iscussion: Diagnosing Neurological Disorders

 

As an advanced practice nurse, you will likely observe patients who experience neurological disorders. Challenging to the diagnosis of neurological disorders is the realization that many manifestations of disease may not be overt physically.

For this Discussion, consider the following three case studies of patients presenting with neurological disorders.

Case Study 1

80-year-old male Caucasian male brought to the clinic by his wife concerned about his “memory problems”. Per the wife, she has noticed his memory declining but has never interfered with his daily activities until now. He is unable to remember his appointments and heavily relies on written notes for reminder. Just last week, he got lost driving and was not found by his family until 8 hours later. He is unable to use his cell phone or recall his home address or phone number. He has become a “hermit” per his wife. He has withdrawn from participating with church activities and has become less attentive.

PMH: HTN, controlled Prostate cancer 20 years ago Dyslipidemia SH: no alcohol or tobacco use; needs assistance with medications PE: VS stable, physical exam unremarkable

Case Study 2

A 30-year-old Asian female presents to the clinic with headaches. History of headaches since her teen years. Headaches have become more debilitating recently. Describes the pain as sharp, worsens with light and accompanied by nausea and at times vomiting. Rates the pain as 7/10. Typically takes 2 tabs of OTC Motrin with ‘some help’. “Sleeping it off in a darkened room’ helps alleviate the headache. VS WNL, physical exam unremarkable.

Case Study 3

A 50-year-old African American male presents with complaints of dizziness left arm weakness and fatigue. PMH: poorly controlled diabetes, hypertension, hyperlipidemia PE: Upon exam, you noted a very mild dysarthria, he understands and follows commands very well. Mild weakness on the left side of the face is noted, and left sided homonymous hemianopsia but no ptosis or nystagmus or uvula deviation.

To Prepare:

•  select  one of the three case studies provided.
• Reflect on the provided patient information including history and physical exams.
• Think about a differential diagnosis. Consider the role the patient history and physical exam played in your diagnosis.
• Reflect on potential treatment options based on your diagnosis.

Post an explanation of the primary diagnosis, as well as 3 differential diagnoses, for the patient in the case study that you selected. Describe the role of the patient history and physical exam played in the diagnosis. Then, suggest potential treatment options based on your patient diagnosis.

Use an issue of interest from your current or past nursing practice.

Create a 4 page submission in which you develop a PICO(T) question for a specific care issue and evaluate the evidence you locate, which could help to answer the question.

PICO(T) is an acronym that helps researchers and practitioners define aspects of a potential study or investigation.

It stands for:

·       P – Patient/population/problem.

·       I – Intervention.

·       C – Comparison (of potential interventions, typically).

·       O – Outcome(s).

·       T – Time frame (if time frame is relevant).

·

In your submission, make sure you address the following grading criteria:

1.     Define a practice issue to be explored via a PICO(T) approach. Notes how the exploration of the practice issue will benefit from a PICO(T) approach.

2.     Interpret findings from scholarly quantitative, qualitative, and outcomes research articles and studies.

Explain the findings from articles or other sources of evidence.

3.     Analyze the relevance and potential effectiveness of evidence when making a decision. Identify sources of evidence that could be potentially effective in answering a PICO(T) question.

Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Present criteria or rational used to determine potential to answer the PICO(T) question.

4.     Apply an evidence-based practice model to address a practice issue. Define a practice issue to be explored via a PICO(T) approach. Explain the findings from articles or other sources of evidence. Explain the findings from articles or other sources of evidence that are relevant to a PICO(T) question. Note which sources are the most credible.

5.     Explain the relevance of the findings from chosen sources of evidence to making decision related to a PICO(T) question. Note which findings are the most relevant or likely to lead to positive outcomes.

 

Number of references:Cite a minimum of four sources of scholarly or professional evidence that support your findings and considerations. Resources should be no more than 5 years old.

·       APA formatting: Format references and citations according to the current APA style.

For this assessment, you are a presenter. References: Cite at least three professional or scholarly sources of evidence to support the assertions you make in your video. Include additional properly cited references as necessary to support your statements.

·       APA reference page: Submit a correctly formatted APA reference page that shows all the sources you used to create and deliver your video. Be sure to format the reference page according to current APA style.

·

1.Propose an evidence-based care plan that you believe will improve the safety and outcomes of the patient in Remote Collaboration on Evidence-Based Care media scenario. explain the ways in which an evidence-based practice model was used to help develop the care plan for

2.Discuss the ways in which an EBP model and relevant evidence helped you to develop and make decision about the plan you proposed.

3. Apply an evidence-based practice model to address a practice issue. Explain the ways in which an EBP model was used to help develop the care plan. Plan care based on the best available evidence. Propose an evidence-based care plan to improve the safety and outcomes for a patient. Reflect on which evidence was most relevant and useful when making decisions regarding the care plan

4. identify benefits and strategies to mitigate the challenges of interdisciplinary collaboration to plan care within the context of a remote team identifying the benefits of the remote collaboration in the scenario, as well as discuss strategies you found in the literature or best practices that could help mitigate or overcome one or more of the collaboration challenges you observed in the scenario

 

Care media scenario

Dr. Copeland: Nurse, can you give me an update on Caitlynn? I know she’s two years old and she’s been admitted for pneumonia. Does she have any history of breathing problems?

Virginia Anderson: Yes, this is her second admission for pneumonia in the last six months. She had a meconium ileus at birth.

Dr. Copeland: All right. Is she presenting with any other symptoms?

Virginia Anderson: She has decreased breath sounds at the right bases and rhonchi scattered in the upper lobes. Respirations are 32 and shallow with a temp of 101.

Dr. Copeland: What have we done for her so far?

Virginia Anderson: The respiratory therapist administered nebulized aerosol and chest physiotherapy. After the aerosol she had thick secretions.

Dr. Copeland: I see her weight is 20.7 pounds, and there’s been some decreased subcutaneous tissue observed in her extremities?

Virginia Anderson: Correct. I noticed this too, so she might have some malabsorption of nutrients.

Dr. Copeland: Have we done a sweat chloride test yet?

Virginia Anderson: Yes, and the results were 65 milliequivalents per liter. Also, the mother reports that when she kisses her, she tastes salty.

Dr. Copeland: All right. Well, I think it’s fair to say we might be dealing with cystic fibrosis here. Let’s get her started on an IV with piperacillin, and keep an eye on her temperature.

Dr. Copeland: Let’s talk about Caitlynn Bergan. Her mother, uh, [checks notes] Janice, has been informed of her diagnosis. I didn’t realize this when she first came in, but she doesn’t live in Valley City; she’s in McHenry.

Rebecca Helgo: That’s a tough drive during winter. They’re over an hour away, aren’t they?

Dr. Copeland: That’s right. It was a toss-up between coming here or going to Jamestown, but I guess the father — Doug — thought Valley City was the better choice. Anyway, I’ve put her on Pancrease enzymes and we’ll be recommending a high-protein, extra-calorie diet along with the fat-soluble vitamins — A, D, E, and K. I’ll update her pediatrician on her condition, and order dornase alfa. Let’s see how she does with the breathing treatments. How are those going?

Rebecca Helgo: Quite well, actually. She’s too young to get her to do the huff breaths, but we’re keeping the secretions thin and manageable with the aerosol treatments. I am concerned about her day-to-day treatment, though. She’ll be back here with pneumonia if the parents can’t stay on top of that. She’s at risk for impaired gas exchange and respiratory distress, which will cause her anxiety and more distress, and that’s not going to help her stay well.

Dr. Copeland: How well do you think the parents will be able to handle the treatment?

Virginia Anderson: That might get tricky. I gather that the mother and father are still married but separated. We’ll need to make sure that at least one of them gets the education they need. But they both work, and trips here aren’t the easiest choice. We should get a social services consult to coordinate services and identify some assistance for the family in McHenry.

Rebecca Helgo: I can do some education here, and then do a Skype consult with one or both of them once she’s been discharged and is back home.

Dr. Copeland: It sounded like both parents work long hours. Are you going to be able to schedule times that work?

Rebecca Helgo: I may have to do some after-hours appointments. We’ll have to sort that out.

Virginia Anderson: She’s had one bowel obstruction already, so I think we need to help them monitor for DIOS too. Does the pediatrician’s office have a telemedicine relationship with us? That might be helpful in preventing unnecessary trips here.

Dr. Copeland: Let’s find out a bit more and see what our options are.

Dr. Copeland: Hello, Dr. Benjamin. I’m sorry to be meeting under such circumstances, but I hope we can work with you to help the Bergans handle Caitlynn’s care. On the line with me is Virginia Anderson, the nurse assigned to Caitlynn while she’s here.

Dr. Benjamin: Hello to both of you. Yes, it’s unfortunate. This is the first case I’ve seen among my own patients.

Dr. Copeland: Are you familiar with the CF protocol?

Dr. Benjamin: I am, but I’d love to get any more details that relate to Caitlynn. She’s done with most of her immunizations, but she’s still needs her HAV and influenza, of course. I’m also not sure where to order some of the pancreatic enzymes and medications you listed.

Virginia Anderson: We can help with all that. Do you have telemedicine access to Valley City?

Dr. Benjamin: No, but we do have it with Cooperstown Medical Center. We kind of have to in a town of less than 100 people.

Dr. Copeland: We may be able to use Skype on a more informal basis for consults between us, but it might be good to get connected with Valley City on your telemedicine equipment. If the parents bring Caitlynn to you with symptoms, and you’re not sure whether the hour-long trip is necessary, we can do a telemedicine appointment and make sure.

Dr. Benjamin: All right. It sounds like we might see them often initially, and I understand that bowel obstructions and pneumonia are two possible complications. We can handle some of those issues here, but assuming they have trouble during working hours, I assume we can reach you by phone?

Dr. Copeland: You or your staff can send me a text. If we need to talk further we can set up a call, but if not, text is the quickest way to get my attention, and the easiest way for me to respond between things.

Virginia Anderson: And I’m available via text as well if you’re having trouble reaching Dr. Copeland or if it’s a question I can field.