Response: Comprehensive Patient Assessment

Response to Beatrice

Hello, Beatrice.

Thank you for a comprehensive patient assessment with a concise discussion of the HPI, social and medical histories, physical exam, and assessment. Knee pain among teens is uncommon and can occur for different reasons, including overuse, injuries to the knee, or medical issues like the Osgood-Schlatter disease, osteochondritis, and juvenile arthritis (American Academy of Orthopedic Surgeons, 2019). The client assessed has no history of injury, but the knee pain has been worsening with a nagging soreness and a clicking and catching under the patella. The pain is in both needs and reduces or flattens when the client is resting. I agree that the patient has musculoskeletal pain. I do not agree with the primary diagnosis or a differential of migraine headache and sinusitis because there is not adequate subjective or objective data to back them. The patient complains of knee pain and no headache. When assessing HEENT, the patient denied headache, and when assessing respiratory function, the patient did not indicate any symptoms of chest pain or cough. I am confused with the differential diagnosis because it does not match the description or symptoms in the subjective and objective data. However, Osgood-Schlatter disease is a possibility because it is marked by pain about an inch below the kneecap (Smith & Varacallo, 2019). It occurs primarily due to overuse of the muscles of the thigh.

References

American Academy of Orthopedic Surgeons. (2019, January). Adolescent Anterior Knee Pain. https://orthoinfo.aaos.org/en/diseases–conditions/adolescent-anterior-knee-pain/

Smith, J. M., & Varacallo, M. (2019). Osgood Schlatter’s disease (tibial tubercle apophysitis). StatPearls. Treasure Island (FL.

(Response: Comprehensive Patient Assessment)

Response to Kim

Hello Kim.

Thank you for an informative and elaborative clinical assessment involving musculoskeletal issues. Back pain is common among middle-aged individuals, particularly lower back pain, due to multiple reasons like physical capabilities, maintaining a high degree of activity, and changes in the lumbar spine and tissues surrounding it, which is age-related. The 7/10 pain rating is significant and can impact the client’s ability to perform activities of daily living, sleep properly, or walk around with ease. During the assessment, you failed to provide subjective data on musculoskeletal functioning. I agree with your primary diagnosis of Sciatica, which refers to the pain that travels along the path of the sciatic nerve, which is from the lower back via the hips and buttocks and down each leg (Davis et al., 2022). The disease occurs mostly due to an overgrowth of a bone or herniated disk that exerts pressure on the part of the nerve. Establishing sciatica as the primary diagnosis requires a thorough differential list because several diseases present with almost similar symptoms, including herniated lumbosacral disc, Cauda Equina syndrome and muscle spasms. You have a good list of differential diagnoses. However, based on the fact that the patient reported significant pain and you did not observe stiffness around the lower back and hips, I would disagree with listing spondylosis disease as differential (McDonald et al., 2022). Patients with spondylosis report duller pain and stiffness around the back and hips.

References

Davis, D., Maini, K., & Vasudevan, A. (2022). Sciatica. StatPearls. Treasure Island (FL.

McDonald, B. T., Hanna, A., & Lucas, J. A. (2022). Spondylolysis. StatPearls. Treasure Island (FL.

Response: Comprehensive Patient Assessment