Pain syndrome or a neurologic disease process

 

Select either a type of pain syndrome or a neurologic disease process (headache, CVA, acute bacterial meningitis, Alzheimer’s, anxiety, depression, chronic pain syndrome) and discuss the pathophysiologic process involved.

Identify current evidence-based treatment modalities for the selected syndrome or disease and discuss how the treatment impacts the disease process.

Conduct an evidence-based literature search to identify the most recent standards of care/treatment modalities from peer-reviewed articles and professional association guidelines (www.guideline.gov). These articles and guidelines can be referenced, but not directly copied into the clinical case presentation. Cite a minimum of three resources.

Include the following in your clinical case presentation:

A discussion of the pathophysiology of the disease, including signs and symptoms.
An explanation of diagnostic testing and rationales for each.
A review of different evidence-based treatment modalities for the disorder obtained from guideline.gov or a professional organization.
Next, address the following questions:

How does the information in this case inform the practice of a master’s prepared nurse?
How should the master’s prepared nurse use this information to design a patient education session for someone with this condition?
What was the most important information presented in this case?
What was the most confusing or challenging information presented in this case?
Discuss a patient safety issue that can be addressed for a patient with the condition presented in this case.

Sample Solution

aist Circumference (WC) is a good indicator of central adiposity and is a better predictor of metabolic syndrome (24,25), cardiovascular disease risk factors (26) and insulin resistance in children than BMI.
A cut-off of 70th WC percentile is suggested to screen children for risk of MS in our population. WC is measured with the child standing using a non-stretchable tape applied horizontally just above the upper lateral border of the right ileum(27). Measurement is made at the end of a normal expiration and recorded to the nearest 0.1cm. Age- and sex-specific reference curves for WC for 2-18 year old Indian children are available by Khadilkar et al (18).

3) Clinical Examination:
This includes assessment of vital signs especially measurement of Blood pressure with an appropriate size cuff.
Look for dysmorphic features that would suggest a genetic syndrome. Cushingoid facies, hyperpigmented stretch striae and hypertension suggest cushing’s or exogenous steroid exposure. A hump on the back of neck and stretch striae may also be present in children with simple obesity. Dry skin or enlarged thyroid gland may suggest hypothyroidism and presence of acanthosis nigricans is an indicator of insulin resistance. Acne and hirsutism in girls could be due to PCOD. Shortening of 4th and 5th metacarpal should raise the suspicion of pseudohypoparathyroidism.
Look for gynecomastia in males. Genital examination for Tanner staging & evaluation of early puberty should be done. Undescended testes in males could be associated with syndromic obesity.

4) Laboratory Investigations:

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