Discussion Assignment:

Respond to the following Case study:

Explain how you might apply knowledge gained from the Response case studies to your own practice in clinical settings.

· Share additional interview and communication techniques that could be effective with your colleague’s selected patient.

·  

· Suggest additional health-related risks that might be considered.

·  

· Validate an idea with your own experience and additional research.

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· Explain your reasoning using at least TWO different references from current evidence-based literature in APA Format.

Case Study: Knee Pain

Patients Initial:  JD       Age: 15    Genders:  Male

S.
CC: “Knee pain”.
HPI: A 15 year old male who presents with dull pain started about 2 months in his both knees. Sometimes one or both knees click, and he also describes a catching sensation under the patella.  He is young soccer player.

· Location: One or both knees bilaterally

· Onset: Pain and other symptoms goes and comes back for about 2 months

· Character: Dull pain

· Associated signs and symptoms: Click and catching sensation under patella

· Timings: comes and goes

· Relieving factors: Rest

· Severity: 8/10 pain scale

Current Medications:  One Tylenol over the counter, 325 mg 6 hours for pain control

Allergies: No known allergies of medications, food or latex materials.

PMHx: JP has received all of the vaccines recommended to protect him from life-threatening diseases, meningococcal and papillomavirus vaccines per pediatrician’s recommendation. No major illnesses and surgeries in the past. His major issue is knee pain which bother him during soccer ball practice.

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Soc Hx:  JP is 9th grade first year of high school. He plays soccer when knee pain permits; does not smoke, no alcohol, lives with parents no siblings. He uses school bus to and from school. He uses seat belt while rides motor vehicles, does not use cell phone while driving. They have working smoke detectors in the house, help parent with house chores.

Fam Hx. JP’s mother (40 years old), father (46 years old), paternal grandfather (70 years old), PGM (66 yrs old), MGM (64 yrs old) MGF (71 yrs old). They all are healthy but little overweight.  MGF has minor joints pain; he takes extra strength 1 Tylenol at night so he can sleep well. JP is the only child (Ball et al., 2019).

ROS:

GENERAL: No fever, chills, weakness or fatigue

Musculoskeletal: Bilateral knee pain, click, and catching sensation under the patella. 

Skin: Intact around the knees bilaterally

Objective

Physical exam:

• Vital signs: BP 140/80, P      72, RR 16, temp  36.9C, O2 sat 100,  Wt 134.5 lbs, Ht       70”  BMI: 24.4
• General: Patient is      AA&Ox4, moderately appears ill because of knee pain otherwise appears      strong and healthy, genital are at adult size with pubic hair and spread      to the inner thigh’s, has deeper voice, weighs 170 lbs, ht. 70”, no fever,      no chills, no weakness, was happy to give information (Coguen, 2019).
• HEENT: Normocephalic, no      visual loss, pupils are normal in size and reactive to light, no ocular      discharge noted. No hearing loss. N o sneezing, congestion, no runny nose.      No sore throat (Ball et al., 2019).

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• Mouth: He has all teeth      without evidence of carries. There are no lesions present in the oral      cavity (Hui, 2015).
• Neck: On auscultation no      carotid bruits. No tracheal deviation noted. No masses palpated.  His      neck is supple and able to move all directions without resistant. There is      no erythema or tenderness of the nodes (Ball et al., 2019).
• Skin: JP’s skin is clear      of rash and lesions, it is warm to touch. There is no cyanosis of his      skin, lips, blond thin hair combed; he has good skin turgor on examination      (Ball et al., 2019).
• Nails: Pink, smooth, flat      with smooth edges and rounded (Ball et al., 2019).
• Cardiovascular: Regular      heart rate and rhythm, no murmur, gallops or rubs (Balls et al., 2019).
• Respiration:  Breath      sounds clear to auscultation in all lung fields. Diaphragmatic excursion      is symmetrical. No increased AP diameter (Ball et al., 2019).
• Abdomen: Soft, nontender.      No masses or organomegaly. Bowel sounds physiological in all four      quadrants. No guarding or rebound noted (Ball et al., 2019).
• Rectal/GU: Normal male      genitalia with full puberty. No burning on urination (Ball et al., 2019).
• Neurological: CN 11-X11      grossly intact. No focal neurological deficit noted (Ball et al., 2019).
• Musculoskeletal: No      clubbing, cyanosis, or edema, muscles are too tight below knees      bilaterally; upper extremities have good muscle bilaterally tone in all      extremities. Has full range of motion of all extremities without pain      except knees (Ball et al., 2019).
• Hematologic: No complaint      of bleeding, no bruises noted on the body (Ball et al., 2019).
• Lymphatic: There is no      erythema or tenderness of the nodes (Ball et al., 2019).
• Psychiatric: Appears      happy, no sign of depression, anxiety, nor autism (Ball et al., 2019).

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• Endocrinologic: HE denies      of sweating, cold or heat intolerance, polyuria or polydipsia (Ball et      al., 2019).
• Allergies: Not known of      any medication, food, and environmental allergies at this time (Ball et      al., 2019).

Assessment:

           JP’s complaint pain in front of knee pain bilaterally with squat, kneel, going down stairs. He feels of popping, grinding, slipping, or catching in knee cap when he bends or straighten his legs.  His thigh muscles bilaterally are slightly weak. His muscles are too tight, have a trace of edema bilaterally and he is overweight. JP’s knee cap are slightly misaligned; with palpitation femoral pulses are 2+ regular normal bilaterally with knee flexion, at the middle of posterior knee at popliteal fossa with tight hand (Sullivan, 2019).  

Diagnostic Results: MRI, Labs, x-rays might not show soft tissues of the knees, CT scan (black, 2016).

Treatment:  Often begins with simple measures. Rest the knees as much as possible. Avoid or modify activities that increase the pain, such as climbing stairs, kneeling or squatting.   Physical therapies will be ordered by physician upon diagnostic findings (Black, 2016).

Differential diagnoses
1. Patellar tracking disorder (PTD): PTD means that the knee cap (patella) shifts out of the leg bends of straightens. The knee cap sits in a groove at the end of the thigh bone. The thigh weak muscle, tendons, ligaments, or muscles in the legs that are too tight. The activities that stress the knee again and again, especially those with twisting motions (Black, 2015)

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2. Patellar tendonitis (PT): PT is a common overuse injury, caused by repeated stress on your patellar leading to injury to the tendon connecting your knee cap to your shinbone and pain is found in between that area. It is most common in athletes whose sports involve frequently jumping such as basketball and volleyball. At first be present only as you begin physical activity or just after an intense workout (Black, 2015).
3. Patellofemoral joint syndrome: It is one of the most common knee complaints of both the young active sports athlete and the elderly. It can be caused by overuse of the knee joints, physically trauma, or misalignment of the knee cap.  Patients may report a painful catching sensation and a painful giving way of the knee and is mainly due to overuse or a change in exercise intensity (Black, 2015).
4. Osteoarthritis: Obesity in children and adolescents has been linked to   musculoskeletal disorders, loss of flexibility, bone spurs, swelling, grating sensation. High-impact, high-intensity, and repetitive athletics have a strong association with the occurrence of osteoarthritis in teenagers (Black, 2015).
5. Bursitis:  Sudden inability to move a joint, excessive swelling, redness, bruising or rash in the affected area, sharp  or shooting pain, especially on exert. Bursa reduces friction and cushion pressure between your bones, tendons, muscles, and skin near your joints and inflamed pain is felt with activity or rest (Black, 2016).