Management plan Template Nursing Assignment Essay

Management plan Template Nursing Assignment Essay

Management plan Template Nursing Assignment Essay

Management plan Template Nursing Assignment Essay Sample

Management Plan

Primary Diagnosis

Testicular torsion N44.0 Testicular torsion is a common surgical emergency that is usually seen in the ER. Kevin is most likely to be having testicular torsion because he presents with a sudden onset history of severe pain, nausea and vomiting which was preceded by history of layups while playing football. Kevin is also in the age bracket where testicular torsions are commonly seen  i.e.12- 18 years(Laher et al., 2020). To confirm the diagnosis a physical examination should be conducted to check for brenzels sign (high riding testicle), Gers sign and prehns sign which is lack of pain relieve on elevation of the affected side.

Guidelines used to develop the primary Diagnosis

The American Urological Association guidelines for an acute scrotum were used to come up with the primary diagnosis of testicular torsion.

Differential Diagnosis

Epididymitis N45.1 Epididymitis is the inflation of the epididymis and usually presents with acute onset scrotal pain. Severe cases usually present with nausea vomiting, dysuria and even fever.  Epididymitis in older men is mostly caused by infectious agents such as gonorrhea, E.coli while in the young its mostly noninfectious with most cases being secondary to genitourinary trauma, autoimmune diseases or urethral instrumentation(Bonner et al., 2021). This is a possible differential diagnosis since the patient presented with acute onset pain associated with trauma but does not have any urinary symptoms.

Appendicitis K35.80 Approximately 10% of the total population is at risk of getting acute appendicitis making it the most common surgical condition. It is the inflammation of the appendix which can be due to an infection, tumors or calcified fecolith. Patients with acute appendicitis present with acute onset abdominal pain in the right lower quadrant, nausea, vomiting, fever and loss of appetite(Moris et al., 2021). On examination, one might elicit a positive rovsigns sign, positive psoas and McBurney’s sign.

Urolithiasis N20 this is the expulsion or passage of renal stone from the renal pelvis into the collecting systems. These stones can pass without major events but if they are large the patient experiences discomfort. If not managed on time it can lead to obstruction which predisposes one to infections and kidney failure. Patients with urolithiasis presents with sudden onset unilateral flank pain, nausea, vomiting, fever and hematuria(Qian et al., 2022). The patient has nausea and pain thus this is a possible differential diagnosis however the pain is not typical of that with patients of urolithiasis and patient has no urinary symptoms.

Inguinal Hernia K40:90 it is the most common abdominal wall hernia and it refers to the protrusion of abdominal contents in the groin area through an area of weakness in the abdominal wall. It usually presents with groin swelling, pain and a patient with this type of hernia might have a history of obesity, previous surgeries, positive family history and heavy lifting(Şahiner & Altunal, 2023).

Medications, Education, Additional Ancillary Tests, Referrals and Follow ups.

Surgery is the mainstay treatment of testicular torsion. Manual detorsion can however be attempted first before surgery. Administer analgesics for pain relieve i.e. Morphine 0.2-0.5 mg/kg 8 hourly. Since opioids are known to cause respiratory distress and constipation the patient and his father should be educated on the same and the person administering should watch out for signs of respiratory depression. Can be given a laxative to counter this side effect lactulose 0.7-2g/kg/day P.O. Give an antiemetic i.e. ondansetron 4mg/kg IV 8 hourly.

A scrotal ultrasound can be used to visualize the testicular blood flow. Decreased blood flow to the testicles will confirm the diagnosis of testicular torsion. The patient should be referred to a surgeon (urologist) if the manual detorsion fails for further management. The child should be given a return date of two week after discharge from the hospital. He should be advised to seek immediate medical consult in case of persisting pain even after discharge.

Problem Statement.

K.M is a 13-year-old male who presents to the emergency department accompanied by his father with a 2-hour history of testicular pain that was preceded by a probable trauma while playing basketball. He also reports of one episode of vomiting associated with nausea and loss of appetite. He denies changes in bowel movements and urinary symptoms such as frequency. To make a diagnosis the vitals signs should taken and a thorough genitourinary system examination be conducted.

Social Determinants to consider, Health promotion and Patient Risk factors.

Kevin and his father should be educated on his diagnosis and the possible etiology. He should be made aware on the treatment modalities available, the benefits of each modality and even the complications and the possible side effects. Since he is a teenager he can also be educated on other problems that commonly affects teens such as substance abuse and peer pressure and personal safety.

References.

 Bonner, M., Sheele, J. M., Cantillo-Campos, S., & Elkins, J. M. (2021). A Descriptive Analysis of Men Diagnosed With Epididymitis, Orchitis, or Both in the Emergency Department. Cureus. https://doi.org/10.7759/cureus.15800

Laher, A., Ragavan, S., Mehta, P., & Adam, A. (2020). Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies. Open Access Emergency Medicine, Volume 12, 237–246. https://doi.org/10.2147/OAEM.S236767

Moris, D., Paulson, E. K., & Pappas, T. N. (2021). Diagnosis and Management of Acute Appendicitis in Adults: A Review. JAMA, 326(22), 2299. https://doi.org/10.1001/jama.2021.20502

Qian, X., Wan, J., Xu, J., Liu, C., Zhong, M., Zhang, J., Zhang, Y., & Wang, S. (2022). Epidemiological Trends of Urolithiasis at the Global, Regional, and National Levels: A Population-Based Study. International Journal of Clinical Practice, 2022, 1–12. https://doi.org/10.1155/2022/6807203

Şahiner, İ. T., & Altunal, Ç. (2023). Evolution of Inguinal Hernia Publications: A Bibliometric Analysis from 1980 to 2021. Medical Science Monitor, 29. https://doi.org/10.12659/MSM.939613

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 Management Plan Template– must include these headings

Primary Diagnosis with ICD-10 code, rationale and resources. Include CPT codes, and any procedural codes, including nurse lab draws, vaccinations given, biopsies, etc…10 pts.

Guidelines used to develop this primary diagnosis. 5 pts

Differential diagnoses with rationale and resources. 3-5 Ddx required, unless well visit. 5 pts

Medications including OTC, dosage and education, additional ancillary tests needed, referrals and follow up – 10 pts

Problem Statement – 5 pts

Social Determinants of Health to consider, Health Promotion and Pt risk factors – 5 pts

Must use 3 scholarly references the course text may NOT be used as a reference. The references must be professional and not general patient education websites.

Worth 40 points

HPI: 13 year old male presents with his father for testicular that started 2 hours ago. Pt states he was playing basketball while doing layups when pain suddenly started. He reports 9/10 constant pain. Pt have pain with resting and movement and states it feels like someone punched him. Pt is currently not taking any medication or using any modalities to treat pain. He is having feelings of nausea and vomited once. He reports change in his appetite and states he don’t have much of an appetite. He denies changes in bowel movements and urinary frequency.

Primary Diagnosis:

Testicular torsion

Differential Diagnosis:

Appendicitis

Epididymis

Hernia, inguinal

Urolithiasis

Medications: Pt not OTC medication or prescriptions.