Assignment: Assessing Neurological Symptoms
Assessing Neurological Symptoms: 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 SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Comprehensive SOAP Template in the Week 4 Learning Resources for guidance. Remember that not all comprehensive SOAP data are included in every patient case.
Assessing Neurological Symptoms 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.
Assessing Neurological Symptoms 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.
Assessing Neurological Symptoms 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.
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.
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 a description of the health history you would need to collect from the patient in the case study to which you were assigned. Explain what physical exams and diagnostic tests would be appropriate and how the results would be used to make a diagnosis. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.
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.
Submission and Grading Information
To access your rubric:
Week 9 Discussion Rubric
Post by Day 3 and Respond by Day 6
To participate in this Discussion:
Important information for writing discussion questions and participation
Please read through the following information on writing a Discussion question response and participation posts.
Contact me if you have any questions.
Important information on Writing a Discussion Question
- Your response needs to be a minimum of 150 words (not including your list of references)
- There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
- Include in-text citations in your response
- Do not include quotes—instead summarize and paraphrase the information
- Follow APA-7th edition
- Points will be deducted if the above is not followed
Participation –replies to your classmates or instructor
- A minimum of 6 responses per week, on at least 3 days of the week.
- Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
- Each response needs to be at least 75 words in length (does not include your list of references)
- Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
- Follow APA 7th edition
- Points will be deducted if the above is not followed
- Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
- Here are some helpful links
- Student paper example
- Citing Sources
- The Writing Center is a great resource
Welcome to class
Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to.
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I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Initials: GM Age: 33 y.o Sex: Female Race: African American
Chief complaint: She states, I have a drooping on the right side of my face
HPI: G.M is a 33-year-old African American woman who presents in the clinic complaining of a right-sided facial drooping. She states that she noted it after waking up in the morning. She further says that her right eye has been watering continuously, and she cannot stop drooling out of her mouths side right. She has no pain.
Current Medications: Multivitamin every day, Tylenol 325mg-2 PO every 4 hours as required, Ibuprofen 200mg-2 PO as required, Valtrex 500mg – PO 3 x every day
Past Medical History: Asthma when she was a child and genital herpes some years back.
Past Surgical History: Cholecystectomy in the year 2000 and extraction of wisdom teeth while young
Social History: She takes alcohol rarely; denies making illicit drug use or smoking.
Family History: She has one brother with hypertension and a daughter who is 13years old healthy and living at home
Immunizations History: Her vaccinations are up to date. She had a flu vaccine lastly on February and had tetanus shot the previous two years when she had injured her arm on a metal piece.
REVIEW OF SYSTEMS
General: Pleasant 33-year-old woman posing in a chair talking reasonably fast. She appears very worried and is anxious; she has had a stroke. She is a good historian.
HEENT: No variations in hearing or vision; she had an eye test previous two years. GL stated no glaucoma, floaters, diplopia, photophobia, or extreme tearing history. She never before had any current infections of the ear, release, or tinnitus from her ears. Intact smell sense. GL has had no epistaxis episodes. She has no nasal polyp’s history or current sinus infection. Her previous dental examination was three years. She denied lesions, ulceration, bleeding gums, gingivitis, and she has no dental applications. No trouble swallowing or eating.
Throat: No sneezing, loss of hearing, congestion, sore throat, or runny nose.
Skin: No itching or rash.
Cardiovascular: No chest distress, palpitations murmurs, no history of arrhythmias, paroxysmal nocturnal dyspnea, orthopnea, claudication, or edema history.
Respiratory: Denied hemoptysis and has no trouble breathing at rest.
Gastrointestinal: No nausea. No abdomen ache, no variations in the bowel pattern.
Genitourinary: No variation in her urinary form, incontinence, or dysuria. GL is heterosexual. She has consistent menses. Human Papilloma Virus is positive and is not sexually active presently.
Neurological: No episodes of syncopal or dizziness, headaches, and paresthesia. No variation in the original patterns; no abnormal movements or twitches; no gait disorder history or difficulties with coordination. No seizure or falls history.
Musculoskeletal: No myalgia or arthralgia, gout or restraint in her motion range by the report, no arthritis. No history of fractures or trauma.
Hematologic: No anemia, bleeding, or bruising.
Lymphatic: No itching or staining, rashes. G.I use lotion to avert dry skin. No skin cancer history or removal of the lesion. She has no blood loss conditions, clotting problems, or transfusions history.
Psychiatric: No depression or anxiety history. No delusions sleep disruption or a history of mental condition. Denied homicidal or suicidal history
Endocrine: No signs of endocrine or hormone therapies
Allergies: She has no recognized immune shortages. Had an HIV test lastly the previous two years
Vital signs: B/P: 120/80, RR 18, T 98.8 orally; Wt. 115, Ht: 5’2 and BMI 21
General: Nothing Abnormal Detected, appears to be contented
HEENT: EOMI, PERRLA, clear oronasopharynx; extreme tearing right eye; faces right side drooping as well as mild nasolabial fold destruction
Neck: No JVD or legally and bruit
Chest: CTA AP&L
Heart: RRR with no murmurs, gallop or rub; pulsations, two bilat pedal, and two radial
Abdomen: benign, no organomegaly; no suprapubic sensitivity; no reverberation
Genital/Rectal: Peripheral genitalia complete no cervical wave sensitivity, no adnexal crowds.
Musculoskeletal: Asymmetric muscle growth. All joints are ordinary.
Neuro: CN II – XII grossly complete, Deep Tendon Reflex perfect for paresis on the faces right side and for trouble making facial languages.
Skin/Lymph Nodes: No clubbing, edema, or cyanosis; no tangible nodes
History essential to obtain from the patient
If the patient has any pain, burning, loss of feeling anywhere in her body if she is having problems with her vision. History of her recent illness, history of stroke in her family, her past medical history, surgeries, and medications would be necessary as well.
Additional Physical Examinations:
Performing an original Cincinnati Stroke Scale and Glasgow Coma Scale to evaluate mentation and stroke possibility, thoroughly inspect her face, head, and neck, neurovascular valuation in all the 4 extremities, swallow assessment, and cost of her facial cranial nerve function through raising her eyebrows, squeezing her eyes shut, puff out her cheeks, smile and purse her lips and blow out. This will indicate more of Bell’s palsy.
Additional Diagnostic Testing
In an outpatient situation, I would reach out for 911 for transport to an emergency unit for further assessment, and insist on a head CT to rule out a severe stroke. I would then consider extra electrophysiological testing on a cranial facial nerve in case an acute stroke was ruled out to find if the facial nerve is the culprit.
- Priority Diagnosis: Facial Nerve Paralysis (Bell’s Palsy)-Classically presents as one-sided upper and lower facial paralysis with reduced eyelid cessation to the affected side and trouble tearing, sensory variations to the affected side occasionally noted, and flattened forehead with incapability of creating creases whenever raising eyebrows on affected side (Eviston, Croxson, Kennedy, Hadlock & Krishnan 2015).
- Stroke: Frequently present with the facial drooping, but affects one side of body Writing, (Mozaffarian, Benjamin, Go, Arnett, Blaha & Fullerton 2016). If a patient can raise their eyebrows usually and correspondingly, but the inferior part of their face remains paralyzed, the health care provider will need to rule out stroke
- Tetanus: Cephalic tetanus, although uncommon, generally occurs after an ear infection or trauma, and presents with cranial nerve palsy, which might be localized
- Mastoiditis: This is a bacterial infection of the temporal bone and presents with otalgia, otorrhea, tenderness, swelling like symptoms, and facial palsy is an intertemporal problem (Mather, Yates, Powell & Zammit-Maempel 2019).
- Lyme disease: A disease triggered by a bacteria that ticks may carry. Lyme disease causes Bell’s palsy since advanced signs of Lyme illness can affect the nervous system.
- Guillain-Barre Syndrome: Generally begins as weakness and paresthesias weakness and gradually ascending, the symptoms include facial droop, dysphagia, diplopia, dysarthria, and pupillary disorders (Willison, Jacobs & van Doorn 2016).
Eviston, T. J., Croxson, G. R., Kennedy, P. G., Hadlock, T., & Krishnan, A. V. (2015). Bell’s palsy: etiology, clinical features, and multidisciplinary care. J Neurol Neurosurg Psychiatry, 86(12), 1356-1361.
Mather, M. W., Yates, P. D., Powell, J., & Zammit-Maempel, I. (2019). Radiology of acute mastoiditis and its complications: a pictorial review and interpretation checklist. The Journal of Laryngology & Otology, 1-6.
Willison, H. J., Jacobs, B. C., & van Doorn, P. A. (2016). Guillain-barre syndrome. The Lancet, 388(10045), 717-727.
Writing, G. M., Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., … & Fullerton, H. J. (2016). Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation, 133(4), e38