Lesson 2.1
- What are the red flags of back pain that must be considered in the management of any patient?
The red flag symptom is pain. The details are antecedents of minor or major pain, MVA occurrence or heavy lifting (Bigos et al. 1994; Jackson & Browning, 2005; Chou et al., 2007; Leerar et al., 2007). The red flag symptom is chronological age. There is an augmented hazard of cancer resulting from aortic aneurysm (Bigos et al. 1994; Jackson & Browning, 2005; Chou et al., 2007; Leerar et al., 2007). The red flag is antecedents of cancer. There is the possibility of tumors which are metastatic which originate in the lung, breast, prostate, thyroid and kidney area. The red flag symptom is elevated temperature and nocturnal sweating. The patient’s bodily temperature is in excess of normal body temperature. In these circumstances, there is an augmented hazard of cancer or infection (Bigos et al. 1994; Jackson & Browning, 2005; Chou et al., 2007; Leerar et al., 2007).
The red flag symptom is loss of body weight with a weight loss of more than 4.54 kg in 90 day period. There is an augmented possibility of cancer. The red flag symptom is a recent infection. The urinary tract may be infected. There is a suppression of the immunological matrix. This suppression may be the outcome of steroid ingestion, drug abuse or surgical transplant. There may also be an augmented hazard of aortic aneurysm or cancer (Bigos et al. 1994; Jackson & Browning, 2005; Chou et al., 2007; Leerar et al., 2007).
Additional red flag symptoms may be a bladder dysfunction with hematuria, dysuria and urinary incontinence. There may be Cauda aquina dysfunction. Cauda aquina may also cause a lack of sensation in the lumbar areas. There may be slight trauma during sleep. This is a resuilyt of the lack of sensation in the 2nd and 5th sacral nerves (Boissonnault 1995).
2. What is Cauda equina? How do you know if a patient has it?
Cauda equina dysfunction (CES) is a serious dysfunction which results in diminished function of the lumbar area and the corresponding nerve roots and the spinal conduit which is beneath the end of the spinal cord. Cauda equine dysfunction is a laceration of the neurons which govern the lower motor area.
The manner in which Cauda equina dysfunction manifests itself is a lack of strength in the muscles which administrate the lower lumbar area which are aggravated by the compacted lumbar roots. This condition is recognized as often paraplegia. Cauda equine dysfunction is also characterized by a lack of strength in the detrusor area which caused the patient’s urine to be retained. There is also augmented fecal continence, sexual malfunction, lack of sensation in the lumbar area. The symptoms also include sciatic trauma, lack of strength and the inability of maintaining an ankle reflex. There may be no trauma manifested, the patient may indicate urinary incontinence.
3. What might cause a patient to be more susceptible to a vertebrate fracture?
The causal attributes of increased sensitivity to a vertebrate fracture is that may be Cauda equina. Cauda aquina carries an increased risk of osteoarthritis. This is particularly valid for cases where the patient is affected in the knee area, hip areas and lumbar areas. The formation of the red flag symptoms which are indicated may elevate the health care practitioner’s awareness of the diagnosis of Cauda equina (Leerar et al 2007).
Lesson 2.2
Conceptual Mapping
Approximately 1% of the population manifests symptoms of bipolar disorder at some period in their lifespan. Bipolar disorder usually initiates subsequent to adolescence. It is extraordinary for bipolar disease to begin manifesting symptoms during the middle maturity years. Males and females are equally affected by bipolar disorder.
The classifications of bipolar disorder are the following:
In bipolar disease type I and type II, the patient suffers from a minimum of one manic episode. Depression may follow the manic episodes. The disorder may be hereditary. There may be a malfunction with the segment of the cerebral cortex which administrates emotive expressions. The treatment for bipolar disease type I is Lithium, Olanzapine, Sodium Valproate. The treatment for bipolar disease type II is Lithium, Olanzapine, Carbamazepine, Quetiapine, Risperdone.
- What medications might be considered as a treatment for this patient and why?
Bipolar depression is characterized by mood swings. The sensations which the patient may experience are reliant upon the direction which their emotive aspect has demonstrated itself. The depressive aspects which accompany the manic episodes in bipolar disorder are characterized by the following:
• Sentiments of malcontent which persist.
• Sensations of wishing to cry deeply for no apparent cause.
• Lack of interest.
• Inability to enjoy simple things and events.
• Sensations of restlessness and agitation.
• Difficulty in maintaining a sound sleep.
• Difficulty in initiating or completing tasks.
• Irritability.
• Extreme happiness and enthusiasm.
• Experiencing audio hallucinations
• Mood swings.
• Lack of interest in sex (Royal College of Psychiatrists, 2013).
The medications which may be applied in the treatment of bipolar disorder are Lithium, Sodium Valproate, Olanzapine, Carbamazepine and Lamotrigne. Women who are within the child bearing years should avoid ingesting Sodium Valproate. Carbamazepine may be effective for L.R. is the frequency of her mood swings increases (Royal College of Psychiatrists, 2013) Quetiapine and Risperdone may also be effective in diminishing the impact of the mood swings that L.R. is experiencing (NIMH, 2011).
Lesson 2.3
The red flags may be hip pain, difficulty in walking. This may be accompanied by shoulder pain, knee pain or ankle pain. There may be direct contamination from surgery or trauma, continuous spread and hematogeneous (most commonly encountered in children). There may have been recently performed surgery, varicella zoster infection or a urinary tract infection (Ota, 2002; Dodwell, 2013)
- What other differentials might be concerning this patient? What is the pathophysiological basis of your answer?
Septic arthritis usually refers to the bacterial invasion of the voids between the joints. This lining of a histologic aspect is quite vascular and is deficient of a basement membrane. The areas which contain tissue develop a fluid which is synovial. This is a viscous means which possesses an electrolyte concentration and a glucose concentration which is identical to the qualities of plasma. This fluid behaves in the capacity of being a lubricant to the neighboring cartilage. When this fluid is infected by bacteria, the bacteria are able to thrive in this area (Ota, 2002; Dodwell, 2013).
The enzymes of a proteolysis nature which are produced by bacteria and cytokines of an inflammatory aspect produce damage to the cartilage which is articular. This development occurs during the initial stages of the bacterial invasion. The outcomes of the bacterial invasion may be that the articular superficial areas are vulnerable to subsequent degenerative joint dysfunction. In addition, the inflammation of the capsule which contains the joint can cause a predisposition to the femoral cap for avascular necrosis which is a causal attribute of the epiphysis of the femoral head. The movement of superimposition may be an outcome of the augmented pressure from the intracapsular area (Ota, 2002; Dodwell, 2013).
A significant concept which must be acknowledged is that the process of swelling and the damage which is incurred by the tissues may continue. Notwithstanding, this may occur subsequent to the eradication of the causative organisms. When children are afflicted with septic arthritis, there is pain demonstrated in the regions which are affected. This is an outcome of the extension of the joint capsule which results from an effusion or edema. The joint trauma may be manifested as an avoidance of the walking activity, to carry a load upon the joint or to conduct activities which involve the limb which has been affected (Ota, 2002; Dodwell, 2013).
- How does the age of the patient help you to narrow the final diagnosis?
The primary routes for the bacteriological infection of the joint areas are the following: direct contamination from a medical process of trauma, a continuous spread and hematogeneous, which is most commonly encountered in cases involving children. The volume of the blood transfer to the synovial areas is elevated; it is similar to the volume of blood transfer which occurs in the cerebral areas. The moving bacteria may be a causal attribute to an elevated quantity of organisms which are conveyed to this area. The bacteria which have been evacuated of the synovial macrophages may be overcome in the event of being presented with an elevated volume of organisms (Ota, 2002; Dodwell, 2013).
The children may manifest a feverish state and may demonstrate an appearance which carries from wellbeing to being toxically affected. The antecedents of trauma of infections of the upper respiratory area often precede this condition. These symptoms may cause the health care practitioner to misdiagnose the septic arthritic condition of the child. Septic arthritis may be a secondary effect from having surgery recently performed a bacteriological invasion from the virus which has the aspect of varicella zoster and infections of the urinary tract. The bacteriological invasion from the varicella zoster virus may be an outcome or the secondary effects upon the skin of the group A strep or Staph aureus (Ota, 2002; Dodwell, 2013).
References
Bigos, S., Bowyer, O, Braen, G., Brown, K., Deyo, R., Haldeman, S. (1994). Acute Low back problems in adults, Clinical Practice Guideline No. 14, AHCPR Publication No. 95- 0642, Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services.
Boissonault, W.G. (1995). Examination in Physical therapy practice: Screening for M Medical Disease, 2nd Ed. New York: Churchill Livingston.
Chou, R., Qaseem, A., Snow, V. Casey, D., Cross, J. Thomas Jr. & Owen, D.W. (2007). Diagnosis and treatment of lower back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society, Ann. Intern. Med., 147: 478- 491.
Dodwell, E. R. (2013). Osteomyelitis and septic arthritis in children, Current Opinion in Pediatrics, 25(1): 58-63.
Jackson, J. L. & Browning, R. (2005). Impact of national low back guidelines on clinical practice, South Med J, 98(2): 139- 43.
Leerar, P., Boissonnault, W., Domholdt, E & Roddey, T. (2007). Documentation of red flags by physical therapists with low back pain, The Journal of Manual & Manipulative Therapy, 15(1): 42- 49.
National Institute of Mental Health (2011). What is Bipolar disorder? Washington, DC: National Institute of Health. http://www.nimh.nih.gov/health/topics/bipolar-d disorder/index.shtml
The Royal College of Psychiatrists (2013). Bipolar Disorder. London: The Royal College of Psychiatrists. http://www.rcpsych.ac.uk/expertadvice/problems/disorders/
Ota, F. (2002). Cased based pediatrics for medical students and residents, Chap XIX.5, S Septic Arthritis, Department of Pediatrics, University of Hawaii John A. Burns School of Medicine.
