Assignment: Musculoskeletal and the Neurologic System

Research the conditions affecting the musculoskeletal and the neurologic systems. Based on your research and understanding, respond to one of the following scenarios:

A patient is admitted to the unit. He is a diabetic on chronic hemodialysis. He has an Arteriovenous (A-V) graft, which is annulated each time he undergoes dialysis treatments. You notice an area on his graft arm that is red and warm to the touch. He states that he has had this on his arm for several weeks. He asked the dialysis staff about the area, but they told him to apply warm compresses to the site. The staff at the dialysis center continues to use the graft, but they are careful to avoid the area when they cannulate for his treatments. Now the patient presents with extreme low back pain, fever, nausea, and swelling of his lower extremities. On checking his fasting serum glucose, you notice that the reading is 159 (Normal fasting blood glucose range 64 to 110 mg/dl), and his white blood cell count is 36,000 (normal range is 4,500-10,000 white blood cells/mcl). He states that his sugars were normally well controlled, but in the past ten days he seems to be requiring more insulin.

?How would you proceed with this patient?

?What could be the underlying problem?

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Musculoskeletal and the neurologic systems Sample Paper

A 58-year-old female is admitted for a work up for a complaint of neck and low back pain. During admission, you discover that she underwent a renal transplant six years ago. The patient also had blood work collected. When you review the findings, you notice that her serum calcium is elevated at 13.9 (Normal values range from 8.5 to 10.2 mg/dl), her CBC shows a hematocrit of 33%, and hemoglobin of 11.1 g/dl (normal adult female hematocrit Range: 37-47%, normal adult female hemoglobin range: 12-16 g/dl).

What does this mean and what could be the underlying cause of her pain and her abnormal lab values?
What other assessments would be helpful?

The main cause of her pain as well as her abnormal lab values is due to a rapid decrease in bone mineral density (BMD) that occurs in 12 months after a successful renal transplantation and later persists, even though at a lower rate, for many years. The issue of rapid BMD loss considerably increases the fracture risk of these renal patients to levels that are higher as compared to those of patients who have chronic kidney disease in stage 5 and have commenced on dialysis. Bisphosphonates as well as vitamin D metabolites are valuable in preventing early bone loss.

Another helpful assessment would be frequent observation of Hypophosphatemia after renal transplantation. This is because decreased phosphate reabsorption in the proximal tubule is likely to be the main issue responsible for post transplantation hypophosphatemia. Magnetic resonance imaging (MRI) as well as bone scintigraphy should be used to help identify areas of localized inflammation in order to establish the diagnosis.

A 12-year-old female is admitted with severe pain in her spine. While checking history, the patient and her mother state that several weeks ago the patient was treated for an upper respiratory infection. The infection subsided after several days of taking antibiotics. However, several days later, the child complained of joint swelling and pain in her right elbow, which subsided, but then seemed to migrate to her left knee. A week later, today, the child began to complain of worsening back pain. The mother has been treating the pain with over the counter pain medication and heat and ice packs, but this did not seem to help.

What are the possible causes of the pain and how you would proceed?

The pain is caused by a local infection and by this case from the respiratory infection. This can be as a result of systemic diseases such as gout or due to a local infection. Olecranon bursitis is normally associated with the swelling over the tip of the elbow. I would proceed with anti-inflammatory medication such as ibuprofen to reduce inflammation and swelling (Campbell, DeJong & Haerer, 2005).

A 33-year-old Hispanic male is admitted and complains of a tingling sensation in his left leg, vertigo, and loss of balance. When you begin to perform intake history, you notice that his speech is slurred, his teeth are in need of repair, and he seems to be very drowsy.

What other findings may you find in this individual?
What would you think is the underlying cause of this patient’s complaint?
How would you proceed with your assessment specifically for this patient?

Other findings will include, whether the patient is experiencing prickling and tingling sensation in the affected body parts. I will assess whether the patient has a reduced ability to feel pain as well as changes in temperature, particularly in his feet. Also I I will inquire whether he has a burning or sharp pain, usually in his feet and legs.

From the symptoms given, I will consider that the cause is due to peripheral neuropathy. I will refer the patient to a neurologist who is a doctor who specializes in diseases of the nerves. I will give him an electromyogram (EMG) and nerve conduction velocity (NCV) tests, to assess nerve and muscle function as well as measuring the electrical properties of the nerves (In Biller & In Ferro, 2014)..

How would you proceed with this patient?
What could be the underlying problem?

I will referrer the patient to an occupational therapist to fit a graft guard to do some activities safely. The main problem could be an infection of the skin around the graft site making it red or warm to touch.

References

Campbell, W. W., DeJong, R. N., & Haerer, A. F. (2005). DeJong’s the neurologic examination: Incorporating the fundamentals of neuroanatomy and neurophysiology. Philadelphia, PA: Lippincott Williams & Wilkins.

In Biller, J., & In Ferro, J. M. (2014). Neurologic aspects of systemic disease: Part I.

Assignment: Musculoskeletal and the Neurologic System