Patient Presentation

Robert Trinh is a 34 year-old senior truck driver referred to your outpatient physical therapy office for “chronic low back pain” which started 7 months ago. He was lifting a particularly heavy load that day and felt something “tweaked” in his low back as he was bent over and moving the load from the truck into the sidewalk. He remembered being in a bent over posture and cannot straighten up for about 2 weeks and the posture gradually resolved. Current pain level is 8/10 with sharp burning sensation in the low back (P1= symptom location #1) that radiates down to the posterolateral right lower leg (P2= symptom location #2). The entire right lower leg also feels tingling often. Robert reports that the right lower leg can feel very sensitive at

Per the medical report dated 03/29/2016 by Dr. Waghmarae, the patient believes that her left buttock pain has increased over the last month. She describes her pain as aching, throbbing and stabbing. She rates her pain symptoms as 8/10. Pain is relieved by medication, heat, ice and use of a Transcutaneous Electrical Nerve Stimulator (TENS) unit, and is increased by movement and standing for long periods of time. She states that her bilateral legs have also increased in pain severity over the last month. She believes because she is doing a lot of standing and trying to clean up her house. She states that pain is increasing in her left buttock. She is not involved in physical therapy, chiropractic, massage therapy or acupuncture. Palpation of the lumbosacral spine reveals abnormalities along the bilateral facet joints. There is pain in her axial lower back in all planes of lumbar motion that is

DOI: 7/1/2015. Patient is a 63-year-old female nursing assistant who sustained injury to her left shoulder while helping to move a patient. Per OMNI entry, she was initially diagnosed with adhesive capsulitis of the left shoulder, in the setting of a bursal-sided partial rotator cuff tear. IW underwent a left shoulder arthroscopic capsular release, bursal release, and subacromial decompression on 11/16/16.

Per the medical report dated 08/12/16 by Dr. Gunderson, the patient had neck pain, as well as headaches, dizziness and blurred vision. The neck pain radiated into both shoulders, but more so on the right, and occasionally she had tingling in her upper extremities. She described the neck pain as severe and intermittent, and not related to any specific activity, and relieved with massage. The pain in her lower back was in the beltline and radiated into both lower extremities, more so on the left. She described the pain as moderately severe and constant, and not related to any activity, and only relieved with nerve medicines. On examination, the patient had tenderness in the lower cervical region about C5 to C7. Range of motion of her neck was 75% of normal. Motor, sensory, and reflex examinations in the upper extremities were normal. On examination of the lumbar spine, the patient could dress and undress without difficulty. She had a bent forward posture and gait. She had reduced lumbar motion and with maximum forward flexion, her fingertips were 12 inches from the floor. Lateral flexion was 50% of normal, and she had no active extension in the lumbar spine. Motor, sensory, and reflex examinations in the lower extremities were normal. There was paravertebral tenderness about L4-5 bilaterally, as well as in both sacroiliac and sciatic notch regions. Straight leg caused hip and thigh pain at 50 degrees bilaterally. Of note, X-rays of the cervical spine demonstrated disc degeneration at C5-6. X-rays of the lumbar spine were normal. Patient sustained

The study was a systematic review of scientific papers selected by a search of the SciELO, Cochrane, MEDLINE, and LILACS-BIREME databases. Among the 2169 articles found, 12 studies proved relevant to the issue and presented an evidence strength rating of B. No publications rated evidence strength A. Seven of the studies analyzed were prospective cohorts and 5 were cross-sectional studies.

She presents with severe episodes of back pain and sometime extension in the lower extremity .Her problem started when she fell off a horse when she was 10 or 11 age . This pain aggravate during movement and walking . Additional she complains of often epigastric pain , probably combined with intake of different food components.

The patient rejected the invasive nature of treatment protocols and opted for continuation of nonoperative treatment under conservative chiropractic management. The patient primarily complains of lumbosacral spinal pain at the right sacroiliac joint radiating into

The patient that I have chosen for my diagnostic reasoning paper is a 47-year-ol-Hispanic female. The presenting problem that I have chosen to use as my patient’s chief complaint is back pain. The only other clues that I have to use in order to help narrow my focus is that she is a female, she is 47-years-old, and she is Hispanic. I do not know how long she has been experiencing pain or how severe her pain is. Given these parameters, I will “cast a wide net” as I evaluate my patient and create my list of differential diagnoses.

Most of the literature is made up of low quality retrospective non-randomised cohort studies with small sample sizes. Ultimately, large multi-centred, adequately powered, well-designed randomised trials are needed to establish clearer guidelines for the management of these patients.

Developed and implemented the admission documentation process, when a patient is admitted to the facility supporting documentations are required with 24 hours of admission. The process was previously walking the documents from one department to the next, requiring up to two working days to complete and would halt if an individual within the process was out for the day or on leave.

On admission, Ms. Kelly complained of low back pain ranging in intensity from 7 to 8, out of 10, on the pain scale where 0 is no pain and 10 is the worst imaginable pain. She subjectively describes this pain as throbbing, stabbing, burning and radiating down into both legs, left worse than right. In addition, she has sharp, stabbing, burning pain in both her arms, left worse than right, and experiences intermittent tingling and numbness sensations in both her hands. She has pain in her neck and shoulder that she defines as tension-type pain. Factors that can aggravate the pain include

In the Case Presentation, Cora is a 45-year-old adult who is alert and oriented. She is aware of her COPD disease and has been educated on the consequences of smoking. It is her right to continue smoking and to return to the free clinic as she deems necessary or as permitted. Burkhardt & Nathaniel (2014) states, “refusal to participate in a plan of care, regardless of the outcome, is the prerogative of the patient and must not affect the care given by the nurse. Ultimately, choices about health care practices belong to patients” (p.69). As a healthcare provider, it is our responsibility to educate the patient on the disease process, signs and symptoms, and treatments. It is up to the patient to follow the recommended plan of care.

Evidence based practice is the incorporation of individual clinical expertise with best research evidence and patient values and expectations. Health care decision of individual patients should be based on best available research evidence. A health decision made from a sound research evidence has the potential to ensure best practice and reduce variations in health care delivery. In health science, an ever increasing plethora of studies being published and is challenging for clinicians to keep up with the literature. Integrating research into practice is time consuming and need methods for easy access to such evidences for busy clinicians. Indeed, clinical decision should be based on the latest research evidence. Systematic reviews and meta-analyses summarize the research evidence, which is generally the best form of evidence, thereby making the available evidence more accessible to decision makers and are positioned

The author considers the simplest way of finding out best practice is by using guidelines. According to Field & Lohr (1992) guidelines are “systematic developed statements to assist practitioners and patients decisions for specific clinical circumstances.” Evidence is always current and a generous collection of many different systematic research reviews with multiple random control trials are available (AGREE, 2000). These types of trials are graded at the top level of hierarchy (Guyatt et al 2002).Nevertheless in contrast Devereaux and Yusuf (2005) argue that top level hierarchy is not a guaranteed deviation from the truth in randomized trials. The clinical guidance used is the National Institute of Clinical Guidance (NICE 2009) is based in the author’s homeland and is an independent organisation responsible for providing guidelines. The ethos behind NICE (2009) is to promote and prevent poor health nationally involving the public, health professionals and patients in the process (NICE 2009).

* For the writer to attend a home-visit on Tuesday 7th of June at 10:00am.