Shadow Health Assignments
NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment
Two days after a minor, low-speed car accident in which Tina was a passenger, she noticed daily bilateral headaches along with neck stiffness. She reports that it hurts to move her neck, and she believes her neck might be swollen. She did not lose consciousness in the accident and denies changes in level of consciousness since that time. She states that she gets a headache every day that lasts approximately 1-2 hours. She occasionally takes 650 mg of over the counter Tylenol with relief of the pain. This case study will allow you the opportunity to examine the patient’s optic nerve via use of the ophthalmoscope as well as assess her visual acuity. You will need to document your findings using appropriate medical terminology. Be sure to assess for foot neuropathy using the monofilament test. Reason for visit: Patient presents complaining of headache. NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment.
NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment
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Pre Brief
Two days after a minor car accident, Tina noticed daily headaches and neck stiffness. Her neck hurts when she moves it, and she thinks it might be swollen. She didn’t lose consciousness in the accident and hasn’t experienced any changes in consciousness since. Tina gets headaches every day for about 1-2 hours. She sometimes takes over-the-counter Tylenol (650 mg) and it helps relieve the pain. This case study lets you examine Tina’s optic nerve using an ophthalmoscope and assess her visual acuity. You need to record your findings using appropriate medical terms. Make sure to use the monofilament test to check for foot neuropathy. Tina’s reason for the visit is her headache.
Objective Data Collection: 36.75 of 37 (99.32%)
Confirmed orientation to person, place, and time.
Evaluated abstract thinking and relevance.
Evaluated attention span through the Serial 7s Test.
Evaluated comprehension and general knowledge.
Evaluated judgment and memory.
Observed vocabulary and articulation.
Tested olfactory nerve for the sense of smell.
Tested visual acuity (optic nerve) for both eyes.
Examined retina with an ophthalmoscope.
Subjective Data Collection: 20 of 20 (100.0%)
Chief Complaint:
Tina’s chief complaint is daily headaches and neck stiffness following a recent car accident.
History of Present Illness:
Tina experienced headaches and neck stiffness two days after the accident. She didn’t lose consciousness during the accident and recalls having low vehicle speed. She was wearing a seatbelt.
Transcript
Hello Tina. I’m Pam, and I’ll be interviewing you today and later performing a physical examination on you.
What brings you to the clinic today?
Tina: I got into a fender bender a week ago, and I’ve been having headaches and neck soreness since.
Have you had any neck stiffness?
Tina: Yes.
When did the neck stiffness start?
Tina: About two days after the accident.
When did the headaches start?
Tina: They began about two days after the accident.
Review Questions
1. To assess spinal levels L2, L3, and L4 in Tina, which deep tendon reflexes need to be tested?
– Patellar (Correct Response)
2. If Tina had a fever and photophobia, what test would you perform to check for meningitis?
– Kernig’s sign
Lifespan
In the case of Tina’s three-year-old neighbor with fever, neck pain, headache, and confusion, the greatest concern is bacterial meningitis due to lack of immunizations.
Tina’s 83-year-old great uncle, experiencing memory issues, might have a stroke, Alzheimer’s, or other cognitive conditions. Different assessments would be needed to identify the underlying cause.
- Results: Transcript
- Results: Subjective Data Collection
- Results: Objective Data Collection
- Results: Education & Empathy
- Results: Documentation / Electronic Health Record
- Results: Pre – Survey Lifespan
- Results: Review Questions
- Results: Self-Reflection
- NR 509 Week 3 Shadow Health Neurological Physical Assessment Assignment
Objective Data Collection: 36.75 of 37 (99.32%)
- Correct
- Partially correct
- Incorrect
- Missed
To Person (1/3 point)
- Oriented to person
- Not oriented to person
To Place (1/3 point)
- Oriented to place
- Not oriented to place
To Time (1/3 point)
- Oriented to time
- Not oriented to time
Abstractness (1/2 point)
- Abstract
- Concrete
Relevance (1/2 point)
- Relevant
- Not relevant
Serial 7s Test (1/1 point)
- Accurate
- Not accurate
Observations (1/1 point)
- Able to follow instructions
- Unable to follow instructions
Evaluated general knowledge
1 of 1 point
Accuracy (1/1 point)
- Accurate
- Not accurate
Evaluated judgment
1 of 1 point
Observations (1/1 point)
- Intact
- Not intact
Evaluated memory
1 of 1 point
Remote Memory (1/3 point)
- Intact
- Not intact
Immediate Memory (1/3 point)
- Intact
- Not intact
New Learning Ability (1/3 point)
- Accurate
- Not accurate
Observed vocabulary
1 of 1 point
Complexity (1/1 point)
- Expected complex for patient’s age, education level, and general ability
- Not expected complexity
Observed articulation
1 of 1 point
Observations (1/1 point)
- No observed problems with pronunciation or expression
- Imprecise pronunciation of consonants
- Slurring
- Hesitation
- Stutter
Tested olfactory nerve
1 of 1 point
Sense Of Smell (1/2 point)
- Able to discriminate
- Not able to discriminate
Symmetric (1/2 point)
- Symmetric bilaterally
- Asymmetric
Tested visual acuity (optic nerve)
1 of 1 point
Right (1/2 point)
- 20/100
- 20/70
- 20/50
- 20/40
- 20/30
- 20/25
- 20/20
- 20/15
- 20/13
- 20/10
Left (1/2 point)
- 20/100
- 20/70
- 20/50
- 20/40
- 20/30
- 20/25
- 20/20
- 20/15
- 20/13
- 20/10
Examined retina with ophthalmoscope (optic nerve)
Right: Fundus (No point)
- No visible abnormal findings
- Myelinated nerve fibers
- Papilledema
Subjective Data Collection: 20 of 20 (100.0%)
Hover To Reveal…
Hover over the Patient Data items below to reveal important information, including Pro Tips and Example Questions.
- Found:
Indicates an item that you found.
- Available:
Indicates an item that is available to be found.
Category
Scored Items
Experts selected these topics as essential components of a strong, thorough interview with this patient.
Patient Data
Not Scored
A combination of open and closed questions will yield better patient data. The following details are facts of the patient’s case.
Chief Complaint
Finding:
Established chief complaint
Finding:
Reports recent “fender bender”
(Found)
Pro Tip: Patients choose to seek treatment for a variety of reasons. Asking why Tina chose to seek treatment today might indicate primary concerns, the severity of her symptoms, or failure to manage symptoms herself.
Example Question:
Why are you seeking treatment today?
Finding:
Reports headaches
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina if she’s had headaches specifies the way her individual symptoms and pain manifest.
Example Question:
Have you had any headaches?
Finding:
Reports neck symptoms
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina if she’s had neck stiffness specifies the way her individual symptoms and pain manifest.
Example Question:
Have you had any neck stiffness?
History of Present Illness
Finding:
Asked about onset of symptoms
Finding:
Reports accident occurred 1 week ago
(Available)
Pro Tip: Soliciting a relevant history of Tina’s car accident will allow you to understand the context in which she was injured and the injuries she sustained.
Example Question:
When did the accident happen?
Finding:
Reports symptoms began 2 days after accident
(Found)
Pro Tip: Symptoms often vary from patient to patient. Asking Tina when the headaches begin specifies the way her individual symptoms and pain manifest.
Example Question:
When did the headaches begin?
Finding:
Followed up on details of car accident
Finding:
Denies loss of consciousness
(Found)
Pro Tip: Soliciting a relevant history of Tina’s car accident will allow you to understand the context in which she was injured and the injuries she sustained.
Example Question:
Did you lose consciousness during the car accident?
Finding:
Reports low vehicle speed
(Found)
Pro Tip: Soliciting a relevant history of Tina’s car accident will allow you to understand the context in which she was injured and the injuries she sustained.
Example Question:
How fast was the car going?
Finding:
Reports wearing seatbelt
Transcript
Started: Mar 18, 2020 | Total Time: 219 min
All Lines (155)Interview Questions (94)Statements (3)Exam Actions (58)
| Hello Tina. Welcome to our clinic. Am Pam, i will be interviewing you today, and later do a physical examination on you | Greet | |
| Hey. | ||
| What brings you to the clinic today? | Question | |
| Well, I got into a little fender bender a week ago and I’ve been getting these headaches ever since. And my neck is sore too. | ||
| Am sorry to hear that you are having headaches | Empathize | |
| Thanks for saying that. | ||
| Have you had any neck stiffness? | Question | |
| Yeah. | ||
| When did the neck stiffness begin? | Question | |
| My neck started hurting about two days after the accident. | ||
| Am sorry that you got an accident (No matching questions found.) | Question | |
| Am sorry that you got an accident | Empathize | |
| Thanks. | ||
| And when did the headaches begin? (Clarified to When did the headache begin?.) | Question |
Review QuestionsActivity Time: 6 min
To assess spinal levels L2, L3 and L4 in Tina, which deep tendon reflexes would have to be tested?
Correct: The patellar deep tendon reflex involves the sensory and motor nerve fibers associated with spinal segments L2, L3, and L4. Location of abnormal reflexes may be helpful in identifying neurological pathologies of the spine.
- Achilles
- Biceps
- Patellar (Correct Response)
- Triceps
Imagine that you were preparing to irrigate a Foley catheter of a patient with a spinal cord injury at T4 in a urology clinic. Upon moving the leg bag, the patient became suddenly flushed and diaphoretic above the nipple line. What would you suspect was happening?
Correct: Autonomic dysreflexia is the sudden increase in blood pressure caused by dysregulation of sympathetic and parasympathetic nervous systems reacting to a noxious stimulus below the site of spinal injury. Other symptoms include bradycardia, anxiety, blurred vision, headache, flushing, and sweating. The noxious stimulus (pulling of the Foley catheter) should be alleviated to resolve the condition.
- Odynophagia
- Febrile reaction
- Idiopathic spinal reaction
- Autonomic dysreflexia (Correct Response)
Which of the following is not a common symptom of Parkinson’s disease?
Correct: Parkinson’s disease is characterized by tremors at rest, bradykinesia, cogwheel rigidity, postural instability, festination, lack of facial expression, reduced arm swing, autonomic and neuroendocrine dysfunctions, and a variety of psychological issues such as depression, anxiety, and sleep disturbances.
- Lack of facial expression
- Festination
- Cogwheel rigidity
- Intention tremors (Correct Response)
Name at least three ways to assess cerebellar function during a physical exam.
Student Response: Test cerebellar function by assessing gait and instructing the patient to perform the finger-to-finger, finger-to-nose, heel-to-shin, rapid alternating movements
Model Note: The cerebellum is responsible for smooth and accurate coordination of voluntary movements. You can test cerebellar function by assessing gait and by instructing the patient to perform the finger-to-finger, finger-to-nose, heel-to-shin, rapid alternating movements, and Romberg tests.
If Tina had a fever and photophobia, you would have had to test for meningitis. Describe how you would have tested for the Kernig’s sign.
LifespanActivity Time: 10 min
Tina’s three-year-old neighbor presents to the clinic with fever, neck pain, headache, and confusion. He has no symptoms of an upper respiratory infection. The parents mention that they do not believe in immunizations. Based on the information given, what diagnosis is of the greatest concern? What is your next action?
Student Response: Rule out bacterial meningitis, there was no immunizations to increase meningitis risk.
Model Note: Bacterial Meningitis needs to be ruled out immediately. He has not had immunizations which puts him at increased risk for meningitis from Haemophilus influenzae type B. Seizure disorder does not cause fever. Children with immunodeficiency syndrome are at increased risk for meningitis but this child has no previous history of chronic infections. Although children with strep throat can present with fever and neck pain, they are not confused. He needs an immediate spinal tap to determine the nature of the meningitis, and broad spectrum antibiotics should be started as soon as possible. He should be sent to the emergency room.
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Tina’s 83-year-old great uncle forgets where he is during his yearly check-up. He doesn’t remember if he’s had memory problems before and no family members came to your office with him. List your differential diagnosis. What assessments would you perform?
Student Response: Differential diagnosis include stroke…