Sally’s Headaches
Purpose:
The purpose of this Assignment is to enhance knowledge the evaluation and
management of acute versus chronic presentation of headache.
Case Study Description:
Sally Jones, 45 years old, presents to the primary care clinic with complaint of a headache. She says the headache usually comes when she is at work. She works as an administrative assistant for a chief Executive Officer at a local hospital. The headache is usually generalized and bilateral and most of the intensity of pain is around the neck or the back of her head. Sally says, “When the pain comes it is like a tight band around my head.” She says the headaches have been occurring more frequently over the past 30 days. Sally takes “homeopathic” tea she recently bought on her most recent trip to Mexico to visit her family. She does not believe in taking medicine for pain because of the side effects.
Directions:
Based on the case study please provide a response to each of the following items:
- What are the pertinent subjective findings? What other questions would you ask Sally to gain more information about her headaches?
- Describe the focused physical assessment you will perform on this patient. Provide rationale for conducting the focused assessment and support with peer-reviewed scholarly references.
- Identify the diagnostic studies/tests you will order for this patient (if any). Provide scientific, evidence-based rationale from a nationally accepted clinical guideline to justify the diagnostic studies/tests you will order for this patient.
- Develop a list of three differential diagnoses for Sally’s symptoms. Prioritize the three differential diagnoses from the most serious diagnosis to the least significant diagnosis.
- What is the most likely diagnosis based on Sally’s history of present illness and chief complaint? Is this condition acute or chronic-provide your justification?
- Develop a comprehensive, holistic treatment plan including pharmacologic and non-pharmacologic therapies for this patient taking into consideration Sally’s health belief and cultural belief practices.
- Discuss the difference in your pharmacologic intervention in acute versus chronic presentation. How will your treatment change if your patient is an adolescent?
Please include 3 references in APA formart.
How to solve
management of acute versus chronic presentation of headache Nursing Assignment Help
Introduction:
In this case study, we will explore the evaluation and management of acute versus chronic presentation of headaches in a patient named Sally Jones. Sally is a 45-year-old administrative assistant who presents to the primary care clinic with complaints of headaches. We will analyze her symptoms, conduct a focused physical assessment, order appropriate diagnostic studies, develop a list of differential diagnoses, determine the most likely diagnosis, and create a comprehensive treatment plan considering Sally’s health beliefs and cultural practices. This discussion will also include the differences in pharmacologic intervention between acute and chronic presentations, as well as the potential variations in treatment if the patient were an adolescent.
Answer to each question:
1. What are the pertinent subjective findings? What other questions would you ask Sally to gain more information about her headaches?
Pertinent subjective findings in Sally’s case include her complaint of a headache that is usually generalized and bilateral, with most of the pain intensity in the neck or the back of her head. She describes the pain as a tight band around her head. The headaches have been occurring more frequently over the past 30 days. To gain more information, additional questions would include the frequency and duration of the headaches, any triggers or alleviating factors, any associated symptoms such as nausea or sensitivity to light, and any previous history of similar headaches or head trauma.
2. Describe the focused physical assessment you will perform on this patient. Provide rationale for conducting the focused assessment and support with peer-reviewed scholarly references.
The focused physical assessment for Sally will include a thorough neurological examination, with a particular focus on assessing cranial nerves, visual fields, and fundoscopic examination. This assessment is crucial to identify any neurological abnormalities that may be contributing to her headaches, ruling out any serious underlying pathology. Peer-reviewed scholarly references recommend neurological examination as a key component in the evaluation of headache disorders (Burch et al., 2015; Becker et al., 2019).
3. Identify the diagnostic studies/tests you will order for this patient (if any). Provide scientific, evidence-based rationale from a nationally accepted clinical guideline to justify the diagnostic studies/tests you will order for this patient.
Based on the clinical presentation and to rule out potential underlying causes, I would recommend ordering an imaging study such as a brain MRI or CT scan. This is especially important when a headache has abrupt onset, is recurrent, or associated with neurologic findings. The American Academy of Neurology recommends neuroimaging for patients with new headache features as well as for patients with a change in their headache pattern after the age of 40 (Schwedt et al., 2015).
4. Develop a list of three differential diagnoses for Sally’s symptoms. Prioritize the three differential diagnoses from the most serious diagnosis to the least significant diagnosis.
The differential diagnoses for Sally’s symptoms can include:
1. Tension-type headache
2. Migraine headache
3. Cervicogenic headache
The prioritization would depend on the severity of symptoms, associated factors, and the presence of red flag symptoms such as neurological deficits or concerning physical examination findings.
5. What is the most likely diagnosis based on Sally’s history of present illness and chief complaint? Is this condition acute or chronic – provide your justification?
Based on Sally’s history and chief complaint, the most likely diagnosis is tension-type headache. Tension-type headaches typically present with bilateral, pressing, or tightening pain that feels like a tight band around the head. Sally’s description of the headache aligns with this type of headache. The condition is most likely chronic due to the increased frequency of headaches over the past 30 days and their association with work-related stress.
6. Develop a comprehensive, holistic treatment plan including pharmacologic and non-pharmacologic therapies for this patient, taking into consideration Sally’s health belief and cultural belief practices.
The comprehensive treatment plan for Sally’s tension-type headaches should include both pharmacologic and non-pharmacologic approaches. Pharmacologic options may include over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) as needed for acute pain relief. Non-pharmacologic therapies may include stress management techniques, relaxation exercises, physical therapy for posture correction, and counseling if stress and anxiety are contributing factors. It is important to incorporate Sally’s health beliefs and cultural practices into the treatment plan, respecting her preference for non-pharmacologic approaches while providing appropriate education and guidance.
7. Discuss the difference in your pharmacologic intervention in acute versus chronic presentation. How will your treatment change if your patient is an adolescent?
In the acute presentation, pharmacologic intervention in the form of pain relievers can be used as needed to manage the pain. However, caution should be exercised to avoid overuse of medication and potential medication-overuse headache. In chronic presentations, prevention is key, and medications such as tricyclic antidepressants or antiepileptic drugs may be considered for prophylactic purposes. If the patient were an adolescent, the treatment approach may need to be modified to consider age-specific factors such as medication dosages, potential interactions with other medications, and the patient’s ability to adhere to non-pharmacologic interventions, which may require parental involvement in the treatment plan.
References:
1. Burch, R. C., Buse, D. C., & Lipton, R. B. (2015). Migraine: epidemiology, burden, and comorbidity. Neurologic Clinics, 33(2), 441-449.
2. Becker, W. J., Findley, L. J., & Dzugan, D. (2019). Primary Headaches – An Overview for the Practitioner. Mayo Clinic Proceedings, 94(5), 801-814.
3. Schwedt, T. J., Alam, A., & Reed, M. L. (2015). Migraine. Annals of Internal Medicine, 162(5), ITC1–ITC16.
