Normal and Abnormal Findings of Physical Exam Discussion

Case Study 1

How does the nurse practitioner interpret limited circumduction in the left arm?

Limited circumduction can be defined as the decreased range of motion with which the arm can move in circular motions. In this case, the arm loses its mobility and flexibility, and underlying causes could be arthritis or muscle tightness. In most cases, limited circumduction is often a sign of weakened muscles or shoulders. The nurse practitioner can interpret limited circumduction by determining how much the left arm can move from all angles. This includes trying to move the arm up and down or even towards the front of the body, as this could create insight for the nurse practitioner on the limitation of the arm. Normal and Abnormal Findings of Physical Exam Discussion

When the patient arrives, the nurse practitioner correlates the kyphosis with what physical finding? What causes kyphosis in older adults?

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Significant kyphosis in the patient is directly correlated with the physical finding of decreased height and shrinking. Kyphosis called the rounded back, occurs among older adults for several reasons. Osteoporosis, a disorder where the bone mass decreases and a person’s overall bone structure weakens, contributes to this problem. People’s bones become brittle with age, which causes the spine to curve (Ishihara et al., 2020). Improper sitting and standing posture, stiffness of the joints, and bone fragility are other risk factors for this illness, in addition to osteoporosis.

What is the rationale for ordering bone d in this patient?

The rationale for ordering bone d in this patient is to determine whether the patient could have osteoporosis. By ordering the test, the nurse practitioner can determine how much a patient can get fractures (Crandall et al., 2020). This is, therefore, a tremendous proactive measure that allows for early interventions to be taken, ultimately slowing down the progression of osteoporosis. The bone d test determines mineral levels, including calcium, reflecting the patient’s bone health. Normal and Abnormal Findings of Physical Exam Discussion

Case 2: Focused Skin Assessment

After the preparation stage, which involves cleaning, sanitizing my hands, and putting on gloves, I will proceed with introductions and give the patient a brief overview of the examination. Noting that the patient has already undergone subjective assessment, I will proceed with the objective assessment, which will involve inspection, auscultation, and palpation. While auscultation is not necessary for skin assessment (Ernstmeyer & Christman, 2021), it is vital because the patient suspects having flu.

Inspection

First, a general assessment of the patient will involve looking for signs of distress, including fatigue or fever. The next step will be to inspect the patient’s rash, taking note of the size, color, location, or the presence of lesions. Additionally, I will observe the rush at this stage for any signs of scaling, discharge, crusting, or blistering. It is crucial to check for any signs of redness as well.

Palpation

Skin palpation involves assessing the affected area’s temperature, skin texture, and moisture by gently palpating the affected area while wearing gloves (Karlsson et al., 2020). Assessment of tenderness, itching, and pain in the affected area is also conducted in this step. Since the patient has complained of joint pain, palpation of the joints will be used to assess signs of inflammation or joint damage. Finally, I will assess the patient’s masses on the affected area during palpation. Normal and Abnormal Findings of Physical Exam Discussion

Auscultation

Using a stethoscope, I will assess the patient for any signs of respiratory distress, such as shortness of breath, wheezing, and coughing, to assess her flu symptoms.

Documentation

A 19-year-old female presents to the clinic for assessment of a skin rash that started three weeks ago. Spots, bumps, and blotches were observed on her skin. Shows other symptoms of viral infection, such as fatigue. After evaluation, she is prescribed antiviral medications.

Differential Diagnosis

Possible conditions in the patient’s differential diagnosis include osteoporosis with

• Osteoporosis with vertebral compression fractures

Osteoporosis, common in older adults, may explain kyphosis and shrinking, causing vertebral compression fractures and limited arm motion.

• Rotator cuff tear

A rotator cuff tear could cause left shoulder pain and muscle weakness but may not fully explain kyphosis. Normal and Abnormal Findings of Physical Exam Discussion

• Cervical spondylosis with nerve impingement

Cervical spondylosis might result in nerve impingement and limited arm movement but doesn’t entirely match the symptoms.

Based on the provided information, Osteoporosis and rotator cuff tear are the most likely diagnoses. The patient’s symptoms, including kyphosis, shrinking, left shoulder pain, limited arm motion, and muscle weakness, align with osteoporosis causing vertebral compression fractures and a rotator cuff tear (Hong et al., 2022). These conditions explain the observed clinical findings and are the most likely diagnoses.

References

Crandall, C. J., Larson, J., Wright, N. C., Laddu, D., Stefanick, M. L., Kaunitz, A. M., … & Ensrud, K. E. (2020). Serial bone density measurement and incident fracture risk discrimination in postmenopausal women. JAMA internal medicine, 180(9), 1232-1240. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2768888

Ernstmeyer, K., & Christman, E. (2021). Integumentary Assessment. In Nursing Skills [Internet]. Chippewa Valley Technical College. https://wtcs.pressbooks.pub/nursingskills/chapter/14-4-integumentary-assessment/#:~:text=Palpation%20of%20the%20skin%20includes,blanching%20(whitening%20with%20pressure).

Hong, J. P., Huang, S. W., Lee, C. H., Chen, H. C., Charoenpong, P., & Lin, H. W. (2022). Osteoporosis increases the risk of rotator cuff tears: a population-based cohort study. Journal of Bone and Mineral Metabolism, 40(2), 348-356.

Ishihara, Y., Morishita, M., Kanzaki, K., & Toyone, T. (2020). Age-related progression of degenerative lumbar kyphoscoliosis: a retrospective study. Spine Surgery and Related Research, 4(3), 229-236. Doi: 10.22603/ssrr.2019-0113 Normal and Abnormal Findings of Physical Exam Discussion

Karlsson, K., Nilsson-Wikmar, L., Brogårdh, C., & Johansson, K. (2020). Palpation of increased skin and subcutaneous thickness, tissue dielectric constant, and water displacement method for diagnosis of early mild arm lymphedema. Lymphatic Research and Biology, 18(3), 219-225. 

Assignment Instructions
Review the two case studies below.
Answer the questions for each case.
Remember to support your work with references and APA format Normal and Abnormal Findings of Physical Exam Discussion

Case Study 1:

The nurse practitoner in the outpatient orthopedic clinic is reviewing the medical records of several patients being seen in the clinic today. A 67-year-old, moderately obese woman examined today for increasing back and left shoulder pain. Limited circumduction of left arm noted in comparison with right arm. Strength of left arm is less than right, with less muscle definition in the left arm. Examination of back indicates significant kyphosis, and the patient states that she is ‘shrinking.’ A bone density test was ordered.,

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How does the nurse practioner interpret “limited circumduction” in the left arm?
When the patient arrives, the nurse practitioner correlates the “kyphosis” with what physical finding? What causes kyphosis in the older adult?
What is the rationale for ordering bone d in this patient
Case Study 2: Normal and Abnormal Findings of Physical Exam Discussion

A 19 yr. female patient presents to your student health clinic complaining of a rash and says that she thinks she has the “flu or something.” She returned 3 weeks ago from a spring break trip to the beach. The rash started out “like acne,” located on her face, back, and chest. She now thinks she must have caught something during her trip, as she has developed joint pain in addition to the rash. The pain is most notable in her hands, although she has some stiffness and pain in both of her wrists, ankles, and knees. She describes the rash as generalized all over her arms and abdominal area. solid raised area with distict borders. She denies any vesicles or weeping to rash. She notes that warm baths make her feel better.

Perform and document a focused skin assessment on this patient Do not forget that your exam has to be done in a systematic way. Think Inspection, Palpation, Percussion, and Auscultation – (if indicated).
What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)? Normal and Abnormal Findings of Physical Exam Discussion