Tag: Diagnosis

Migraine Discussion Paper

Migraine
Migraine

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Migraine

Migraine occurs at all ages, but it is most common in the 3rd -5th decades of life. The prevalence rates are higher between 20-55 years, and peaks at age 40. Migraine is inherited.  Most people suffering from migraines usually have family members that have them too. Research indicates that if one of parents suffers from migraines, there is a 50% chance that the child will suffer from migraines. If both patients suffer, the probability that the child will suffer from migraines increases to 75% (Bolay and Ertas, 2012).

The discussion explored the various types of headaches including rebound headaches and tension type of headache. The emerging theme from this discussion is the need to conduct complete history and physical assessments to rule out other causes of headaches. This includes the use of CT and EEG, their importance during diagnosis and monitoring disease progression.

However, these diagnostic tests should be conducted only if health assessments dictate so. It has been reported that headaches with aura increases a person’s risk factor for stroke. Therefore, it is important to assess patient risk to ischemic stroke, especially on women under hormonal replacement therapy and birth control tablets (Lampl et al., 2014).

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Most contributions on triggers have been mentioned.  This includes fasting, stress, worry, menstrual periods, fatigue, head trauma, birth control pills, physical inactiveness, lack of sleep, hunger, and certain foods or drinks especially those that contain nitrites, tyramine, glutamate, and aspartate. Certain medications and chemicals substances have been found to trigger headaches, including estrogens, perfumes, nitroglycerin, hydralazine, and organic solvents with a strong (Rana et al., 2014).

 The issue on treatment was also discussed. The main preventive strategies are lifestyle modification.  NSAIDs such as ibuprofen, naproxen, and diclofenac are more effective as compared to aspirin or paracetamol. However, Triptans and Excedrin are more efficient for treating acute head attacks. Propranolol can also be prescribed if no contraindications are noted. Botox medications are effective for treating chronic migraines; usually used when all other treatment regimen is unsuccessful (Jackson, Kuriyama, & Hayashino, 2012).

References

Bolay, H., & Ertas, M. (2012). Advances in migraine treatment. International Journal of  Clinical Reviews.

Lampl, C., Jensen, R., Martelletti, P., & Mitsikostas, D. (2014). Refractory headache: One term does not cover all – A statement of the european headache    federation. The Journal of Headache and Pain, 15(1), 1-2. doi:10.1186/1129-2377-15-50

Jackson, J. L., Kuriyama, A., & Hayashino, Y. (2012). Botulinum Toxin A for Prophylactic Treatment of Migraine and Tension Headaches in Adults. The Jouranl of American Medicine, 307(16), 1736-1745. doi:10.1001/jama.2012.505.

Rana, A. Q., Saeed, U., Khan, O. A., Qureshi, A. R. M., & Paul, D. (2014). Giant cell arteritis or tension-type headache?: A differential diagnostic dilemma.  Journal of Neurosciences in Rural Practice, 5(4), 409-411. doi:10.4103/0976-3147.140005

Donnet, A., Daniel, C., Milandre, L., Berbis, J., & Auquier, P. (2012). Migraine with aura in patients over 50 years of age: The marseille’s registry. Journal of Neurology, 259(9), 1868-73. doi:http://dx.doi.org/10.1007/s00415-012-6423-8

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SOAP Note for a Patient with; Ectopic Pregnancy

Ectopic Pregnancy
Ectopic Pregnancy

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SOAP Note for a Patient with; Ectopic Pregnancy

Subjective

A 30-year-old female, gravid 1, para1+0.The patient complained of abdominal pain in the right adnexal area which was generalized. She complained of dizziness, light headedness, and syncope. She experienced abnormal uterine bleeding for three days. She had not undergone and gynecological operation and had been on folic and iron supplements. Her menarche was at the age of 14years. Her menses were regular and used to last for 5days and occurred every 28days.The patient had used hormonal implant for three years and had been removed three months ago. She had not received her menses for two months. She was sexually active and had post-coital bleeding. She used to take alcohol on a regular basis.

Objective

The patient was sick looking and was groaning in pain.On palpation, there was generalised abdominal tenderness, and unilateral adnexal mass was present on the right hypochondria. Her vital signs were; Temperature -36.7degrees Celsius, blood pressure-98/56 mm/Hg, pulse-50beats/min. On bimanual examination, there was cervical motion tenderness. Her Serum HCG levels were 4500 IU/l; a trans-vaginal Ultrasound revealed a tubal mass in absence of intrauterine gestational sac.

Assessment

  • Ectopic pregnancy which leads to acute abdominal pain and bleeding (Marion & Meeks, 2012).
  • Ovarian torsion resulting in localized lower abdominal pain radiating to the back or thigh  and nausea and vomiting

A  Urinary tract infection leading to lower abdominal pain and dysuria and increased micturition

  • Appendicitis presenting with guarding abdominal pain and nausea and vomiting. Diagnosis of ectopic pregnancy was made due to the acute abdominal pain, associated bleeding, and increased βhCG levels

Plan

The overall goal of management was to preserve the life of the mother, and this was managed through termination of pregnancy and reconstruction of the implantation site. The patient was given a bed rest ensure that she had reduced activity (Marion & Meeks, 2012). The patient was cannulated and started on intravenous fluids to restore the fluid volume deficit. Blood samples for the laboratory were obtained. Relaxation techniques were used to relieve pain.

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Medical management

The patient was put on intramuscular methotrexate. Methotrexate is a folic acid antagonist which deters cell division. The products of conception degenerates and detaches from the uterus leading to death (Epee-Bekima & Overton, 2013). Viability of the cytotrobhoblast is prevented together with β-hCG secretion (Wright, Busbridge & Gard, 2013).

Surgical management

Laparoscopic salpingectomy was considered to be the primary treatment of the ectopic pregnancy. Salpingectomy was conducted so as to repair the ruptured fallopian tube (Marion & Meeks, 2012).

Alternative management

Expectant management, the ectopic pregnancy could be waited to resolve on its own. However, this would be followed by β-hCG measurement and trans-vaginal ultrasound to confirm whether the disorder has resolved (Epee-Bekima & Overton, 2013).

Follow-up

The patient was advised to visit the clinic after 3-4 weeks for b-hCG measurement and ultrasonography. The patient was also advised on early pregnancy clinic visits.

Reflection notes

Patient involvement: I would carefully advise my patient of the advantage associated with any of the treatment approaches and ensure she fully participates in the selection of the mode of therapy. The use of laparoscopy could be used so as to come up with the diagnosis so as to minimize use of Surgery is the primary form of treatment. In addition to that, a less surgical procedure such as laparoscopic approach would have been used since it is associated with minimal intra-operative blood loss and hospital stay.

References

Epee-Bekima, M., & Overton, C. (2013). Diagnosis and treatment of ectopic pregnancy. The Practitioner, 257(1759), 15-18.

Marion, L. L., & Meeks, G. R. (2012). Ectopic pregnancy: history, incidence, epidemiology, and risk factors. Clinical obstetrics and gynecology, 55(2), 376-386.

Mergenthal, M. C., Senapati, S., Zee, J., Allen-Taylor, L., Whittaker, P. G., Takacs, P., … & Barnhart, K. T. (2016). Medical management of ectopic pregnancy with single-dose and 2-dose methotrexate protocols human chorionic gonadotropin trends and patient outcomes. American Journal of Obstetrics and Gynecology.

Practice Committee of the American Society for Reproductive Medicine. (2013). Medical treatment of ectopic pregnancy: a committee opinion. Fertility and Sterility, 100(3), 638-644.

Wright, S. D., Busbridge, R. C., & Gard, G. B. (2013). A conservative and fertility-preserving treatment for interstitial ectopic pregnancy. Australian and New Zealand Journal of Obstetrics and Gynaecology, 53(2), 211-213.

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