Differential Diagnoses And a Treatment Plan Essay Discussion Paper

Differential Diagnoses And a Treatment Plan Essay Discussion Paper

Patient Initials: JM      Age: 28   Sex: Male    Race: White

Chief complaints: Right rib pain, shortness of breath, and bleeding from the index finger

HPI: The patient is a 28-year-old white male from presents to the ED alone and walking without any assistance. He reports feeling out of breath, a sharp pain in his right ribs, which is worse when he breathes in, and bleeding from a finger that started after an accident at work about thirty minutes ago. He reports having had an accident operating a cutting machine at work that fell on him and lacerated his index finger. He does not recall trauma to the chest. The chest pains are on the right side, sharp and stabbing but not radiating to the arms or jaw and arms. They are not made worse by any change of posture. He has been using pressure to stop the bleeding in his hand, which seems to be helping. He does not have any chronic illnesses and is currently not on any medications. Differential Diagnoses And a Treatment Plan Essay Discussion Paper

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Review of systems:

Respiratory- He has sharp pains in his right ribs and shortness of breath. No coughing, no wheezing

Cardiovascular– He reports no feeling of heaviness or tightness in his chest, no orthopnea, no dizziness, no easy fatigability, and no exercise intolerance. He reports bleeding from his index finger.

Physical Exam:

General exam: He is a young male. In fair general health condition and well nourished. He appears to be in respiratory distress, gasping and out of breath, sweating. He has a wound on his right index finger. He is mildly pale but not dehydrated.

Vitals- Temp: 97.9 °F, BP- 126/68 HR-70, RR-21, O2 sat-93% on room air

Local exam– He has a small clean cut on his right index finger that is clotting and not bleeding anymore. Differential Diagnoses And a Treatment Plan Essay Discussion Paper

Respiratory- On inspection, the chest is moving symmetrically with respiration, there is a slight swelling and bruise on the right side below the nipple. There is slight tenderness on palpation around the site, but no crepitus, or palpable masses. Lung sounds clear in all lobes bilaterally, Normal Rhythmic breathing no use of accessory muscles or exaggerated abdominal movement. No abnormal breath sounds on auscultation. The percussion note is resonant.

Cardiovascular- Normal heart sounds S1, S2, no murmurs, gallops, or rubs. Differential Diagnoses And a Treatment Plan Essay Discussion Paper

Differential diagnoses:

1. Fractured rib- With the patient’s history of accidents and the presenting signs and symptoms of rib pain, worsened by breathing in, and shortness of breath, a right rib fracture could be one of the differentials (Kuo & Kim, 2022). This diagnosis is made clinically by physical examination of tenderness, bruising, and crepitus around the site. Sometimes the patient may have pain and difficulty with deep inhalation.
2. Pneumothorax- rib fractures can cause trauma to the lungs and cause pneumothorax. Presentations will include chest pains, shortness of breath, increased respiratory rate, and cough (McKnight & Burns, 2022).
3. Hemothorax- This occurs when there is a collection of blood in the pleural space leading to signs and symptoms of respiratory distress like shortness of breath, chest pains, and decreased or absent breath sounds on the affected side (McKnight & Burns, 2022).

Treatment Plan:

1. Initial stabilization to relieve pain and anxiety, Oxygen if low SPO2
2. Further evaluation is to rule out complications of rib fractures such as hemothorax or pneumothorax. A point-of-care ultrasound and CT will help detect the fracture and pneumothorax.
3. In uncomplicated fractures, conservative management is done with pain control through analgesia, rest, and applying ice (Williams et al., 2020).
4. Any complications like hemothorax or pneumothorax are managed by chest tube insertion
5. Surgery is typically not indicated unless there is rib fracture mal-union, flail chest, or a refractory pain causing respiratory failure Differential Diagnoses And a Treatment Plan Essay Discussion Paper

References

Kuo, K., & Kim, A. M. (2022, August 8). Rib fracture – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK541020/

McKnight, C. L., & Burns, B. (2022, May 4). Pneumothorax – StatPearls – NCBI bookshelf. National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK441885/

Williams, A., Bigham, C., & Marchbank, A. (2020, June). Anesthetic and surgical management of rib fractures. PubMed Central (PMC). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807920/

Please describe how you would care for a patient who presents to the office after an accident at work. He complains of right rib pain, shortness of breath, and bleeding form a finger laceration. Remember to include ROS, PE, 3 Differential Diagnoses and a treatment plan.
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