solved

Question
Answered step-by-step
Asked by SargentKouprey9452

Frances Funstead, a 55-year-old Caucasian woman, presents to the occupational health nurse asking for help with her back pain. She works on an assembly line and believes her back pain may be related to her job.

Biographic Data: Ms. Funstead, 55-year-old Caucasian woman. Alert and oriented. Asks and answers questions appropriately.

Reason for Seeking Health Care: “I have pain and stiffness in my lower back.”

History of Present Health Concern: The client reports that 2 weeks ago she developed low back pain and stiffness that has increased over the past 2-3 days. She describes the pain as dull and achy. Ms. Funstead states that the pain is worse in the morning and with certain movements such as getting in and out of the car, bending over, and changing positions suddenly. She has also noted that the pain increases after standing for long periods of time. Despite taking ibuprofen and resting, the pain continues. Client rates pain as 7 on scale of 0-10 prior to taking ibuprofen. An hour after taking ibuprofen, rates pain as 3-4 on scale of 0-10. Ibuprofen, resting, and stretching alleviate the pain somewhat; however, the pain never goes away. Client denies paresthesia and bowel/bladder incontinence.

Personal History: Ms. Funstead denies any recent weight gain. She denies any past problems with joints, muscles, or bones. She reports that her immunizations are up to date. Denies diabetes, sickle cell anemia, SLE, or osteoporosis. Ms. Funstead reports that she is postmenopausal and not taking any estrogen replacement therapy.

Family History: Ms. Funstead denies family history of rheumatoid arthritis, gout, or osteoporosis.

Lifestyle and Health Practices: Ms. Funstead reports that she tries to walk 30 minutes three times weekly and is usually successful. Client denies issues with weight gain or loss but does feel as if she needs to lose weight. Ms. Funstead’s medications include: Calcium with vitamin D supplement two times daily, ibuprofen 400 mg every 8 hours as needed.

Client denies use of tobacco or alcohol. She admits to drinking 3-4 cups of coffee each morning and 32 oz of diet cola throughout the day. Her 24-hour diet recall includes: Breakfast-cereal bar and coffee; lunch—low-calorie frozen meal, yogurt, apple, diet cola; dinner—chicken noodle soup, salad, fruit smoothie, 8-oz glass of 2% milk. Activities in a typical day include: Awakens at 5:30 AM and gets ready for work. Works from 7 AM to 3 PM. Walks after work with friends. Goes homes, prepares dinner, does household chores, watches TV; in bed by 10:30 PM.

Ms. Funstead works at a local factory on an assembly line. She picks up small parts and places them in a motor. She twists from side to side throughout the workday. She has one 15-minute break in the morning, 30 minutes for lunch, and one 15-minute break in the afternoon. She stands while at work and is required to wear steel-toed shoes. She denies difficulty performing ADLs. She does not require the use of assistive devices for mobility. Client denies any change in body image or self-esteem.

Physical Examination Findings

Inspection: Posture erect. Movement is coordinated and rhythmic. Arms swing in opposition. Able to stand on heels and toes. Cervical and lumbar spines are concave. Thoracic spine is convex.

Palpation: Cervical, thoracic, and lumbar spinous processes nontender. Lumbar paravertebral muscles are firm, taut, and tender bilaterally.

Lumbar spine: Flexion is decreased at 60 degrees; lateral bending is decreased at 25 degrees and guarded bilaterally; hyperextension is normal at 30 degrees; rotation decreased at 20 degrees bilaterally and elicits discomfort. Lasègue test (straight leg test) is negative. Leg length is equal.

 

 Step 1 – Describe the patient’s detailed Focused Physical Assessment of the Musculoskeletal system.

Inspection

Palpation

ROM

Muscle Testing

Step 2 – What worries you? What data is relevant and what is its clinical significance?

Step 3 – Are all the facts gathered?  What other information or questions might the nurse need to gather/ consider as you prepare for this client?

Step 4 -What is the priority problem/nursing diagnosis?

Step 5 – What is the pathophysiology of the problem?

Step 6 – Consider developmental, cultural, and nutritional considerations and risk factors when completing health history and physical assessment on the musculoskeletal  system.

 Step 7 -Provide patient teaching as regards to the musculoskeletal system 

SCIENCE
HEALTH SCIENCE
NURSING
NR 304

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."