Differential Diagnosis essay & questions Example

Differential diagnosis essay and Questions 3

Physical & Functional Assignment

By Pricillia Febriani Ng

Physical & Functional Assessments

Dr. Curtis T. Rigney & Dr. Suzanne Saks

Macquarie University

01/04/16

When a patient visits a health facility, the practitioners first assess the possible conditions that the patient may have by creating a list of problems by observing the signs and symptoms. The signs are not used to indicate the specific disease affecting the patient but rather list a number of possible diseases1. The process is critical as it helps the practitioner obtain medical information of the patient and forms part of the diagnosis process.

When diagnosing the patient, the first action by the practitioner is to collect medical history information2. The information is obtained from the individual or from the family member or friend who may be accompanying the patient. The symptoms and signs shown are used by the practitioner to list the possible contributing factors. When listing the possible diseases, the practitioner should ensure that no priority is given to one disease than the others on the list as being more likely to have affected the patient.
Information on past medical history includes medication, surgical history, allergies and patients’ reactions, drug abuse and sexual information3. Family and work information are also collected to help develop a list of problems.

The questions the healthcare provider asks at the stage should be open-ended since they give the patients the freedom to choose the answer they think is most appropriate. However, under different circumstances where some patients can be talkative or difficult (e.g. angry) the types of questions should be asked appropriately, e.g. closed-ended questions. In addition, steps and precaution should be actioned based on the patients’ behaviour. For example, angry or patients in extreme pain. Once the patient has responded, follow up questions should be asked to help the practitioner further understand the issue4. Examples of questions asked by practitioners include; have you ever had the medical issue before? If yes, did you receive health care? If so, was the medication continuous or was it done once? What issue did the treatment address? At this stage, the patient tends to forget essential information about their medical history and can be perceived as intentional. The practitioner should ask relevant questions that will guide the patient towards recalling his/her medical history.

After medical history is obtained, the next stage in diagnosis is the physical examination and is done along with the differential diagnosis. A differential diagnosis helps the practitioner to narrow down the list of diseases that could be the cause of the symptoms patient is showing and the signs the health practitioner is observing5. The choice of the diseases to erase from the list is determined by the results collected during the physical examination carried out by the healthcare practitioner.

After observing the results from the examination, the practitioner then triage the diseases depending on the seriousness. The most life-threatening and severe conditions are investigated first whereas the least life-threatening and easiest to address are addressed last6. Differential diagnosis helps in testing the probability of identifying the disease that has contributed to the signs and symptoms observed. The practitioner also uses the medical history in arriving at the most probable disease.

The most life-threatening disease identified through differential diagnosis is considered first to minimize the probability of a hazard occurring. The response of the patient to these interventions is recorded to be used in the evaluation. The documented responses are then compared to the expected results to assess the extent to which the intended outcomes have been achieved by performing suitable tests e.g. orthopaedics test. When the symptoms and signs persist after treatment plan has concluded, the practitioner should re-do the appropriate tests and change the treatment plan. Also, if needed and depending on the circumstance, the practitioner may need to refer the patient to a general practitioner or to a specialist.

To summarise, the difference between a list of problem and differential diagnosis is that list of problem as used in medicine is made up of possible diseases that may be contributing to the signs and symptoms the patient is showing. The list is compiled by the practitioner observing these symptoms and borrowing information from the patient’s medical history. Differential diagnosis, on the other hand, uses the list of problems and physical examination of the patient to help narrow down the possible diseases that may be affecting the patient. Although both are used in the diagnosis process, differential diagnosis is more accurate to identifying the contributing factor.

A 50 year old female presents with right sided shoulder pain

Five areas of focus when obtaining medical history among the elderly.

The elderly (50 and older) are amongst the special population groups that require special attention in medical care. Medical history is essential in deciding the right treatment to be administered to a patient. Several barriers make it hard for history taking process among the geriatrics patients.

  • Neurological deficit As age increases, neurological deficit also increases. deficits such as decreased hearing- large percentage of the elderly have issues with their hearing system due to loss of high and low-frequency audition
    7. It is important for the practitioner to ensure that the patient received the information as it was intended. Failure may lead to answering of the wrong information, therefore, misdiagnosis. Use of caregivers is necessary to ensure information recorded is accurate.

Neurological illness & mentality are also another major challenge to medical history taking process among the older patients. It ends up leading to memory loss and impaired judgment making the patient miss out on important information about their medical history8. In addition, the reaction time in elderly patient decrease. This consumes a lot of time than usual when processing the question asked for them to respond in comparison to younger adults9. The practitioner, therefore, needs to allocate sufficient time that will allow the processing of information by the patient.

The size of peripheral nerves also decreases thus reducing sensitivity10. In reporting on the medical history, question about how the patient has been feeling are common. For elderly, their answers may be misguided since their senses have been affected. To avoid misdiagnosis, practicing care is essential.

  • Medication Due to the prevalence of multiple illnesses among the elderly, they take frequent medication putting them at risk of adverse drug reaction
    11. During information collection, it is important for the health provider to consider past issues that such patients may have had with certain drugs.

  • Failure to report symptoms

Misperception among the elderly patients has seen them fail to report some symptoms as they consider some illness normal for the aged. Common illnesses linked with old age by patients and their caretakers include hearing and vision deficits, falls and back pain12. Failure to report such conditions interferes with the evaluation process by concealing important medical information. Another reason patients may fail to report symptoms is due to fear of hospitalization. A major challenge to history taking among the elderly is the difference in the manifestation of disorder. When a geriatric patient has a similar condition to a normal patient, the body may respond differently. The body instead may respond with general symptoms such as fatigue13. Such instances may provide the wrong information to the practitioner thus misdiagnosis.

  • Issues with Caregivers

Past cases have shown that elderly have problems with caregivers, and it has contributed to some medical conditions. Some caregivers treat the elderly roughly resulting in frequent bruises through grips in the upper arms due to the weak bone structure and soft skin14. The lack of enough registered nurses to provide care to the aged has resulted in the increase of such cases. The available caregivers also lack knowledge essential when interacting with the aged. Ethical issues emerge where some care providers do not allocate resources to the aged, perceiving them as dying. The elderly also develops a lot of fear towards the caregivers and may in turn not inform them when they are having medical issue. The fear of caregivers may make the patient withhold essential information about their health to avoid upsetting them. The healthcare provider should, therefore, create an atmosphere where the patient can freely share information of their medical history.

  • Substance abuse

Data collected from National Epidemiologic Survey of Alcohol Related Conditions has indicated prevalence of substance abuse among the people aged above 65 years15. The most common abused substance is alcohol where at least one in five people abuse alcohol as a way to deal with depression16. Alcohol is associated with illnesses such as liver cirrhosis, nausea and fatty liver. Alcohol abuse also impact on the health of the patient in indirect ways such as increasing the chances of falls. Tobacco is another drug that is commonly abused by the aged.

References

ADLER, S. N., ADLER-KLEIN, D., GASBARRA, D. B., & ADLER, S. N. (2008). A pocket manual of differential diagnosis. Philadelphia, Lippincott Williams & Wilkins.

CARPENITO-MOYET, L. J. (2007). Nursing diagnosis: application to clinical practice. Philadelphia, Pa, Lippincott Williams & Wilkins.

CHOUDHURY, M. A. A. S., SHAH, S. L., & THORNHILL, N. F. (2008). Diagnosis of process nonlinearities and valve stiction data driven approaches. Berlin, Springer.

DOENGES, M. E., & MOORHOUSE, M. F. (2012). Application of nursing process and nursing diagnosis an interactive text for diagnostic reasoning. Philadelphia, PA, F.A. Davis Company.

GATTUSO, P. (2010). Differential diagnosis in surgical pathology. Philadelphia, PA, Saunders/Elsevier.

GUPTA, L., GUPTA, A., & GUPTA, A. (2005). Differential diagnosis: medicine, surgery, ob/Gyn, ophth, paed, dental. New Delhi, Jaypee Bros.

HAMMER, R. M., MOYNIHAN, B., & PAGLIARO, E. M. (2013). Forensic nursing: a handbook for practice. Burlington, MA, Jones & Bartlett Learning.

RAI, G. S., & RAI, G. S. (2009). Medical ethics and the elderly. Oxford, Radcliffe Pub.

RALPH, S. S., & TAYLOR, C. M. (2005). Nursing diagnosis reference manual. Philadelphia, Lippincott Williams & Wilkins

SIEGENTHALER, W. (2007). Differential diagnosis in internal medicine from symptom to diagnosis. Stuttgart, Thieme.

1 DOENGES, M. E., & MOORHOUSE, M. F. (2012). Application of nursing process and nursing diagnosis an interactive text for diagnostic reasoning. Philadelphia, PA, F.A. Davis Company.

2 CHOUDHURY, M. A. A. S., SHAH, S. L., & THORNHILL, N. F. (2008). Diagnosis of process nonlinearities and valve stiction data driven approaches. Berlin, Springer.

3 CHOUNHURY

4 ADLER, S. N., ADLER-KLEIN, D., GASBARRA, D. B., & ADLER, S. N. (2008). A pocket manual of differential diagnosis. Philadelphia, Lippincott Williams & Wilkins.

5 CARPENITO-MOYET, L. J. (2007). Nursing diagnosis: application to clinical practice. Philadelphia, Pa, Lippincott Williams & Wilkins.

6 GATTUSO, P. (2010). Differential diagnosis in surgical pathology. Philadelphia, PA, Saunders/Elsevier.

7 HAMMER, R. M., MOYNIHAN, B., & PAGLIARO, E. M. (2013). Forensic nursing: a handbook for practice. Burlington, MA, Jones & Bartlett Learning.

8 RAI, G. S., & RAI, G. S. (2009). Medical ethics and the elderly. Oxford, Radcliffe Pub.

9 SIEGENTHALER, W. (2007). Differential diagnosis in internal medicine from symptom to diagnosis. Stuttgart, Thieme.

10 RAI, G. S., & RAI, G. S. (2009). Medical ethics and the elderly. Oxford, Radcliffe Pub.

11 SIEGENTHALER, W. (2007). Differential diagnosis in internal medicine from symptom to diagnosis. Stuttgart, Thieme.

12 ADLER, S. N., ADLER-KLEIN, D., GASBARRA, D. B., & ADLER, S. N. (2008). A pocket manual of differential diagnosis. Philadelphia, Lippincott Williams & Wilkins.

13 RAI, G. S., & RAI, G. S. (2009). Medical ethics and the elderly. Oxford, Radcliffe Pub.

14 RAI, 2009

15 RAI, 2009

16 Rai, 2009