You are the RN at the local clinic; NR is a 41 year-old Caucasian female and single mother of 3 who presents with a “pounding and throbbing” headache, the third of its kind within the past month. She works part-time at Walmart and is taking nursing courses in the evening. She denies alcohol, tobacco or illegal drugs. She sleeps about 5 hours each night, admits to poor eating habits-drinking 3-4 cups caffeine, and eating candy “more than she should”. NR describes her pain as being localized to the right temple, increasing in intensity over the past hour rating her pain as a 9 out of 10. She also complains of non-radiating neck pain and states the bright lights in the clinic make her feel worse as she now feels nauseous and dizzy though she has not vomited. Lying in a dark quiet room makes her feel better. Sometimes taking ibuprofen 600mg also helps though her last dose was yesterday. She denies any previous medical history, has never been hospitalized except for childbirth (uncomplicated vaginal deliveries x3), no surgical history, no significant family history.
Assignment
instructions:
Use
the above information to completethe
following questions.
- For the subjective data section of the patient’s medical record what information from above would you include? (5 points)
- What additional questions would you want to ask to obtain any missing data to analyze NR’s symptoms? (5 points)
- As you begin your neurological assessment on NR you start with determining NR’s level of consciousness. To do this you perform the Glasgow Coma Scale. Describe the Glasgow Coma Scale and its components. (10 points)
- How is the Glasgow Coma Scale helpful in the overall assessment of NR? (5 points)
- As you obtain your objective data on NR you decide to continue your physical examination by assessing the intactness of her cranial nerves. Describe why performing a cranial nerves assessment on this patient would be appropriate in a clinical setting. (5 points)
- As you continue to obtain your objective data on NR your next step is to assess her sensory perception. Provide a detailed description on the assessment techniques you would utilize on NR to assess the intactness of her sensory perception. (10 points)
- Next, you assess NR’s motor system. As part of this assessment you include muscle tone and reflexes. NR asks why it is important to check all of her reflexes. Provide a detailed description of the assessment of deep tendon reflexes (DTRs) and what the importance is of including them in a neurological assessment, what information do they provide? Be prepared to demonstrate DTRs to your peers. (15 points)
- Lastly, you assess NR’s cerebellar function as part of her neurological assessment. Provide a detailed description of the techniques used to assess cerebellar function. (10 points)
- You have now completed your neurological examination on NR. However, based on the information relayed in her “chief complaint” list any additional body systems you would want to assess given the data provided by NR and in the background section above. (5 points)
- The care provider assesses NR and diagnoses her with a “migraine headache”. Describe the pathophysiological process that occurs with Migraine headaches. (You will need to utilize additional resources to answer this question i.e. texts from other courses, library texts, online resources etc). (15 points)
- Now that you understand the pathophysiologic process of migraine headaches list at least four potential precipitating factors (causes) or contributing factors for the migraine headaches experienced by NR. (5 points)
- Discuss teaching strategies or realistic health promotion strategies that you could provide for NR that would help to prevent or lessen the recurrence of her migraine headaches. (10 points)
BONUS QUESTION: (additional 5 points)
- Lastly, now that you have reviewed this chapter and the neurological system, create an exam style question for your peers. This question should be an application styled question that if correctly answered allows for demonstration of knowledge in the clinical assessment of the neurological system. Include the correct answer and the rationale for why your answer is correct.
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