Nursing

Question I

According to her symptoms, she might have Rotator Cuff Tendinitis, which is the most common disorder of the shoulders where an inflammation forms in the tendon of the rotator cuffs. She might also have Subacromial Bursitis which has the same symptoms as Rotator Cuff Tendinitis, but its inflammation is in the bursa. In addition, there is a likelihood of her having Rotator Cuff Tears which occur after a long term wear in the shoulder or untreated tendinitis. Lastly, she might have Calcific Tendinitis which also has the same symptoms, and is mainly found in women who have sedentary jobs and is mainly caused when tissue deposits form in the subacromial leading to pain and limited movement of the shoulder (Kahn & Yinfei, 2018). 

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Question II

I would order medication for pain relieving and swelling. Also an image scan to check if her shoulder is fractured, if so I would order a sling for her to wear to reduce straining the arm. I would also order for imaging tests to check image structures of the affected area (Kahn & Yinfei, 2018).

Question III

I would ask Mrs. Johnson about her medical history of her shoulder and also whether she has the proper beddings because poor sleeping positions and sleeping on worn out mattresses is also likely to cause shoulder pains. 

Question IV

The two areas of concern in the x-ray are the rotator cuff and the bursa. The x-ray shows inflammation in the tendon of the rotator cuff which causes tendinitis and inflammation on the bursa (subacromial bursitis) which are both caused by rubbing of the tendon on the soft tissues causing them to wear and tear. The rotator cuff and bursa are characterized by the movement of the shoulder (Kahn & Yinfei, 2018).

Question V

The musculoskeletal system consists of the muscles, bones, tendons, bursa, ligaments and joints (Mansion, Isenberg, Chambers, Shipley & Merill, 2014). These parts connects muscles to bones, they enable movements of the body and connects the end of the bones to form joints. In Mrs. Johnson’s case, her x-ray shows that she has a dislocation and an improper hyper-extension and hyper-flexion since it’s quite hard for her to move her arm and shoulder without feeling pain. The inflammation is causing the soft tissues of her shoulders to wear and tear with every movement hence causing her pain (Gatchel & Schultz, 2015).

Question VI

The symptoms to expect from this disorder include; tight shoulders, having clicking sounds when raising the arm, being sour on the neck and also having difficulties moving the neck and turning the head, having severe headaches, pain in the neck, shoulder and upper arm and tenderness in the shoulders. In case of a fracture, one might notice a deformity on the shoulder in form of a bump, and also the upper arm might change its skin color to pinkish-purplish. One is likely to feel a pinching pain while moving the arm or an ache deep in the shoulder. All these are accompanied by arm weakness and loss of arm mobility (Kahn & Yinfei, 2018). With a thorough history and physical examination, one is likely to find unexplainable injuries, abnormal upper extremity or an abnormality with the cervical spine. In addition, one may find lesions on the skin around the affected area and even a gross deformity indicating dislocation (Mansion, Isenberg, Chambers, Shipley & Merill, 2014).

Question VII

Mrs. Johnson’s diagnosis must be Rotator Cuff Tendinitis. This is because her tendons are irritated that’s why she is experiencing pain, and it can also be activities that involves one lifting an arm over the head, which is exactly what she used to do when she worked at the factory. Her symptoms too lead to rotator cuff tendinitis that is pains and swelling in the shoulder, stiffness of the shoulder (Kahn & Yinfei, 2018). 

Question VIII

The information I would like to get from a conversation with Mrs. Johnson is; her medical history concerning the shoulder, her daily activities to know whether she strains too much or she is too sedentary. I would also want to know whether she gets any unusual headaches, also whether she has comfortable sleep accessories and whether she has fallen or hit her shoulder before. Lastly, I would want to know the ways of shoulder self-care she uses. 

Question IX

Mrs. Johnson probably has a medical history of a fractured neck or a fractured shoulder where the tissues of her shoulder did not heal properly, which was made even worse by the pressure she input on her shoulders while carrying boxes at the factory which caused them to wear out even more. 

Question X

Additional imaging tests will also be done which include; x-rays – to be able to see any bone spurs and the causes of pain, ultrasound – to be able to check images of structures in the body, to assess them and also to differentiate between the affected area and the none-affected. Lastly, a magnetic resonance imaging will be done to help get the structures of the affected area in great detail and also to check for damage in the soft tissues. (Gatchel & Schultz, 2015). 

Question XI

I would refer her to a physical therapist, to help her with stretching and exercises to help bring back energy to the muscles. Just in case the nonsurgical treatment is unsuccessful and the shoulder still dislocates, I will recommend rotator cuff surgery to ensure full recovery. This means that I will refer her to an Orthopaedic surgeon (Gatchel & Schultz, 2015). 

REFERENCES

Gatchel, R. J. & Schultz, I. Z. (2015). Handbook of Musculoskeletal Pain and Disability Disorders in the workplace. New York: springer publishers.

Kahn, S. B. & Yinfei, R. (2018). Musculoskeletal sports and spine disorders: A comprehensive guide. New York: springer publishers. Mansion, J. J., Isen berg, D., Chambers, S., Shipley, M. E., Merill, J. T. (2014). Rapid review of rheumatology and musculoskeletal disorders. Boca Raton: CRC press.

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