Further questions

Further questions:

With your right foot show me how you injured your left foot? (sprain, strain, fracture) Have you injured your left ankle in the past? (sprain, strain, fracture) When you bear weight on you left ankle is there pain? (sprain, fracture) Are you able to move your foot and/or wiggle your toes? (sprain, strain, fracture) What treatments have you tried? Ice, pain medication, elevation, compression? (sprain, strain, fracture) Any numbness, tingling or paralysis in your foot or toes? (dislocation, fracture) What would you rate your pain 0-10? (sprain, strain, fracture) When does your ankle hurt rest, with movement, weight bearing? (sprain, strain, fracture)

Differential Diagnosis:

Left ankle sprain- tearing of the ligaments that bind the joint, as the joint is forced beyond its normal range of motion, tearing occurs (Buttaro, Trybulski, Bailey, & Sandburg-Cook, 2013).Rational- Elizabeth is a dancer; she landed on the side of her ankle and heard a pop. When Elizabeth tries to bear weight, her left ankle gives away, and she is unable to walk unassisted.Left ankle avulsion- an avulsion occurs when the ligament pulls away from the bone bringing fragments of bone with it, this is most commonly seen in athletes (Buttaro, Trybulski, Bailey, & Sandburg-Cook, 2013).Rational- Elizabeth is a dancer; she landed on the side of her ankle and heard a pop. When Elizabeth tries to bear weight, her left ankle gives away, and she is unable to walk unassisted.Left foot fracture- a fracture is a break in the cortex of the bone. Fractures of the talus and calcaneus have been misdiagnosed as ankle injuries. A foot fracture should be a differential diagnosis with reports of a twisting injury or fall and walking is compromised (Buttaro, Trybulski, Bailey, & Sandburg-Cook, 2013).Rational- Elizabeth is a dancer; she landed on the side of her ankle and heard a pop. When Elizabeth tries to bear weight, her left ankle gives away, and she is unable to walk unassisted Diagnostic tests: AP/Lateral X-ray of the left foot and ankle non-weight baring- indication for an x-ray includes trauma followed by immediate pain, swelling, discoloration, limited range of motion or decreased strength. Fractures are diagnosis with a visible break on two radiographic views (Goost, Wimmer, Barg, Kabir, Valderrabano, & Burger, 2014). This study source was downloaded by 100000822939343 from CourseHero.com on 06-16-2021 05:37:38 GMT -05:00

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Physical exam:

Vital signs (rule out infectious process- Positive: fever, tachycardia)

Cardiopulmonary (looking for abnormal heart/lung sounds) The left leg should be free of clothing; gross deformity, malalignment, swelling, ecchymosis, cyanosis, sensation/temperature and pulses of affected limb/foot should be noted. (sprain, fracture, dislocation, compartment syndrome) Positives: swelling, ecchymosis, hematoma, cyanosis, pallor, gross deformity, protruding bone, pulseless, hot or cold to touch Bony structures to be palpated include; shaft of tibia and fibula, borders of both medial and lateral malleoli, neck and dome of talus (done with inverting and everting the foot). (fracture,

dislocation) Positives: crepitus, pain, lack of movement, deformity

Palpation to the soft tissue ligamentous structures include; anterior and posterior talofibular ligament, calcaneofibular ligament, deltoid ligament complex, anterior tibiofibular syndesmosis, anterior/posterior tibialis, flexor/extensor digitorum longs, flexor/extensor hallucis longus.

(Sprain, avulsion) Positives: pain, deformity, lack of movement, laxity

Assessing active, passive and resistive range of motion includes; dorsiflexion, plantar flexion, inversion, and eversion. This range of motion should be compared bilaterally. (strain, sprain, avulsion, fracture) Positives: pain, limitation of motion, lack of active motion, crepitus, laxity Pulses- radial, femoral, popliteal, posterior tib, pedal (comparing right to left) (looking for differences in pulses or lack of) (Luke, 2011) Did mom do the right thing? I agree mom did the right thing; Elizabeth had no emergent signs of injury such as loss of a pulse, gross deformity or protruding bone. RICE (rest, ice, compression, and elevation) are the key elements in providing pain relief and limiting swelling (Buttaro, Trybulski, Bailey, & Sandburg-Cook, 2013). Elizabeth is wearing an ace bandage, using crutches to keep weight of the foot, and mom iced the ankle, she did the right thing.HIPPA- According to the Center for Adolescent Health & the Law (2010), in Florida, there is no law against sharing “general” healthcare information with the parents of Elizabeth if she was not present. If Elizabeth was an emancipated minor, a married minor or a minor parent, she would be considered an “adult” and Elizabeth would have to sign consent for her parents to have information about her healthcare. Florida provides strong confidentiality protection for minors with diagnosis related to STD, drug and alcohol services, and pregnancy-related care; including family planning and contraception. In the state of Florida minors are not allowed to consent for an abortion without a parent present.References This study source was downloaded by 100000822939343 from CourseHero.com on 06-16-2021 05:37:38 GMT -05:00

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Buttaro, T. M., Trybulski, J., Bailey, P., & Sandburg-Cook, J. (2013). Primary Care: A

collaborative practice (4th ed.). St. Louis, MO: Elsevier Mosby.

Center for Adolescent Health & the Law. (2010, January).State Minor Consent Laws: A

summary. Retrieved from http://www.freelists.org/archives/hilac/02-

2014/pdftRo8tw89mb.pdf.Goost, H., Wimmer, M. D., Barg, A., Kabir, K., Valderabano, V., & Burger, C. (2014, May).Fractures of the ankle joint. Deutsches Arzteblatt International, 111(21), 377-388.Luke, A. (2011). Ankle Physical Examination. Retrieved from http://orthosurg.ucsf.edu/oti/patient-care/divisions/sports-medicine/physical-examination- info/ankle-physical-examination/.Part 2

Primary Diagnosis:

Left ankle avulsion (S93) - an avulsion occurs when the ligament pulls away from the bone bringing fragments of bone with it, this is most commonly seen in athletes (Buttaro, Trybulski, Bailey, & Sandburg-Cook, 2013). Rational- x-ray shows acute avulsion of the medial malleolus; pain, swelling and unable to bear weight.

Secondary Diagnosis:

Acute pain due to trauma (G89.11) – Pain due to broken bone (Fenstermacher & Hudson, 2015). Rational- pain due to acute avulsion of the medial malleolus. Her left ankle gives away, and she is unable to walk unassisted.P.I would call the orthopedic MD to let them know the x-ray results and make Elizabeth an appointment for today.

Diagnostic tests: No more test at this time, referral to orthopedic MD

Rx:

Ibuprofen 400 mg tablets

• tablet every 6 hours as needed for pain

(Fenstermacher & Hudson, 2016) This study source was downloaded by 100000822939343 from CourseHero.com on 06-16-2021 05:37:38 GMT -05:00

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Conservative measures:

Ace wrap bandage to ankle, no weight bearing until patient sees the orthopedic doctor, continue to use crutches.RICE- rest, ice, compression, elevation (Goost, Wimmer, Barg, Kabir, Valderrabano, & Burger, 2014).

Education:

The x-ray revealed an acute avulsion of the medial malleolus. An avulsion occurs when the ligament pulls away from the bone bringing fragments of bone with it, this is most commonly seen in athletes, and is due to a rolling action of the ankle (Goost, Wimmer, Barg, Kabir, Valderrabano, & Burger, 2014).When a fracture is diagnosed treatment depends on the type of fracture and other associated injuries. Anytime a fracture is diagnosed an orthopedic doctor must be consulted (Goost, Wimmer, Barg, Kabir, Valderrabano, & Burger, 2014).Referral: If a fracture is confirmed with x-ray an orthopedist must be consulted (Buttaro, Trybulski, Bailey, & Sandburg-Cook,2013).Follow up: After seeing the orthopedic doctor follow up in 4 weeks for a repeat x-ray to verify appropriate healing (Goost, Wimmer, Barg, Kabir, Valderrabano, & Burger, 2014).References Buttaro, T. M., Trybulski, J., Bailey, P., & Sandburg-Cook, J. (2013). Primary Care: A

collaborative practice (4th ed.). St. Louis, MO: Elsevier Mosby.

Center for Adolescent Health & the Law. (2010, January). Retrieved from State Minor Consent Laws: a summary: http://www.freelists.org/archives/hilac/02-2014/pdftRo8tw89mb.pdf Goost, H., Wimmer, M. D., Barg, A., Kabir, K., Valderabano, V., & Burger, C. (2014, May).Fractures of the ankle joint. Deutsches Arzteblatt International, 111(21), 377-388.Luke, A. (2011). Ankle physical examination. Retrieved from Orthopedic Trauma Institute: http://orthosurg.ucsf.edu/oti/patient-care/divisions/sports-medicine/physical-examination- info/ankle-physical-examination/ This study source was downloaded by 100000822939343 from CourseHero.com on 06-16-2021 05:37:38 GMT -05:00

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