Writing Homework Help

Help me study for my Nursing class. I’m stuck and don’t understand.

41-Year-Old Patient Evaluation and Management Plan

Question 1

Lateral epicondylitis is a clinical diagnosis. The diagnosis is primarily made by use of three tests specific for the condition during physical examination. The tests whose positive findings can confirm the diagnosis for lateral epicondylitis are Cozen’s test, Mill’s test, and Maudsley’s test. Cozen’s test is positive if the pain is elicited on the lateral epicondyle when a patient tries to dorsiflex the wrist against resistance to that movement. A positive Mill’s test is when patients feel pain as they try to do a passive wrist flexion and pronation with an elbow in an extended position. Maudsley’s test I positive when a patient feels pain on the lateral epicondyle when they try to extend the third digit against a resistance. Postie findings for these tests are usually confirmatory for lateral epicondylitis (Ma and Wang, 2020). However, imaging techniques such as ultrasound, x-ray, and MRI can be used to rule out other differential diagnoses.

Question 2

Hypothetically, the patient is an undocumented immigrant. Based on the daughter’s response, she may be worried about the consequences that the patient and the entire family may have if they are found out to be working for a local construction company. An undocumented immigrant may not have the legal protection of working in the country. The patient may also not want to involve the construction company because this would mean the possible loss of a source of livelihood if the company decided to terminate his employment.

Question 3

Ma and Wang (2020) pointed out that besides the mentioned tests done as part of the physical examination, palpation of the lateral epicondyle is another assessment that can be performed on this patient. Palpation of the affected elbow will elicit localized tenderness. The tenderness may also be experienced below the lateral epicondyle. The range of motion of the elbow joint and flexibility can also be assessed. A neuromuscular examination such as forearm muscle strength using a grip test can be done.

Question 4

According to Ma and Wang (2020), lateral epicondylitis is treated conservatively. Some of the recommended treatment approaches include activity modifications and analgesics, commonly NSAIDs. Physical therapy is also recommended to maintain joint function. A patient can be asked to wear a counter-force strap to protect themselves from recurrent injury to the common extensor tendon. Steroid injections to the site of injury can be administered to reduce inflammation. Other complementary approaches are acupuncture and iontophoresis. In severe cases, operative management can be instituted, and it involves repairing the extensor carpi radialis brevis origin.

Question 5

These patient reactions may suggest that they are uncomfortable. There might be a misunderstanding between them and the clinician due to the language barrier and possibly due to cultural differences. Under these circumstances, it may be necessary to involve a certified professional interpreter who can facilitate clear communication. Proper communication can alleviate anxiety and help build a trusting therapeutic relationship with the patient. Undocumented immigrant workers may have some level of mistrust in the healthcare providers because of fear of being reported to authorities (Samra et al., 2019). As such, I would reassure the patient and daughter of confidentiality and that information about their condition and immigration status will not be shared with authorities. Such reassurance can help gain their trust and result in healthcare provider-patient collaboration, satisfaction, and treatment adherence.

References

Ma, K. L., & Wang, H. Q. (2020). Management of Lateral Epicondylitis: A Narrative Literature Review. Pain research & management, 2020, 6965381. https://doi.org/10.1155/2020/6965381

Samra, S., Taira, B. R., Pinheiro, E., Trotzky-Sirr, R., &Schneberk, T. (2019). Undocumented Patients in the Emergency Department: Challenges and Opportunities. The western journal of emergency medicine, 20(5), 791–798. https://doi.org/10.5811/westjem.2019.7.41489