharge. No loss of vision, no runny or stuffy nose. The patient’s neck is supple.

Skin: The skin is warm and dry, with no wounds and no skin rashes. Bruising was seen in the right lateral ankle.

Chest: The heartbeat and heart rate are both regular, with no gallops, murmurs, or extra sounds. No cough or dyspnea. The patient’s lungs are clear.

The musculoskeletal system: The patient’s right ankle has bruises, and the fibula’s lower aspects are tender upon palpation. Less motion range was observed in the ankles. The swelling was also observed. Pain experienced on the leg when bearing weight. The left ankle had no bruising, swelling, or tenderness.

Diagnostic results: The Ottawa Ankle rule is to be used to help determine if the patient needs an X-ray to confirm or rule out a fracture (Morais et al.,2021). Ultrasound can be conducted to assess the structure of the soft tissues such as ligaments and tendons.

Differential Diagnoses

An Ankle sprain: This is a condition which usually occurs when the ligaments supporting a person’s ankle are torn or stretched. In most cases, the foot can forcefully turn outward or inward. Ankle sprains are known to be common when individuals participate in activities such as soccer and go for a sudden directional change (Halabchi & Hassabi, 2020). The condition can have varied severity, usually from mild to severe. This condition may present with various symptoms, such as finding it difficult to walk, joint stiffness, soreness, bruising, swelling, and pain. The patient was playing soccer when she heard a pop sound, leading to pain and swelling in her right ankle. The patient showed several of these symptoms which makes an ankle sprain one of the diagnoses.
Achilles tendonitis: This is a condition that may present with pain and discomfort due to tendon injuries like a tear or inflammation. The condition is sometimes known as Achilles tendinitis. In most cases, the illness may come due to a repetitive strain or overuse of the Achilles tendon, which then makes a patient to experience swelling and pain. It can also result due to weak or tight calf muscles which is known to lead to higher strain on the Achilles tendon. Other causes include a sudden increase in physical activity which can be characterized by an increased frequency, duration or intensity of the physical exercise or activity that a person engages in. Some of the symptoms include pain in the back of a person’s leg, pain exacerbated with activity, a stiff Achilles tendon, and swelling (Touzell, 2020). In addition, a patient may experience a mild thickening of the tendon, tenderness and a significant reduced range or motion. The patient heard a pop sound when playing soccer, which makes this condition suspect.

Chronic Ankle Instability: This is a condition that may result from multiple cases of ankle sprains, which then makes the patient prone to injuries. This condition may present with various symptoms such as ankle instability, injuries, swelling, pain, and re-injuries for more than half a year (Herzog et al.,2019). The patient may also experience recurrent sprains, complications maintaining balance and feelings of giving away. The condition is also known to substantially impact a persons, stability, mobility and the overall quality of life. The patient reported some of these symptoms, which makes this condition to be a potential diagnosis. However, the patient has no history of incomplete healed ligaments, which again makes this condition less likely.

Ankle fracture: This is a condition that entails cracking or breaking of one or more of the bones which make up the ankle joint. It can occur in either the talus, fibula or tibia. Ankle fracture may happen when a person experiences events such as an awkward landing or forceful impact. The condition can also be caused by osteoporosis which causes the bones to weaken, hence exposing the person to the condition. Sudden rolling or twisting of the ankle with force can also lead to this condition. Consequently, a person may put stress on the ankle, leading to the condition. Some of the symptoms include complications bearing weight, bruising, and swelling (Briet et al.,2019). Other symptoms may also include misalignment or deformity of the ankle and pain. The patient presented with some of these symptoms, making this a potential diagnosis.
Muscle soreness: Muscle soreness can be experienced after an individual takes part in physical activity or exercise. The condition is sometimes known as a delayed onset of muscle soreness. The condition is in most cases experienced when an individual takes part in physical exercise or activity that entail the eccentric muscle contraction, or lengthening of the muscle under tension. In addition, it is known to typically begin twenty four hours to forty eight hours after an exercise can have its peak around seventy two hours. The patient may experience reduced flexibility and strength and pain or discomfort in the skeletal muscles (Heiss et al.,2019). Other symptoms may include muscle discomfort, tenderness and stiffness. An individual with the condition may also experience an exacerbation of the soreness when the affected muscles are stretched or moved. The patient experienced pain when playing soccer, which makes this a potential diagnosis.

References

Briet, J. P., Hietbrink, F., Smeeing, D. P., Dijkgraaf, M. G., Verleisdonk, E. J., & Houwert, R. M. (2019). Ankle fracture classification: an innovative system for describing ankle fractures. The Journal of Foot and Ankle Surgery, 58(3), 492-496. https://doi.org/10.1053/j.jfas.2018.09.028

Halabchi, F., & Hassabi, M. (2020). Acute ankle sprain in athletes: Clinical aspects and algorithmic approach. World Journal of Orthopedics, 11(12), 534. https://doi.org/10.5312%2Fwjo.v11.i12.534

Heiss, R., Lutter, C., Freiwald, J., Hoppe, M. W., Grim, C., Poettgen, K., … & Hotfiel, T. (2019). Advances in delayed-onset muscle soreness (DOMS)–part II: treatment and prevention. Sportverletzung· Sportschaden, 33(01), 21-29. DOI: 10.1055/a-0810-3516

Herzog, M. M., Kerr, Z. Y., Marshall, S. W., & Wikstrom, E. A. (2019). Epidemiology of ankle sprains and chronic ankle instability. Journal of Athletic Training, 54(6), 603-610. https://doi.org/10.4085/1062-6050-447-17

Morais, B., Branquinho, A., Barreira, M., Correia, J., Machado, M., Marques, N., … & Diogo, N. (2021). Validation of the Ottawa ankle rules: Strategies for increasing specificity. Injury, 52(4), 1017-1022. https://doi.org/10.1016/j.injury.2021.01.006

Touzell, A. (2020). The Achilles tendon: Management of acute and chronic conditions. Australian Journal of General Practice, 49(11), 715–719. Doi: 10.3316/INFORMIT.553809190362672.

Sample Answer 3 for Assignment NURS 6512 Assessing Neurological Symptoms

Patient Information:

Initials: P.L Age: 47 years Sex: Female Race: White

CC (chief complaint): “Numbness and pain.”

HPI: P.L is a 47-year-old White female who comes with complaints of numbness and pain.

Location: Right wrist

Onset: Two weeks ago

Character: Aching pain

Associated signs and symptoms: Tingling sensation and numbness in the thumb, index, and middle fingers.

Timing: When styling hair.

Exacerbating/ relieving factors: Pain aggravated by using the right hand and alleviated by rest.

Severity: 4/10

Current Medications: OTC Tylenol for wrist pain.

Allergies: None.

PMHx: No history of chronic illnesses or surgery. The vaccination schedule is up to date. Last TdAP- March 2016; Last Flu shot- June 2022.

Soc Hx: The client is married and has three children 21, 16, and 13 years. She has a certificate course in hairdressing and works as a hairstylist in her salon. She reports enjoying baking and styling people’s hair. She smokes 1PPD and drinks 3-4 beers on weekends but denies using other drug substances. The client reports sleeping 5-6 hours and rarely engages in physical exercises.

Fam Hx: No family history of chronic illnesses. Parents, siblings, and children are alive and well.

ROS:

GENERAL: Negative for weight changes, fever, or increased fatigue.

HEENT: Denies head trauma, visual changes, eye redness, ear discharge or pain, nasal discharge, sneezing, or difficulties in swallowing.

SKIN: Denies rashes, bruises, or lesions.

CARDIOVASCULAR: Denies palpitations, chest discomfort, edema, or SOB on exertion.

RESPIRATORY: Denies cough, breathing difficulties, or wheezing.

GASTROINTESTINAL: Denies abdominal/epigastric pain, bloating, bowel changes, or tarry stools.

GENITOURINARY: Denies dysuria or menstrual irregularities.

NEUROLOGICAL: Reports numbness and tingling sensation in the thumb, index, and middle fingers.

MUSCULOSKELETAL: Reports wrist pain. Denies back pain or joint pain/stiffness.

HEMATOLOGIC: Denies history of anemia or bruising.

LYMPHATICS: Denies enlarged lymph nodes.

PSYCHIATRIC: Denies a history of mood swings, psychotic symptoms, or anxiety.

ENDOCRINOLOGIC: Denies thinning hair, increased perspiration, or cold/heat intolerance.

ALLERGIES: Denies history of hives or eczema.

Physical exam:

Vital Signs: BP- 118/74; HR-80; RR-16; Temp-98.4 Wt-220 lbs; Ht-5’7; BMI- 34.5

General: Obese female patient in her 40’s. The patient is awake, alert, oriented, and in no distress. She is neat and dressed appropriately. She maintains eye contact, and her speech is clear.

Cardiovascular: RRR; S1 and S2 present; No edema, JVD, murmurs, or gallop sounds.

Respiratory: Regular chest expansion with smooth respirations. Lungs are clear on auscultation.

Musculoskeletal: ROM- 5/5; against both gravity and full manual resistance. Normal flexion, hyperextension, and rotation.

Neurological: Erect posture, symmetrical body movement, and smooth gait. Muscle strength- 5/5 and resists equally opposing forces. Phalen’s wrist test- Positive (paresthesia in the palmar side of the thumb, index and middle fingers, and half of the ring finger).

Diagnostic results: Awaiting results for X-ray of the Right Wrist and Fingers.

Differential Diagnoses

Carpal Tunnel Syndrome (CTS): CTS is a condition in which the median nerve in the wrist is compressed, causing pain and numbness. Clinical manifestations of CTS include pain in the hand and wrist accompanied by tingling and numbness. These symptoms are characteristically distributed along the median nerve but can involve the entire hand (Genova et al., 2020). The patient has symptoms consistent with CTS, including wrist pain, numbness and tingling in the thumb, index, and middle fingers, and a positive Phalen’s wrist test.

Peripheral Neuropathy: This is characterized by a loss of sensory or motor function of peripheral nerves in the hands, feet, and arms due to destruction. The typical symptoms include numbness and tingling in the hands or feet; burning, shooting, or stabbing pain in affected areas; loss of balance and coordination; muscle weakness, primarily in the feet (Castelli et al., 2020). The patient’s wrist pain, tingling, and numbness in the fingers make Peripheral neuropathy a differential diagnosis.

Osteoarthritis of the Hand: This presents with pain and stiffness of the proximal or distal interphalangeal joint and the base of the thumb. The wrist is normally spared except if there is preexisting trauma, and there is normally minimal or no metacarpophalangeal joint involvement except if a person has a metabolic disorder (Maffei, 2020). Hand osteoarthritis is a differential diagnosis based on the patient’s reports of pain in the right hand.

Fibromyalgia syndrome (FMS): FMS is a chronic pain syndrome but not an inflammatory disorder. It is characterized by pain, stiffness, and tenderness at specific sites, including the extremities. The pain is classically described as burning and gnawing. Some patients also report numbness or tingling in their extremities (Maffei, 2020). FMS is a differential diagnosis based on the patient’s report of wrist pain, numbness, and tingling in the fingers.

Compartment syndrome: This is a condition in which elevated tissue pressure in a confined anatomic space contributes to reduced blood flow to the area. The reduced circulation causes hypoxia and pain, as well as signs of impaired circulation like swelling, coolness, mottling, and discoloration (Osborn & Schmidt, 2020). Compartment syndrome is a differential based on the positive symptom of pain in the fingers and wrist.

This section is not required for the assignments in this course (NURS 6512) but will be required for future courses.

References

Castelli, G., Desai, K. M., & Cantone, R. E. (2020). Peripheral Neuropathy: Evaluation and Differential Diagnosis. American Family Physician, 102(12), 732–739.

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

Maffei, M. E. (2020). Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies. International Journal of Molecular Sciences, 21(21), 7877. https://doi.org/10.3390/ijms21217877

Osborn, C. P. M., & Schmidt, A. H. (2020). Management of acute compartment syndrome. JAAOS-Journal of the American Academy of Orthopaedic Surgeons, 28(3), e108-e114. doi: 10.5435/JAAOS-D-19-00270