Tommy Thompson
78 year old, male
Russian background
Previous Medical:
1) HTN, 2) Atrial Fibrillation, 3) GERD
Family Hx– dad- died of stroke, mum- died of old age.
Medications: metoprolol, dabigatran, omeprazole
Allergies: None
Job: Concert Pianist
Presenting complaint:
Tripped over the cat middle of the night. “felt a bit dizzy”” “Got up to go to the bathroom”, “fell forward” “was sore last night, but it is more sore today” “it is hard to move it” “I can’t play piano today” “the floor is hardwood”
No other injuries.
No loss of consciousness. Full recall of events
Left hand dominant
History of complaint:
Onset- after injury- approximately 1am.
Provocative: better- if I hold it, worse if I move it or push on it
Quality: sharp
Radiation: moves up my arm
Severity: 5/10
Taken Tylenol and Ibuprofen- 15 mins ago “hasn’t helped at all”
ON EXAMINATION (Objective)
Temp- 37.2, RR 16, HR- 100, BP 145/82, 02- 98%, alert and oriented x 3, awake.
Sitting up, holding left wrist.
Appears uncomfortable.
Look: Syndactyly present- ring and pinky finger. swelling and bruising from mid forearm to mid carpal area. No obvious deformity. No redness. No lacerations. 3cm by 4cm abrasion to palm- over thenar eminence. Bleeding controlled. Slight redness surrounding abrasion.
Feel: Skin warm and dry. Well perfused. Cap refill < 2seconds. Pain over thenar eminence, no snuff box pain. Pain on palpation of at distal radius and distal ulna. Nil pain at olecranon, nil pain at medial or lateral epicondyle.
Move: Full ROM- active and passive- Elbow. Full pronation and supination with pain- active and passive. Wrist flexion to 20 degrees- active, 30 passive. Wrist extension- 30 degrees active- 40 passive.
Special Tests: (see tests below). *please try all against resistance. Some weakness maintaining with “OK sign”
Answer and submit the following questions:
Q1. Match medical history and medications
Metoprolol; HTN
Dabigatran; Atrial Fibrillation
Omeprazole; GERD
Q2. Define words that are highlighted in yellow
Syndactyly – a condition in which children are born with fused or webbed fingers.
thenar eminence – three muscles that control the movements of the thumb (abductor pollicis brevis (APB), flexor pollicis brevis (FPB), and the opponens pollicis), located on the radial portion of the volar hand at the base of the first digit (thumb).
snuff box pain – a painful condition where the tendons forming one side of the ‘anatomical snuffbox’ at the side of the wrist on the thumb side are inflamed.
Q3. Name 2 possible NANDA Diagnosis and give a plan for each one.
| NANDA | Plan | |
| 1 | Risk for powerlessness
as evidenced by pain and inability to play piano |
Discuss with physician to explore solutions to heal inflammation and reduce pain.
Discuss and educate patient and acknowledge for any type of feelings, such as sadness or frustration that may be shared |
| 2 | Risk for decreased activity tolerance as evidenced by snuff box and sharp pain | Evaluate current level of activity, discuss with physiotherapist a plan to assist patient to heal and get back to old routine without causing major impacts on patients life.
Discuss with physician to explore solutions to heal inflammation and reduce pain. |