Caleb Metz week # 10 A 13 Year Old Boy With Testicular Pain Screenshorts Latest Version, Study Guides, Projects, Research of Nursing

Download Caleb Metz week # 10 A 13 Year Old Boy With Testicular Pain Screenshorts Latest Version and more Study Guides, Projects, Research Nursing in PDF only on Docsity! Caleb Metz week # 10 A 13 Year Old Boy With Testicular Pain Screenshorts Latest Version 2024 Ihuman Case Study Case Instructions eS H&P+Dx CASE PLAY SETUP AND INSTRUCTIONS MODE: This assignment is in Leaming Mode, Feedback appears after submitting each section, and a final Performance overview is generated after completing the case. i-Human Case Week #10 ATTEMPTS AVAILABLE: 13 ylo 5'5" (165 cm) © You are permitted 1 attempt for this assignment. 120.0 Ib (54.5 kg) Reason for encounter testicular pain GRADING RUBRIC: * History 40% + Physical exam 40% Case authored by: Allison Tadros, MD Skin: warm, mildly diaphoretic. Pain in private parts Vomiting once on the way to clinic Pain down low in stomach and private parts Pain started two hours ago. Caleb Metz 13 y/o 5'5" (165 cm) 120.0 Ib (54.5 kg) Chief complaint testicular pain Skin: warm, mildly diaphoretic. Pain in private parts Vomiting once on the way to clinic Pain down low in stomach and private parts Pain started two hours ago. Assoc Sx Do you have any pain in your abdomen? Assoc Sx Have you been having fevers? ‘Assoc Sx _ bad pave any problems with Do you have any other Assoc Sx — symptoms or concerns we should discuss? ‘Assoc SX na in have any pain in your Etiology voreen any trauma to Etiology How is your appetite? Any recent change? OLD-CARTS for the HPI @ Asked @ Not asked Graded Approach Question When did your testicular pain Onset start? What are the events Onset surrounding the start of your testicular pain? Location Duration What does your testiculer pai Characteristics fee! like? Characteristics and go? Does your testicular pain come Ly Serie here low on the left. My dad keeps calling it my "groin". It really hurts. No. It doesn't feel like it. Oh, you mean does it hurt my privates when | move or walk. Yes, a lot! | threw up once on the way here, | still feel really sick. No, it's all here in the front. Like, did | get hit playing basketball? No, | don't think so. It was OK this morning, but | don't feel hungry now. Information Obtained Clinic Notes Response Two hours ago. | was playing basketball -- doing lay-ups. Nothing extreme... then suddenly...wham, the pain came out of the blue. in Uh....reallly, really bad. Like | got punched. No. It's bad all the time. Aggravating Reliving Timing/Treatments @ Severity testicular pain? PMH, FH, SH as Needed @ Asked @ Not asked Graded Approach Question Ave you taking any prescription ® PMH medications? Have you aver been diagnased @ PMH with ahernia? Ave you taking any over-the- @ PMH counter or herbal medications? e PMH Do you have any allergies? How is your family and family os life? e SH Ave you sexually active? Are there any diseases that run ® i in your family? Review of Systems (ROS) How severe (1-10 scale) is your Maybe a 9? | have never had anything like this before Information Obtained Clinic Notes Response No, | don't take any pills. No, | don't think so. No. I'm pretty sure | don't. Pretty good, | guess. You're crazy. I'm a kid? That's a weird question. Dad takes something for his blood pressure, but that's it. Select the major body systems that have not bean touched on during the interview process for the HPI @ Asked @ Not asked . Information Obtained Graded Question Response Clinic Notes Have you noticed any bruising, eo bleeding gums, nose bleeds, or Nope. other sites of increased bleeding? Do you have problems with heet or cold intolerance, increased thirst, e Nope. increased sweating, frequent urination, or change in appetite? Do you have problems with dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, or tremor? Nope. Do you have any problems with an itchy scalp, skin changes, moles, No, none of that stuff. thinning hair, or brittle nails? Do you have any problems with nervousness, depression, lack of interest, sadness, memory loss, or mood changes, or ever hear voices or see things that you know are not there? Do you have any problems with fatigue, difficulty sleeping, What does any of that have to do unintentional weight loss or gain, with why my privates hurt? fevers, or night sweats? Nope. Do you have any problems with headaches that don't go away with aspirin or Tylenol (acetaminophen), double or blurred vision, difficulty Nope with night vision, problems hearing, . Do you experience chest pain discomfort or pressure; pain/pressure/dizziness with exertion or getting angry; palpitations; decreased exercise tolerance; or blue/cold fingers and toes? There's nothing wrong with my chest. That's not where it hurts! Do you experience shortness of breath, wheezing, difficulty catching No. your breath, chronic cough, or . sputum production? Exams Chest Wall & Lungs - percuss - anterior & posterior chest « The anterior lung fields are resonant « The left anterior chest (heart) and right lower chest (liver) are dull to percussion « The rest of the lung fields are resonant and are not hyper-resonant Exams Neck - inspect neck e No visible scars, deformities or other lesions * Trachea is midline and freely mobile « No asymmetry or accessory respiratory muscle use with quiet breathing MALE INGUI edial to the inferior vessels through an acquired in the abdominal wall 's triangle). May occur in Indirect inguinal Direct inguinal Femoral « Abdomen lean, muscular, nondistended ¢ No visible herniation Review the pathogenesis of the 3 demonstrated types of inguinal herniation: ¢ Indirect ¢ Direct « Femoral cams bdomen - palpate abdomen * Soft, nontender to palpation e No organomegaly; no abdominal or inguinal mass Exams Abdomen - percuss abdomen e Abdomen normal to percussion  3of3 Index of Physical Exam Exercises Which of the following are risk factors for testicular cancer? (Select all that apply.) @ Correct ® Missing X Incorrect Yours Graded Choice e Caucasian race Oo Ages 12-25 e Family history @ —_Undescended testicles Oo Smoking Oo Bike riding Scoring: Your score will be 0 if you select more than the number of correct choices. Expert Feedback Vitals Documentation: @ Pulse: Good, all correct. (FYI actual rate: 120) @ Respiration: Good, all correct. (FYI actual rate: 18) x BP: Incorrect assessment, correct is normal. (FY! actual BP: 130/70) @ Mental Status: Good, all correct. Exam Documentation: @ Lung Auscultation: Good, all correct. © Cardiac Auscultation: Good, all correct. @ Eyes - Pupils: Good, all correct. Exams Performed: @correct Good job, you performed all appropriate : 1. Vitals: Temperature (provided) 2. Vitals: Skin (provided) 3. Vitals: Pulse 4. Vitals: BP 5. Chest Wall & Lungs: auscultate lungs 6. Heart: auscultate heart 7. Abdomen: auscultate abdomen 8. Abdomen: visual inspection abdomen 9. Abdomen: palpate abdomen 10. Abdomen: percuss abdomen 11. Lymphatic: palpate all lymph nodes 12. Genitourinary: genitourinary male exam You also performed additional exams that were not required, but are never inappropriate. 1. Vitals: SpO2 (provided) 2. Vitals: SpCO (provided) 3. Vitals: eTCO2 (provided) 4. Vitals: Respiration XIncorrect You performed 16 exams not required by expert. 1. Vitals: Mental Status 2. HEENT: examine pupils 3. Neck: auscultate carotid arteries 4. Abdomen: auscultate abdominal/femoral arteries Exam Performance: XIncorrect You made 2 errors performing some exams: 1. Did not auscultate the anterior in the correct order. 2. Did not auscultate the posterior in the correct order. RDamindar: Finalize the ranking of your corrected DDx. Rank the differential diagnose: diagnosis represents a must-not-miss (MnM) diagnosis or condition. Yel a ash ae) 4 : Differential Diagnosis Lead orAlt | MnM ial _ testicular torsion @ - e@ ; hernia, inguinal - @ e ial torsion of testicular appendage - @ . . appendicitis - @ e urolithiasis - @ ° epididymitis - @ e  Test/Diagnosis Association Association of test with diagnosis: @ Correct X Incorrect ® Missing Other Tests testicular torsion X scrotal ultrasound @ scrotal ultrasound, doppler hernia, inguinal X abdomen CT @ CT abdomen/pelvis without contrast X CT abdomen/pelvis with IV contrast torsion of testicular appendage  Association of test with diagnosis: @ Correct X Incorrect @ Missing @ scrotal ultrasound, doppler X scrotal ultrasound appendicitis @ complete blood count (CBC) @ CT abdomen/pelvis without contrast X urinalysis (UA) urolithiasis @ urinalysis (UA) @ CT abdomen/pelvis without contrast epididymitis epididymitis @ urinalysis (UA) X scrotal ultrasound, doppler 4of6 Index of Diagnosis Exercises What diagnosis is the Prehn's sign associated with? ®@ Correct ® Missing X Incorrect Yours Graded Choice Testicular torsion e@ Epididymitis Appendicitis Torsion of the testicular appendage Nephrolithiasis 0\/0'0'0|0 5of6 Index of Diagnosis Exercises What diagnosis is hematuria associated with? @ Correct ® Missing X Incorrect Yours Graded Choice Testicular torsion Epididymitis Appendicitis Torsion of the testicular appendage @ Urolithiasis Oo0000 x 6o0f6 Index of Diagnosis Exercises What diagnosis is Rovsing’s sign associated with? @ Correct ® Missing X Incorrect Yours Graded Choice Testicular torsion Epididymitis Appendicitis Torsion of the testicular appendage OO0G00 e Nephrolithiasis Plan Initially, medications for pain management will be given to the patient. Manual reduction can be considered as an initial management. As testicular torsion is a medical emergency, the patient will be referred to urologist for surgical correction. Pain and edema management after surgical procedure can be done. pLan Gloria Pain management will be the initial step. Nothing from mouth will be given to the patient. IV morphine can be given. Testicular torsion is a medical emergency therefore, the patient will be immediately referred to urologist. manual reduction and surgical correction are two processes. Manual reduction can be done however, surgical detorsion is required to prevent future testicular torsion. 1 of 4 Index of Plan Exercises Salvage rates for testicles in cases of testicular torsion drop off after how many hours? ®@ Correct ® Missing X Incorrect Yours Graded Choice Oo @ 6 hours © x 12 hours oO 24 hours oO 48 hours 2014 Testicular torsion shoule be canfrmed by ulrascund pir to taking a pata tothe OR? © consct ® Massing X Incorrect Yours |Gradea [choice oO x me O @ fase 4o0f4 Index of Plan Exercises Expert's Feedback tocxroct Discussion patent whohas a cassie pesentatan of testicular tarsion should got the CR for explration of the scrotum, 2s m-astabishment af perfusion to th tostice may be dolayed by abaining an ultrasound, In fquitocal cases onthe sation in whic the ulrasoind canbe obtaned queky Whi wating fr the Uuoogist to ave, obiaiing an ultrascund may be apfropriate At this point in the case, what is the most appropriate choice of analgesics? @ Correct ® Missing X Incorrect Yours Graded Choice IV morphine Ibuprofen oo00o00 e Acetaminophen Oral oxycodone Analgesics may mask symptoms and should be avoided