Discussion: NURS 6512 Assessing Neurological Symptoms
Walden University Discussion: NURS 6512 Assessing Neurological Symptoms-Step-By-Step Guide
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How to Research and Prepare for Discussion: NURS 6512 Assessing Neurological Symptoms
Whether one passes or fails an academic assignment such as the Walden University Discussion: 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 Discussion: NURS 6512 Assessing Neurological Symptoms
The introduction for the Walden University Discussion: 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 Discussion: NURS 6512 Assessing Neurological Symptoms
After the introduction, move into the main part of the Discussion: 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 Discussion: 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 Discussion: 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 Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.
Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting 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.
Case 1: Headaches
A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.
Case 2: Numbness and Pain
A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.
Case 3: Drooping of Face
A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.
To prepare:
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.
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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.
Note: Before you submit your initial post, replace the subject line (“Discussion – Week 9”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.
By Day 3
Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in 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.
Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
Sample Answer for Discussion NURS 6512 Assessing Neurological Symptoms
Patient Information:
A.Y, 20 year-old African American male
S.
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.
O.
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).
A.
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.
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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 Discussion NURS 6512 Assessing Neurological Symptoms
Patient Information:
Initials: N.T, Age: 46 years, Sex: Female, Race: White
S.
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
O.
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 Discussion NURS 6512 Assessing Neurological Symptoms
Patient Information:
Initials: JH Age: 33 years old Sex: Female Race: Hispanic
S.
CC: “The right side of my face has been dropping since morning.”
HPI: JH is a 33-year-old Hispanic female who came to the hospital complaining of her right face ‘drooping.’ She claims that the feeling started in the morning on the same day that she came to the hospital. She also complains of excessive tearing and drooling on the whole of her right side. She is however in no pain.
Location: right side of the face
Onset: in the morning
Character: drooping face
Associated signs and symptoms: excessive tearing and drooling on her right side
Timing: In the morning
Exacerbating/ relieving factors: none has been mentioned
Severity: not specified
Current Medications: None
Allergies: No known allergies to drugs, food or any environmental factor.
PMHx: No history given. No surgical history.
Soc Hx: Occupational and major hobbies in addition to family status has not been provided.
Fam Hx: Family history has not been provided.
ROS:
GENERAL: Denies weight loss, chills, fever, fatigue or general weakness.
HEENT: Eyes: Confirms excessive tearing. Denies visual loss, double vision, blurred vision, or yellow sclerae. Ears, Nose, Throat: Denies, hearing loss, congestion, sneezing, sore throat or runny nose.
SKIN: Denies itching or skin rash
CARDIOVASCULAR: Denies chest pain, chest discomfort or chest pressure. No edema or palpitations.
RESPIRATORY: Denies breathing problems, shortness of breath, sputum or cough. No shortness of breath, cough or sputum.
GASTROINTESTINAL: Denies nausea or vomiting, diarrhea or anorexia. Denies abdominal pain or bleeding.
GENITOURINARY: Denies burning on urination, painful urination or excessive urine frequency.
NEUROLOGICAL: Confirms drooping of the right side of the face. Confirms drooling on her right side. Denies headache, syncope, dizziness, ataxia, paralysis. Denies any change in bladder or bowel control.
MUSCULOSKELETAL: Denies muscle or joint pain or stiffness.
HEMATOLOGIC: Denies bleeding, bruises or history of anemia.
LYMPHATICS: Denies enlarged lymph nodes or any history of organomegaly.
PSYCHIATRIC: Denies any history of anxiety, depression or mania.
ENDOCRINOLOGIC: Denies excessive sweating, excessive cold or heat intolerance. Denies polydipsia or polyuria.
ALLERGIES: Denies any history of asthma attacks, eczema, hives, rhinitis or any allergic reactions.
O.
Physical exam:
GENERAL: The patient is fatigued with general body weakness. Fever & chills are also present. No weight gain or weight loss.
HEAD: Her head is normocephalic and atraumatic with no injury
EENT: Eyes: white sclera, pinkish conjunctiva, no jaundice or pallor. Presence of excessive tearing in the right eye, no movement on the eyebrows, eyelid opening is normal; lower lid is sagging. Ears, Nose, Throat: No hearing problems, sneezing, running nose, sore throat or congestion. The nasolabial fold is absent on the right side. Presence of drooling on her right side, no movement of lips and mouth slightly open on the left side.
SKIN: Normal warm skin with no lesions, itching or dryness.
CARDIOVASCULAR: No murmurs. Heart rhythm and heart rate is normal, with good S1 &S2 sound and no S3 & S4. No signs of peripheral edema.
RESPIRATORY: No breathing problems, respiration is even and unlabored. No cough, sputum or shortness of breath.
GASTROINTESTINAL: soft abdomen with no tenderness on palpation. Presence of bowel sounds in all of the four quadrants.
NEUROLOGICAL: Paralysis of the right facial nerve.
MUSCULOSKELETAL: ROM, no joint pain, back pain or stiffness.
LYMPHATICS: No signs of enlarged lymph nodes.
Diagnostic results: unilateral, single episodes that involve all the nerve branches is an indication of Bell’s palsy. Consequently, studies show that unequal distribution of weakness on different zones of the face on physical examination suggests Bell’s palsy (Eviston et al., 2015). This condition occurs at any age above two years, but most commonly experienced by individuals between the age of 15 to 45 years. It is also important to check for the presence or absence of other associated symptoms such as dry eyes, synkinesis, and pain to be able to rule out other differential diagnoses. From the physical examination, the patient is suspected of having an acute unilateral facial palsy which is a significant indication of Bell’s palsy. Other imaging tests such as needle electromyography (EMG), CT scan, and MRI are necessary for ruling out other conditions with the same symptoms (Wiggins, & Ashok, 2015). Serological test for Borrelia Burgdorferi should also be requested, such that a negative result will indicate bell’s palsy as a possible diagnosis.
A.
Differential Diagnoses:
- Bell’s Palsy: Bell’s palsy is a neurological condition characterized by an acute unilateral palsy of the peripheral facial nerve. The diagnosis of this condition is normally confirmed in patients of whom medical history and physical examination are unremarkable, including deficits that affect all the zones of the face equally, and fully resolve within three days. Bell’s palsy leads to a sudden weakness of the facial muscles temporarily, which makes one side of the face to droop (Eviston et al., 2015). The patient in the assigned case scenario is positive for most of the indicating signs and symptoms of Bell’s palsy making this condition the most appropriate diagnosis.
- Lyme disease: This is a bacterial infection that is transmitted by a vector, infected black-legged tick which is commonly referred to as the deer tick. Prolonged infection causes injury to the neurological system that may present as paralysis on one side of the face, weakness in both limbs, numbness, and impaired movement of muscles (Wormser et al., 2015).
- Facial nerve schwannoma: This is a type of a primary benign intracranial tumor of the vestibular nerve of the myelin-forming calls. The main sign and symptoms of this condition is the slow progression of facial nerve paralysis which causes drooping of the face, which the patient in this case study is positive for (Slattery, 2014). Additional symptoms include hearing loss, vestibular symptoms, pain, and tinnitus.
- Idiopathic orofacial granulomatosis (Melkersson-Rosenthal syndrome): This condition is characterized by insidious and slowly progressive paralysis of the facial nerve. The parotid mass is usually palpable upon physical examination (Miest et al., 2017).
- Cerebrovascular accident (CVA): This condition is commonly known as stroke, and it is caused by blockage or rupture of blood vessels supplying blood to the brain. It is characterized by numbness and paralysis in the face which the patients positive for, among other symptoms (Karliński, Gluszkiewicz, & Członkowska, 2015). These symptoms include difficulty in walking, loss of balance and coordination, dizziness, blurred or darkened vision, a sudden headache that is accompanied by nausea and vomiting and difficulty in speaking.
References
Eviston, T. J., Krishnan, A. V., Croxson, G. R., Kennedy, P. G. E., & Hadlock, T. (December 01, 2015). Bell’s palsy: Aetiology, clinical features, and multidisciplinary care. Journal of Neurology, Neurosurgery, and Psychiatry, 86(12), 1356-1361.
In Slattery, W. H. (2014). The facial nerve. New York, NY: Thieme.
In Wiggins, R. H., & In Ashok, S. (2015). Head and neck imaging. Philadelphia, PA: Elsevier.
Karliński, M., Gluszkiewicz, M., & Członkowska, A. (January 01, 2015). The accuracy of prehospital diagnosis of acute cerebrovascular accidents: an observational study. Archives of Medical Science, 11(3), 530-535.
Miest, R. Y., Bruce, A. J., Comfere, N. I., Hadjicharalambous, E., Endly, D., Lohse, C. M., & Rogers, R. S. (January 01, 2017). A Diagnostic Approach to Recurrent Orofacial Swelling: A Retrospective Study of 104 Patients. Mayo Clinic Proceedings, 92(7), 1053-1060.
Wormser, G. P., Weitzner, E., McKenna, D., Nadelman, R. B., Scavarda, C., & Nowakowski, J. (January 01, 2015). Long-term assessment of fatigue in patients with culture-confirmed Lyme disease. The American Journal of Medicine, 128(2), 181-4.