NSG 6020 wk 5 discussion HISTORY collection Assessment
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.
In taking the history I did not ask about previous surgeries. I should have asked if the patient had a history of any surgeries including if they had a history of appendectomy, or cholecystectomy previously. This might help to eliminate potential causes and differential diagnoses that would be moot. Another thing I missed was whether the patient had had any recent travel out of the country. While this question is not as important, different countries could bring some unusual differential diagnoses into consideration depending on the location of travel. According to Bates, taking a complete history is important to consider all possible differential diagnoses (Bickley, 2017). NSG 6020 wk 5 discussion HISTORY collection Assessment.
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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.
When assessing this client, I did not perform a urine analysis. This would be needed to give a complete picture of how the renal system is working and rule out problems that may cause abdominal pain (Bickley, 2017). I also did not palpate and perform the needed exams to rule out or confirm appendicitis as the text mentions. There are several positions and muscle stretches that can be performed that may eliminate or highlight pain if peritoneal inflammation is present. These pieces of the physical exam can and should be evaluated when appendicitis or cholecystitis is suspected (Bickley, 2017). NSG 6020 wk 5 discussion HISTORY collection Assessment.
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.
According to Goolsby, there are several exams that you can perform point of care to identify appendicitis. These include Rovsing’s sign and a CT scan. While I would choose the CT scan to visualize the area and confirm the diagnosis, this cannot always be done point of care. Rovsing’s sign can be. Simply position the patient on his/her back, press deeply on the RLQ of the patient and evaluate for referred pain in the LLQ upon quick release (Goolsby, 2015) NSG 6020 wk 5 discussion HISTORY collection Assessment.
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.
During my assessment of the patient I missed the positive Psoas sign. I palpated the abdomen however I did not maneuver the patient to elicit this or any other sign definitive for appendicitis. According to Goolsby, there are several signs that can be used for identification of appendicitis or peritoneal inflammation. Some examples include Rovsing’s sign, Psoas sign, Murphy’s sign, Heel strike, or Obturator’s sign (Goolsby, 2015). Goolsby describes several ways to induce symptoms if a patient has appendicitis.
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. NSG 6020 wk 5 discussion HISTORY collection Assessment.
One diagnosis I missed was that of pancreatitis. I considered Peptic ulcer disease as well as small bowel obstruction, however because of the specific location of the pain I did not consider it. I think the absence of nausea, vomiting or diarrhea was very unusual given the complaint of gastrointestinal pain. While pancreatitis can cause significant pain, I was unaware that according to our textbook, rebound tenderness is often common in the epigastric area with acute pancreatitis (Bickley, 2017).
References
Bickley, L. S., & Szilagyi, P. G. (2017). Bates’ guide to physical examination and history taking (12th ed.). Philadelphia, PA: Wolters Kluwer/Lippincott, Williams and Wilkins
Goolsby, M. J. & Grubbs, L. (2015). Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses (3rd ed.). Philadelphia, PA: F. A. Davis Company NSG 6020 wk 5 discussion HISTORY collection Assessment