Discussion Question 1

Mr. Rodriguez is a 39-year-old uninsured male who recently moved to the U.S. from the
Dominican Republic. This is Mr. Rodriguez's first visit to the clinic. His chief complaint is
stating that he is having abdominal pain, and it won't go away that started about a year ago
and the pain, which used to happen a few times a week, now hurts every day. He drinks three
to four beers per week and denies drug use. As a laborer on a farm he’s often sore and takes
ibuprofen many days of the week for his muscle soreness as well as drinking herbal tea for
the stomach pain. He recently quit smoking and his father had high blood pressure and his
mother was diabetic. He denies any vomiting, hematemesis, hematochezia, melena or any
pain association with meals other than with use of hot sauce.
Discussion Question 1
Based on your performance and the expert feedback in your HISTORY collection,
describe two missed questions and your understanding of why they were important to collect
for this case history. Use specific references from your text to explain.
Mr. Rodriguez stated that he takes ibuprofen but I missed inquiring on how often he takes
it. Ibuprofen is a commonly used over-the-counter and prescription pain medication. It is
classified as part of the non steroidal anti-inflammatory drug (NSAID) class. Ibuprofen is
effective in relieving symptoms associated with pain, inflammation or fever with minimal
side effects. However, if taken in the wrong dosage or long term, there can be significant
potential side effects, some of which may require medical attention. Knowing how often Mr.
Rodriguez takes ibuprofen could help identify whether this could be the aggravating factor
causing his stomach pain (Chronic Disease Prevention and Health Promotion, 2020).
A second thing I missed in my history collection was asking Mr. Rodriguez the onset of
his stomach pain and whether the pain is gradual or sudden. Asking questions
regarding onset, as well as duration, frequency, and character of the pain could take me
further towards my diagnosis.
Based on your performance and the expert feedback in your PHYSICAL EXAM
collection, describe two errors in your exam performance or documentation. Use specific
references from your text to explain the importance of these findings in correct assessment of
this client.
The physical exam reveals stable vital signs for Mr. Rodriguez and he appears a well and
healthy middle-aged man who, upon physical examination, does not seem to have any serious
medical problems. There are no alarm symptoms or signs of complications that would prompt
immediate gastroenterology referral. He appears anxious which, upon touching upon has
revealed he has no health insurance and reassurance was made to make him feel safe and
trusting. The exam alone seems appropriate enough and nothing more can be thought of to
add as a diagnostic tool to make a diagnosis.
Based on your performance on the PHYSICAL EXAM collection, describe one key
finding that you included in your list and describe a specific physical exam that you can
perform at the point-of-care to further evaluate the finding. Use specific references from your
text.
While abdominal palpation provides information about potential areas of tenderness,
superficial structures, and the abdominal wall, deep palpation permits inspection of the
internal organs and delineation of any intra-abdominal masses. Additional areas of tenderness
could be identified by deep palpation as well. Mr. Rodriguez had minimal epigastric
tenderness on deep palpation of the abdomen. Abdominal palpation, if performed correctly,
would allow for examination of the large and superficial organs. Additionally, it would allow
for assessment of the smaller and deeper structures as well. Abdominal palpation provides
valuable information regarding localization of the problem and its severity, as abdominal
palpation identifies the areas of tenderness as well as presence of organomegaly and tumors
(Chronic Disease Prevention and Health Promotion, 2020).
Based on your performance and the expert feedback in your ASSESSMENT identification
of problem categories, choose one missed/incorrect category and use specific references from
your text to explain the importance of this category in arriving at correct differential
diagnoses for this client.
One missed category of the problems identified during my assessment of Mr. Rodriguez
was to assess for appendicitis. The iliopsoas muscle test is used most often when acute
abdominal pain is present and appendicitis is suspected. Mr. Rodriguez should be told to lie
flat in the supine position and then asked to lift his right leg straight up, flexing only at the
hip. Push down on the lower part of the thigh when he is trying to hold his leg up. If he were
to feel pain in the iliopsoas muscle (the right lower quadrant of the abdomen) the test may
indicate a perforated or inflamed appendix (Jarvis, 2020).
Based on your performance and the expert feedback in your ASSESSMENT of
differential diagnoses, describe one incorrect/missed differential diagnosis and use specific
references from your text to support the inclusion of the diagnosis for this client.
Upon review of my assessment and differential diagnoses of Mr. Rodriguez I feel that a
missed differential diagnosis to include would be anxiety. Anxiety can be one possible
etiology for developing abdominal pain for which a patient might self-medicate, as with Mr.
Rodriguez drinking beer.
With anxiety, some of the hormones and chemicals released by your body enter the
digestive tract, where they can interfere with digestion. It can have a negative effect on
normal gut flora and decrease antibody production. The resulting chemical imbalance can
cause a number of gastrointestinal conditions including epigastric pain such as what brought
Mr. Rodriguez to the clinic and may warrant further careful exploration (Jarvis, 2020).

References:
Chronic Disease Prevention and Health Promotion. (2020). Retrieved March 20, 2013, from
Centers for disease control and prevention:
http://www.cdc.gov/chronicdisease/overview/index.htm
Jarvis, C. (2020). Physical Examination and Health Assessment. St. Louis: Elsevier.

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