ihuman Case Study - Caleb Metz - 13yrs Old Male CC: Testicular Pain A+ Rated Solution Guid, Exams of Nursing

Download ihuman Case Study - Caleb Metz - 13yrs Old Male CC: Testicular Pain A+ Rated Solution Guid and more Exams Nursing in PDF only on Docsity! 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. AasouSY Do you have any pain in your abdomen? Assoc Sx __ Have you been having fevers? Do you have any problems with ARSON movement? Do you have any other Assoc Sx symptoms or concerns we should discuss? ‘Assoc Sx Do you have any pain in your back? a Have you had any trauma to Etiology your groin? Etiology How is your appetite? Any recent change? mo MVE ny owinaun. Wo, wows 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 I move or walk. Yes, a lot! | threw up once on the way here, | still fee! 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. OLD-CARTS for the HPI @ Asked ® Not asked Information Graded Approach Question Response Obtained Clinic Notes @ Onset wae did your testicular pain Two hours ago. | was playing basketball -- doing What are the events @ Onset surrounding the start of your aes Nothing extreme... then testicular pain? suddenly...wham, the pain came. out of the blue, Location Duration . What does your testicular pain Uh...really, really bad. Like | got @ = Characteristics fool like? a : @ Characteristics DPS your testicular paincome iy. it bad all the time. and go? Aggravating Reliving Timing/Treatments ‘ How severe (1-10 scale) is your +Maybe a 9? I have never had @ Severity testicular pain? anything like this before, PMH, FH, SH as Needed @ Asked @ Not asked information Graded Approach Question Response Obtained Clinic Notes @ PMH eee any prescription — iNo | don't take any pills. @ PMH Have you ever been diagnosed No, | don' think 50. Are you taking any over-the- | @ PMH counter or herbal medications? fe @ PMH Do you have any allergies? I'm pretty sure | don't. e SH see is your family and family Pretty good, | guess. nl You're crazy. I'm a kid? That's a @ su Are you sexually active? ‘quent: e FH Are there any diseases thatrun Dad takes something for his in your family? blood pressure, but that's it. Review of Systems (ROS) Select the major body systems that have not been touched on during the interview process for the HPI. @ Asked ® Not asked Graded Question Response piblpnints fs Obtained Have you noticed any bruising, @ _ bleeding gums, nose bleeds, or Nope. other sites of increased bleeding? Do you have problems with heat or e cold intolerance, increased thirst, h ‘ increased sweating, frequent urination, or change in appetite? Do you have problems with dizziness, fainting, spinning room, seizures, weakness, numbness, tingling, or tremor? Do you have any problems with an itchy scalp, skin changes, moles, 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, unintentional weight loss or gain, fevers, or night sweats? Do you have any problems with headaches that don't go away with aspirin or Tylenol (acetaminophen), double or blurred vision, difficulty 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? Do you experience shortness of Nope. No, none of that stuff. Zz lope. What does any of that have to do with why my privates hurt? Nope. There's nothing wrong with my chest. That's not where it hurts! 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 e 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 otrusion at the deep inguinal ring d through the inguinal canat Fypically a congenital detect resulting om failure of the processus vaginalis Indirect inguinal Direct inguinal Femoral « Abdomen lean, muscular, nondistended e No visible herniation Review the pathogenesis of the 3 demonstrated types of inguinal herniation: « Indirect ¢ Direct « Femoral Kams bdomen - palpate abdomen ¢ Soft, nontender to palpation « No organomegaly; no abdominal or inguinal mass Exams Abdomen - percuss abdomen « 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 @ ~—= Caucasian race oO Ages 12-25 Se Family history e@ Undescended testicles | 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. (FY! actual rate: 18) x BP: Incorrect assessment, correct is normal. (FYI 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 XiIncorrect 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: Incorrect 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. Ramindar: Finalize the ranking of your corrected DDx. Rank the differential diagnose. diagnosis represents a must-not-miss (MnM) diagnosis or condition. Tela a SC lil t Differential Diagnosis Lead orAlt | MnM ial __ testicular torsion @ - e ? hernia, inguinal - @ & ial __ torsion of testicular appendage - @ ® . appendicitis - @ e urolithiasis - @ ° epididymitis - @ 6  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 XX 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 O0000 Nephrolithiasis 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 0/'0|0/0/0 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 Nephrolithiasis O0e 00 e 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. 1of4 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 @ (arours: | © x 12 hours oO | 24 hours Oo | 48 hours 214 tmstPo Eos ats Febliack ‘ni yh pe ing pitt CP enna @orrmct B Mroeng X incorvecs Discussion Youre raged Chance oe Ast a we ant ele ran as ean Oo @ te 4of4 Index of Plan Exercises At this point in the case, what is the most appropriate choice of analgesics? @ Correct ® Missing X Incorrect Yours Graded Choice | | oO | | Acetaminophen O Oral oxycodone © oe IV morphine Oo Ibuprofen oO Analgesics may mask symptoms and should be avoided