Tina Jones Musk skeletal Assignment
Assignment ID Number AFFGEHU83939HD Type of Document Essay Writing Format APA/MLA/Harvard Academic Level Masters/University References/Sources 4 References
Description / paper instructions
Graduate Shadow Health: Musculoskeletal: Tina Jones
Upon completion of the Shadow Health assignment, you need to synthesize the clinical findings from your completed assessment and provide a list of the following:
Pathophysiology of the selected diagnosis
Treatment plan utilizing the enclosed template, including any medication recommendations, along with the rationale
Your submission should be 3 pages with a minimum of 3 scholarly references and a minimum of 1 reference from UpToDate®. The faculty member will review your recorded assessment of Musculoskeletal: Tina Jones in Shadow Health prior to assignment grading.
Diagnosis are 3 and needs supported for why choosing them.”
NRSG653- Can use a cover page and running head, or add your name to this template
Individual Project Case Presentation Template
(Based on Shadow Health Assignment)
Identified case title:
Significant history findings: (Note findings acquired from Shadow Health case).
Pertinent physical exam findings: (Note findings acquired from Shadow Health case).
Differential diagnosis: (Select a minimum of 3 medical diagnoses.) Provide supporting rationale
(reasons you think the diagnosis fits)
Diagnostics: (List what diagnostic exams would be used to obtain a diagnosis.) Provide supporting
rationale (why you are ordering the tests)
Final diagnosis: (Provide medical diagnosis with supporting rationale for chosen diagnosis.)
Pathophysiology of diagnosis: (Describe the process that occurs within the body for the diagnosed
Treatment plan: (Include pharmacological treatment with patient education.) Treat the patient.
Medication? Therapies? Over the counter treatments? Follow-up? Return to clinic? Referrals?
NOTE: Must utilize a minimum of 3 references with one being UpToDate®. Must be in APA format
Gastrointestinal: Tina Jones
Ms. Jones is a 28-year-old African American female who has come to the clinic,
reporting upper stomach pain that started one month ago and continues daily. Ms. Jones rates her
pain as 5/10 and states that the pain feels like heartburn that worsens when she eats spicy or fast
food. Ms. Jones verbalized noticing symptom relief when she sits up, uses an antacid, and with
increased time after her meal. Ms. Jones reports increased thirst and no significant fluctuations in
weight. She denies significant changes in her diet and further denies smoking or using any illicit
Pertinent Physical Exam Findings
Ms. Jones is an obese 28-year-old female who is cooperative and maintains eye contact
during the history taking period. Her breath sounds are clear and unlabored, negative of cough,
wheezing, and crackles. The cardiovascular portion of her assessment is unremarkable, with no
murmurs gallops or rubs. Ms. Jones has normoactive bowel sounds present in all four quadrants,
absent abdominal tenderness with light and deep palpation. Her spleen and kidneys are non-
palpable, and her abdomen is tympanic throughout. She is negative of CVA tenderness, and her
liver presents at 7cm of the mid-clavicular line and 1cm below the right coastal margin.
Based on the patient’s complaints and the exam finding, there are three possible
differential diagnoses. The first one is peptic ulcer disease, according to Narayanan, Reddy, and
Marsicano (2018), patients with peptic ulcers disease present with burning pain located near the
midline of the epigastrium near the xiphoid process (Narayanan et al.). Ms. Jones’s chief
complaint is burning pain to her epigastrium area, making peptic ulcer disease a possible
GI:TINA JONES 3
diagnosis. A second differential diagnosis is gastritis; symptoms of gastritis include abdominal
pain and heartburn (Liu, & Abell, 2017). A third differential diagnosis for Ms. Jones is
gastroesophageal reflux disease (GERD), GERD presents with significant discomfort and
heartburn post meals, often relieved with antacids and periods of rest (Penner & Fishman, 2020).
GERD is characterized by symptoms similar to Ms. Jones’s chief complaint.
In order to make a final diagnosis, several diagnostic tests need to be carried out. The
first one is an X-ray study with a contrast medium to detect the presence of ulcers or GERD
(Narayanan et al., 2018). If the test does not indicate the presence of ulcers, then peptic ulcer
disease can be ruled out. If GERD can not be accurately diagnosed with an X-ray using contrast
medium, then an ambulatory esophageal pH monitoring test will be conducted to confirm GERD
(Forootan, Zojaji, Ehsani, & Darvishi, 2018). Since H. Pylori is the most common cause of
gastritis in the U.S., performing laboratory testing for serologic titers of H. Pylori antibodies is
important in order to partially rule out gastritis (Narayanan et al., 2018).
According to Forootan et al. (2018), test results from the x-ray with contrast and an
ambulatory esophageal pH monitoring test in conjunction with presenting symptoms and
obtaining a thorough history are enough to diagnose Ms. Jones with GERD.
GERD occurs when the lower esophageal sphincter weakens, allowing a backward
movement of gastric contents into the esophagus (Forootan et al., 2018). The gastric contents
irritate the mucosal lining of the esophagus resulting in a destructive erosion of the mucosal
lining that causes a painful burning sensation in the epigastric region (Forootan et al., 2018).
GI:TINA JONES 4
Initial treatment for Ms. Jones’s includes Famotidine 10mg, 1 Tab PO BID for two
weeks. Ms. Jones is to return to the clinic in 2 weeks for a re-evaluation of symptoms and to
determine medication effectiveness (Sandhu, & Fass, 2018). Part of Ms. Jones’s treatment plan
includes education on the importance of exercise and weight loss to promote a healthy weight
and assist in alleviating symptoms and predisposing factors. Ms. Jones will be encouraged to
avoid foods that exacerbate symptoms, to eat small frequent meals versus three large meals,
avoid eating 2-3 hours before bed, and utilize a wedge pillow to sleep at an incline (Sandhu, &
Fass, 2018). Ms. Jones is instructed to seek emergent care if she experiences blood in her
stool/emesis, or chest pain (Sandhu & Fass, 2018).
GI:TINA JONES 5
Forootan, M., Zojaji, H., Ehsani, M. J., & Darvishi, M. (2018). Advances in the diagnosis of
GERD using the esophageal pH monitoring, gastro-esophageal impedance-pH
monitoring, and pitfalls. Open Access Macedonian Journal of Medical Sciences, 6(10),
1934-1940. doi: 10.3889/oamjms.2018.410
Liu, N., & Abell, T. (2017). Gastroparesis updates on pathogenesis and management. Gut and
Liver, 11(5), 579-589. doi: 10.5009/gnl16336
Narayanan, M., Reddy, K. M., & Marsicano, E. (2018). Peptic ulcer disease and helicobacter
pylori infection. Missouri Medicine, 115(3), 219-224. Retrieved from
Penner & Fishman (2020). Evaluation of the adult with abdominal pain. In A.D. Auerbach, M.
D. Aronson, L. Kunins (Eds.), UpToDate. Retrieved from
Sandhu, D. & Fass, R. (2018). Current trends in the management of gastroesophageal reflux
disease. Gut and Liver, 12(1), 7-16. https://doi.org/10.5009/gnl16615
Tina Jones tweaked her back lifting a box
Week 3 Shadow Health Assessment Musculoskeletal
HPI: Ms. Jones presents to the clinic complaining of back pain that began 3 days ago after she tweaked it
while lifting a heavy box while helping a friend move. She states that lifted several boxes before this event
without incident and does not know the weight of the box that caused her pain. The pain is in her low back and
bilateral buttocks, is a constant aching with stiffness, and does not radiate. The pain is aggravated by sitting
(rates a 7/10) and decreased by rest and lying flat on her back (pain of 3-4/10). The pain has not changed over
the past three days and she has treated with 2 over the counter ibuprofen tablets every 5-6 hours. Her current
pain is a 5/10, but she states that the ibuprofen can decrease her pain to 2-3/10. She denies numbness, tingling,
muscle weakness, bowel or bladder incontinence. She presents today as the pain has continued and is
interfering with her activities of daily living.
Social History: Ms. Jones job is mostly supervisory, although she does report that she may have to sit or stand
for extended periods of time. She denies lifting at work or school. She states that her pain has limited her
activities of daily living. She denies use of tobacco, alcohol, and illicit drugs. She does not exercise.
ROS: General: Denies changes in weight, fatigue, weakness, fever, chills, and night sweats.
Musculoskeletal: Denies muscle weakness, pain, joint instability, or swelling. She does state that she has
difficulties with range of motion. She does state that the pain in her lower back has impacted her comfort while
sleeping and sitting in class. She denies numbness, tingling, radiation, or bowel/bladder dysfunction. She
denies previous musculoskeletal injuries or fractures.
Neurologic: Denies loss of sensation, numbness, tingling, tremors, weakness, paralysis, fainting, blackouts, or
ROS: General: Ms. Jones is a pleasant, obese 28-year-old African American woman in no acute distress. She is
alert and oriented. She maintains eye contact throughout interview and examination.
Musculoskeletal: Bilateral upper extremities without muscle atrophy or joint deformity. Bilateral upper
extremities with full range of motion of shoulder, elbow, and wrist. No evidence of swollen joints or signs of
infection. Bilateral lower extremities without muscle atrophy or joint deformity, full range of motion of
bilateral hips, knees, and ankles. No evidence of swollen joints or signs of infection. Flexion, extension, lateral
bending, and rotation of the spine with reduced ROM – pain and difficulty. Bilateral upper extremity strength
equal and 5/5 in neck, shoulders, elbows, wrists, hands. Bilateral lower extremity strength equal and 5/5 in hip
flexors, knees, and ankles.
ASSESSMENT: Low back muscle strain related to lifting
Diagnostics None at this time
Medication Initiate treatment with ibuprofen 600 mg by mouth every six to eight hours with food as needed
for pain for the next two weeks She may use acetaminophen 500-1000 mg by mouth every 8 hours for
Education Provide Ms. Jones with materials detailing stretching techniques for the lower back Encourage
Tina to be active and avoid prolonged periods of lying down Ms. Jones can also use adjunct therapy of
topical heat or ice per comfort TID-QID Educate on proper body mechanics and lifting techniques 10-
pound lifting restriction for 10 days
Referral/Consultation Referral to physical therapy if symptoms persist in two weeks
Follow-up Planning Instruct Tina to seek emergent care including loss of bowel or bladder function, acute
changes in sensation of lower extremities, or limitations in movement of lower extremities Return to clinic in
2 weeks for follow up and evaluation of symptoms
Information on post assignment questions
Teen Girl with one shoulder higher than the other
Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just
before puberty. While scoliosis can be caused by conditions such as cerebral palsy and muscular
dystrophy, the cause of most scoliosis is unknown.
Scoliosis. Scoliosis testing usually begins with a history and physical exam. This includes the forward-
bending test, a simple test in which the child bends forward at the waist, arms hanging loosely and palms
touching, and the examiner looks for unevenness in the child’s back or ribs.
Plain X-rays can confirm the diagnosis of scoliosis and reveal the severity of the spinal curvature. If a doctor
suspects that an underlying condition such as a tumor is causing the scoliosis, he or she may recommend
additional imaging tests, such as an MRI.Dec 29, 2017
Joint pain worse in am
Rheumatoid arthritis symptoms also include prolonged morning stiffness lasting greater
than 30 minutes. Osteoarthritis patients may feel morning stiffness, but it generally
subsides within the first 30 minutes.
When palpating joints in a musculoskeletal exam, crepitus indicates:
Roughened articular cartilages
An effusion in the joint
Supporting muscles are contracted
***Roughened articular cartilages
(Crepitus is the sound of two rough surfaces inside the body rubbing together. This is commonly
found in rheumatoid arthritis and osteoarthritis when the cartilage of joints is eroded, and the
bones rub against one another. Crepitus may be a sign of bone fracture.)
Imagine that Tina has hard painless bumps on the dorsolateral aspects of the distal
interphalangeal joints that had limit flexion during a range of motion test. How would you have
documented these abnormalities?
Describe the major differences in acute versus passive range of motion (ROM) when distinguishing
between an articular and nonarticular joint issue.
passive range of motion is usually 5% greater than active range of motion. this should be equal in bilateral
joints. pain, limited range of motion, spastic movement, joint instability, deformity, and contractor
suggests a problem with the joint, related to muscle group or serve supply
joint (articular), there is pain and often swelling with limited passive and active ROM nonarticular, there
is pain on active, but not passive, ROM Active ROM involves the use of structures (ligaments, tendons,
muscles) outside of the joint, hence there is a limitation with active ROM and not passive ROM when a
problem is outside of the joint.
What would be some of the ways in which you could assess Tina for suspected lumbar
is the pain relieved by laying down?
is there spasm and tenderness over the paraspinal musculature ay be present
difficulty heel walking or toe walking
numbness, tingling, or weakness in back
L4 have the patient extend quads-weakness, squat and rise- will have pain, and diminished knee
L5 pain with dorsiflexion of great toe and foot, weakness sin heel walking
L6 weakness i plantar flexion of great toe and foot, have the patient walk on toes, ankle jerk will
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