Comment using your own words but please provide at least one reference for each comment.

Do a half page for discussion #1 and another half page for discussion #2 for a total of one page.

Provide the comment for each discussion separate.

Discussion 1

Discussion Question 1

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.

            The history collection portion of these assignments seems to be the most challenging to me. There are so many questions, and sections, that is difficult to ask all the expected questions.  I did fail to ask a few of the questions deemed to be important, according to the experts.  The first question, “When you urinate, have you noticed:  pain, burning, blood, difficulty starting or stopping, dribbling, incontinence, urgency during day or night or any changes in frequency?”  This is an important question because spinal injury can result in issues with bowel or bladder control.  These findings are “red flags” according to Goolsby and Grubbs (2015).  Loss of bladder or bowel control could indicate the patient is suffering from Cauda Equina syndrome, which is a medical emergency that requires treatment to prevent long-term complications (Ahad, Elsayed, and Tohid, 2015).

The second question I omitted was, “Any other symptoms or concerns we should discuss?”  This question is very useful to help patient’s talk about other issues they may be experiencing.  During my personal clinical rotation, this question has often revealed a whole new problem the patient is experiencing.  

Discussion Question 2

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.

            My physical exam of this patient was decent, but I was so focused on this patient’s current complaint that omitted some key assessments.  I failed to auscultate that patient’s heart sounds, before moving on to something else.  Cardiovascular assessment is essential on all patients, and should not be skipped.  Many patients have underlying cardiovascular issues, that are only caught during physical examinations (Bickley, 2016).  

            I did not perform a breast exam on this patient, simply because her last mammogram was normal.  This patient’s family history of breast cancer is a good indication for screening (Goolsby & Grubbs, 2015).  Situations like these are difficult for me to decide if a portion of an exam should be omitted or not.  In the beginning of this class I was doing unnecessary exams during my iHuman exams, so I attempt to be more focuses.  This was not a good plan for this patient.  

Discussion Question 3

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.

            The patient’s complaints of lower back before and during assessment prompted me to perform the straight leg raise test.  Bilateral leg raises were positive for causing increased pain in the patient’s lower back.  At this point, I should have assessed the patient for neurological sensory changes, such as touch, pain, temperature, and vibration.  I failed to do this during the exam, but this test could reveal impairments in neurological functions (Bickley, 2016)

Discussion Question 4

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.

            One of the identification issues for this patient that I missed was her smoking history.  I later realized that she had been a smoker for 40 years.  Smoking can play a huge part in the development in many different types of cancers, as well as other health conditions.  This patient has a history of asthma, and was actively having wheezing bilaterally.  I didn’t even think to ask her about her smoking history, and I didn’t add asthma to her list of problems.  

Discussion Question 5

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.

            When I selected differential diagnoses, I chose radiculopathy, and the system told me that was incorrect.  In fact, this patient was experiencing radiculopathy, as her back pain was radiating into her sciatic nerve causing her pain in her right leg.  Spinal neoplasm was one that I did not choose because I did not think this patient suddenly experienced acute pain from a tumor, as she was lifting at the time of pain onset.  As mentioned above her history of smoking and familial history of cancer, should have been reason enough to suspect a mass or tumor as the cause of her pain (Goolsby & Grubbs, 2015).

Discussion 2

Discussion Question 1
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.
 

What are the events surrounding the start of your leg pain?

I did not find it necessary to inquire about the circumstances related to pain in leg again after I had already asked similar questions when the pain had just started. She responded that the beginning of pain was associated with the backache that she obtained together with the injury at work. I realize that further investigation and extra questions could be helpful as her answers hinted at having radiculopathy in her leg. Certain changes in back can lead to pinching or damaging the nerves, which consequently results in this condition. (Bickley, 2017)

Any new or recent changes in medications?

 It did not seem necessary to ask this question after the previous questions related to the prescribed medicine, herbal supplements, and over-the-counter medications taken by her. It is quite possible that medications can change over time, in particular when the patient gets prescriptions from a number of different specialists and doctors. Every medical appointment should include a thorough review of the taken medication to make sure that there have been no changes in the patient’s chart on medications. Prescribing of new medications can be done only after careful review of all previous prescriptions to prevent possible adverse reactions or contraindications with the medications the patient is taking. (Bickley, 2017)

 
Discussion Question 2
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.
 

Doing this portion of physical assessment, I concentrated on the spine palpation; however, it was without any neurological exam included as related to reflexes of the deep tendon and reflex of the planter/ Babinski reflex. It is an essential part of checking reflexes as it is important to check whether reflexes are equally bilateral using the scale grading with 0 as no response at all to +4 meaning that response is extremely brisk (Codina, 2018).  A particular nature of Babinski reflex can be explained via the assessment of motor neuron in the lower extremities for lesions. The definition of this reflex presents it as is an extension of the big toe in the upward direction with the other toes fanning. Checking starts from stroking the heel in a firm manner toward the front of the foot to the sole outer side. Babinski sign of the adults is supposed to be negative (Codina, 2018).

 
Discussion Question 3
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.
 

I think the main key finding is the acute onset of lower back pain. As with all pain syndromes, it is important to obtain a detailed history of the onset and progression of the pain. The medical history should identify previous episodes of back pain and other musculosketal disorder and should include the treatment and response for them. The physical examination should begin by noting the patient’s posture and apparent level of comfort. The standing patient should be directed through a series of maneuvers to assess the back motion, including flexion, hyperextension, lateral flexion and rotation, ROM and any obvious signs of discomfort are noted. Palpate along the spinal column with the patient standing and them bending forward. Note the presence of absence of the natural curvature and any focal, midline tenderness.  (Goolsby & Grubbs, 2015). 

 
Discussion Question 4
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.
 

The category that I omitted was lack of correlation between the respiratory system with the patient’s symptoms. It means that since the patient takes steroid to treat asthma, the risk of osteoporosis is higher because of the long-term taking of corticosteroids; thus, the health problems of the patient can be related to this previous treatment. It is of special importance for the providers to be careful when it deals with the medical history of the patient as all health problems are interrelated. (Goolsby & Grubbs, 2015)

 
Discussion Question 5
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.
 

I missed spinal neoplasm as a differential diagnosis that engages the spine leading to the compression of spinal cord, which may have terrible consequences. The origin of primary spinal cord tumors can be various CNS (central nervous system) elements, in particular meninges, supporting glial cells, and neurons. In terms of anatomy, classification of the spinal cord neoplasms presents them in accordance with the origin compartment:  extramedullary (outside the cord) and intramedullary (inside the cord). (Bickley, 2017)