Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation.
Discussion 1
Discussion Question 1
Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.
The interview process with this patient was pretty straight forward, however, I did miss a few of the expert interview questions. One of the questions was, “Do you have new headaches that you have not experienced previously?” This patient has already stated that she had similar headaches like these in the past, and I feel this question was repetitive in nature. The severity, location, and intensity of the patient’s headaches should be noted. Changes in the patient’s complaints can indicate a new problem or cause of the patient’s pain (Goolsby & Grubbs, 2015).
Secondly, I failed to ask, “Does the pain change with your period?” Once again the patient denies menstrual irregularities, so I didn’t continue to probe into her history. Hormonal variations in a premenopausal woman can cause symptoms such as headaches, fatigue, and many other physiological changes (Goolsby & Grubbs, 2015)
Discussion Question 2
Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings in correct assessment of this client.
During my physical exam of this patient I failed to assess her musculoskeletal strength and her ROM. These exams could provide information related to patient’s headaches, such as muscle spasm/strain, impingement of nerves, or other abnormalities that could be resulting in tension that is causing the patient to have headache pain (Goolsby & Grubbs, 2015).
Discussion Question 3
Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.
Patient is complaining of visual disturbances with headaches, when a patient complains of impairments of vision. The next step is assessing patient’s visual acuity. The Snellen eye chart would be the next step in assessing the patient’s actual vision (Goolsby & Grubbs, 2015). The patient’s pupillary response and accommodation to light is a common expansion of the visual exam to make sure the patient’s neurological function isn’t impaired preventing them from seeing appropriately.
Discussion Question 4
Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnosis for this client.
One finding I failed to document was the person’s family history of headaches. The patient reported that her Mother also had debilitating headaches, that caused her to have to seclude herself and sleep to eliminate the headache symptoms. Family history interviews are important, as patients tend to have hereditary traits that make them more predisposed to certain illnesses (Bickley, 2016).
Discussion Question 5
Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from your text to support the inclusion of the diagnosis for this client.
In diagnosing the patient, and creating a list of differential diagnosis, I did not include cluster headaches. Cluster headaches are usually unilateral headaches that are localized, and typically last up to 3 hours (Leone, Giustiniani, & Cecchini, 2017). The patient stated hers last upwards of 15 hours at time, which caused me to omit this diagnosis. The varying lengths of time she has experienced these headaches could call for inclusion of cluster headaches in her diagnosis.
Discussion 2
Discussion Question 1
Based on your performance and the expert feedback in your HISTORY collection, describe two missed questions and your understanding of why they were important to collect for this case history. Use specific references from your text to explain.
My first missed question is ‘Do you have any tingling or numbness anywhere?’. Some of the patient’s symptoms are psychological and psychiatric conditions, this tension could cause temporary weakness in the body.
My second missed question is ‘Do you drink caffeinated beverages or eat chocolate?’. Her social history of intake of caffeinated beverages and processed food are determining factor in diagnosing neurological disorders.
Discussion Question 2
Based on your performance and the expert feedback in your PHYSICAL EXAM collection, describe two errors in your exam performance or documentation. Use specific references from your text to explain the importance of these findings incorrect assessment of this client.
My first error was I did not auscultate all required respiratory location. It is important to auscultate correctly so to differentiate between the sounds and help to identify a problem if any
My second error was I did not auscultate the anterior in the correct order. It is important to distinguish normal respiratory sounds from abnormal ones.
Discussion Question 3
Based on your performance on the PHYSICAL EXAM collection, describe one key finding that you included in your list and describe a specific physical exam that you can perform at the point-of-care to further evaluate the finding. Use specific references from your text.
Photophobia is one of the auras preceded by headaches and it is also one of the symptoms of migraine. I would not perform any further physical exam, but I educate the patient regarding migraine trigger awareness and minimization.
Discussion Question 4
Based on your performance and the expert feedback in your ASSESSMENT identification of problem categories, choose one missed/incorrect category and use specific references from your text to explain the importance of this category in arriving at correct differential diagnoses for this client.
I missed the psychologic category. The patient’s multiple lifestyle stressor (her grad school and work) could evoke psychological distress to a degree thus giving her migraine.
Discussion Question 5
Based on your performance and the expert feedback in your ASSESSMENT of differential diagnoses, describe one incorrect/missed differential diagnosis and use specific references from I did not miss any differential diagnosis.
All of the patient’s symptoms ranging from headaches with increasing frequency, disabling headache which lasts up to 15 hours, triggered by junk food, preceded by aura all suggest complex neurogenic factors (migraine and cluster), psychological and musculoskeletal disorders.
