6512 Week 9 Ihuman Neck Pain

6512 Week 9 Ihuman Neck Pain

History Questions

1. What is your name?
2. How can I help you today?
3. Do you have any other symptoms or concerns we should discuss?
4. What happened?
5. When did your neck pain start?
6. What does your neck pain feel like?
7. How severe (1-10 scale) is your neck pain?
8. Does your neck pain come and go?
9. What are the events surrounding the start of your neck pain?
10. Does anything make your neck pain better or worse?
11. Where more precisely is your neck pain?
12. Have you had any trauma to your head?
13. Has your partner ever used physical violence against you?
14. Have you ever experienced an event that was frightening, horrible, or traumatic?
15. Is your partner jealous toward you or controlling of you?

Reason for encounter

Neck pain

History of present illness (HPI)

A 30-year old female presents at the outpatient clinic for the evaluation of neck pain that has lasted for the past two days. The pain begun after an argument with her husband when he lunged at her neck, grabbed it with one hand and held her over for 30 seconds. She also attributes the neck pain to her recently working extra hours as a dental hygienist with prolonged neck flexion where she always bends over patients to look into the corners of their mouths. She also informs that during the incident, her husband destroyed the family clock and threatened her with harm. The neck pain is constant and uncomfortable especially when she brushes her teeth. She rates its severity as 7 out of 10. Patient informs that husband has job problems with his boss and has led to more arguments and threats such as changing the locks if she goes out of town. He has also combined their bank accounts and put her on a budget to maintain control of the finances. He keeps track of expenses and checks her weekly purchases, a measure she attributes to ensuring they are financially okay given his worry about keeping his job. Husband does not help with laundry, house chores, grocery shopping, and vacuuming. She also reports worsening fatigue for the last six weeks which is aggravated by night-time awakening and partly relieved with a cup of coffee for approximately an hour. She has a mild headache that’s relieved with OTC ibuprofen. She feels anxious and has difficulty concentrating or making decisions. This negatively impacts her occupation. Patient denies pain or difficulty with swallowing, visual disturbances, fevers, chills, night sweats, loss of consciousness, tingling or numbness in upper or lower extremities, sexual abuse, muscle pain/cramping, lack of coordination, dizziness, or shortness of breath (SOB).

Physical Exam 

• Blood pressure
• Pulse
• Respiration
• Temperature
• SPO2
• Assess stance & gait
• Inspect nails
• Inspect eyes
• Examine pupils
• Inspect/palpate neck

Case Findings 

1. Neck pain x 2 days
2. Physical harm (acts of force) by partner
3. Financial restrictions imposed by partner
4. Threats of harm from partner
5. Damage of personal objects  by partner
6. Fatigue/sleep disturbance

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Case Problem Statement

A 30-year old female with multiple life stressors presents  with 2 days  of achy 7/10 non radiating neck pain following an argument with her partner in which he applied force to her  throat with one hand for approximately 30 seconds. She reports escalating arguments with spouse leading up to the recent incident, which included breakage of personal objects and financial constraints followed by feelings of sleeplessness, edginess and nightmares. She continues to work as a dental hygienist but reports tenderness and difficulty with neck flexion, unrelieved by supportive care. She denies loss of consciousness or current hoarseness, dysphagia, dyspnea or sexual abuse. Physical examination shows stable vital signs, handprint shaped ecchymosis on anterior neck, and ecchymoses in various stages of healing on limbs without truncal injury, lacerations or bleeding.

Management Plan

Diagnostic tests

No additional diagnostic tests needed.

Medications

Ibuprofen 600mg-800mg PO 8hourly for headaches & pain

Suggested consults/referrals

• Psych consult for further mental health evaluation and management (Gary et al., 2023).
• Social care consult for safety planning, support to community resources, legal aid, and access to shelter planning (Gary et al., 2023).

Patient education

• Educate patient about IPV; help her understand how current relationship negatively impacts her physical and psychological well-being (Lutgendorf, 2019). IPV is a pattern of abusive behaviors used by a partner to gain control or power over another in intimate relationships (Gary et al., 2023).
• Discuss safety planning/preparation; include options for transportation, housing, go-bag (include items to carry) (Gary et al., 2023). Emphasize the need to have her car full of gas and phone charged all the time in case of an emergency exit.
• Provide options to press legal charges including seeking ER services to speed up the process (Gary et al., 2023).
• Educate the patient about the need to leave an abusive relationship and how abuse affects the social, emotional, mental, and physical well-being of an individual (Lutgendorf, 2019). Comprehensively discuss options for housing (friends, family, or shelter) and food.
• Recommend online resources for IPV victims to encourage the patient to leave the abusive relationship. The national domestic violence hotline found at https://www.thehotline.org/ is a perfect resource that offers 24/7 support via phone or chat.

Follow-up

• Follow up in 1 week with primary care provider (PCP) for re-evaluation of progress.
• Visit the ER immediately for evaluation of worsening symptoms; pain & difficulty swallowing, respiratory distress, visual disturbances, or neck swelling (Gary et al., 2023).

References

Gary, A., Kiper, V., Geist, R., & Rice, L. (2023). Intimate partner violence: Warning signs and interventions. Nursing made Incredibly Easy, 21(3), 12-21.

Lutgendorf, M. A. (2019). Intimate partner violence and women’s health. Obstetrics & Gynecology, 134(3), 470-480. https://doi.org/10.1097/aog.0000000000003326

6512 Week 9 Ihuman Neck Pain – A 30-year old female with multiple life stressors presents  with 2 days  of achy 7/10 non radiating neck pain following an argument with her partner. Place your order here.