Health Medical Homework Help

All replies must be constructive and use literature where possible.

• Yerenis Llanes.

Patient Evaluation & Management Plan

• Chronic pain at the lateral or medial epicondyle of the elbow is a relatively common condition, particularly among tennis players and golfers, respectively, and among manual laborers. Chronic pathologic changes in the tendon origins are associated with such pain, although the underlying causes remain unclear (Bickley, 2012). The pain is associated with a repeated extension of the wrist and pronation and supination of the forearm, particularly against resistance, which occurs in movements such as opening jars, hammering, and turning doorknobs. The common complaint is a pain in the elbow that radiates into the forearm.

We suspect the pain reported as coming from the elbow and radiating down the forearm is caused by repetitive motions, perhaps indicating lateral epicondylitis. What can you do to confirm this diagnosis? 

Mill’s test: The Patient is seated and the clinician palpates the patient’s lateral epicondyle with one hand while pronating the patient’s forearm, fully flexing the wrist, the elbow extended. A production of pain in the area of the insertion at the lateral epicondyle indicates a positive test.

While performing the physical examination, you ask the patient, through his daughter, if he has reported this injury to his employer, because the injury is most likely work-related. The daughter responded without consulting her father that this is an old injury that happened before he started working at his current place of employment. You could tell that she was becoming more distressed. What is the most likely explanation for her concern?

Unfortunately, undocumented immigrants, who occupy some of the most important jobs in our economy, face many injustices detrimental to their well-being. Exploitation in the form of strenuous physical work, long hours, and substandard wages are intensified by potential employer retaliation and encouraged by the deep-rooted influence of immigration law in labor dispute cases (Bickley, 2012). Intensified by anti-immigrant sentiment, these conditions promote negative mental and physical health outcomes in communities of undocumented immigrants, many of whom have already undergone a great amount of trauma.

Visual inspection reveals erythema around the affected area with no evidence of overlying skin lesions, scars, or deformities. What other assessments should you perform?

Upon assessment, the range of motion is generally normal, but caution is needed to rule out septic bursitis. We should assess for fever, redness, heat, and warmth at the site. We should also assess for decreased movement on passive elbow extension, wrist flexion, and ulnar deviation, and pronation. 

How is lateral epicondylitis treated?

Ice to affected are 

Rest 

NSAIDs

Splinting

Corticosteroid injection may be necessary.

Refer to physical and/or occupational therapy

Surgical procedures are a last resort

When discussing possible treatment approaches, you notice that the patient is very worried and seems to suggest to his daughter that they should leave. The daughter begins trying to explain why they have to leave right away. What would you tell the patient and his daughter to help them feel comfortable staying for treatment?

Decreased proficiency in the language of the host country and fear of deportation may also present barriers to health care for this type of patient. To provide the undocumented immigrant community with the tools of empowerment that they need, we must provide accessible services in a culturally sensitive manner (Fitzgerald, 2017. Patient and daughter should be explained that health care providers have no affirmative legal obligation to inquire into or report to federal immigration authorities about a patient’s immigration status. In fact, the Health Insurance Portability and Accountability Act (HIPAA) privacy rule generally prohibits the use or disclosure of patient information without the patient’s consent, except when required by law. 

References 

Bickley L. (2012). Bates’ Guide to Physical Examination and History Taking (9th ed.). Lippincott Williams & Wilkins.

Fitzgerald, M. A. (2017). Nurse Practitioner certification examination and practice preparation (5th ed.). F.A. Davis Company.