Question: The nurse in the outpatient orthopedic clinic is reviewing the medical records of several patients being seen in the clinic today.

Case Study 1:

The nurse in the outpatient orthopedic clinic is reviewing the medical records of several patients being seen in the clinic today. In the most recent note by the provider, the nurse reads the following: A 67-year-old, moderately obese woman examined today for increasing back and left shoulder pain. Limited circumduction of left arm noted in comparison with right arm. Strength of left arm is less than right, with less muscle definition in the left arm. Examination of back indicates significant kyphosis, and the patient states that she is ‘shrinking.’ Bone density testing of the hip is ordered.”

How does the nurse interpret “limited circumduction”?
When the patient arrives, the nurse correlates the “kyphosis” with what physical finding? What causes kyphosis in the older adult?
How should the nurse explain the patient’s decreasing height?
What is the rationale for ordering bone density testing of the hip in this patient

Case Study 2:

A 19 yr. female patient presents to your student health clinic complaining of a rash and says that she thinks she has the “flu or something.” She returned 3 weeks ago from a spring break trip to the beach. The rash started out “like acne,” located on her face, back, and chest. She now thinks she must have caught something during her trip, as she has developed joint pain in addition to the rash. The pain is most notable in her hands, although she has some stiffness and pain in both of her wrists, ankles, and knees.

Perform and document a focused assessment on this patient Do not forget that your exam has to be done in a systematic way. Think Inspection, Palpation, Percussion, and Auscultation – (if indicated).

What three conditions would be considered in your differential diagnosis, with most likely condition listed first (with rationale)?

Bickley, L. S. (2017). Bates' guide to physical examination and history taking (12th ed.). Philadelphia: Lippincott. ISBN: 978-1-4698-9341-9

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment & clinical diagnosis in primary care (5th ed.). St. Louis: Elsevier. ISBN: 13-9780-32326625-3