Potential differential diagnoses for ankle pain:

Achilles tendon rupture, Achilles tendon strain, lateral ligament sprain, fracture, gout, dislocation.

Various types of ankle pain:

Ankle pain may be acute or chronic. Pain may be attributed to various differential diagnoses.

The treatment for ankle pain is largely the same. Patient should be encouraged to “protect” the joint. This may be encouraged by wearing a brace around the affected joint. “Rest” the joint by non-weight bearing, using crutches during ambulation. Applying ice to the affected area. Compressing the surrounding tissues with an ace wrap. Elevating the joint to reduce inflammation. Lastly, using oral NSAIDs for pain control.

Ankle Sprain:

Lateral ligament injuries are the most commonly reported injury to the ankle (Van Rijn et al, 2011). Lateral ligament injuries are the most common injury due to the anatomy of the ankle. The lateral ligament is the most vulnerable ligament.

Sprains are treated in phases.

1 – Protection, Rest, Ice, Compression, Elevation & NSAIDs.

2 – Introduce gentle weight bearing

Various types of treatment

Ice, compression, and elevation.

Depending on the severity of injury immobilization or surgical repair may be indicated.

Diagnostics

The mechanism of injury leading to the ankle pain is important to formulating an accurate differential diagnosis. Imaging may be required to narrow down a diagnosis. Imaging such as CT, MRI, and x-ray may be helpful.

Ankle Fractures

Risk factors which predispose patients to a higher risk of ankle fractures include: osteoporosis, diabetes, and obesity (Strauss et al, 2011).

Generally, patients with ankle fractures present with pain, swelling, deformity, and an inability to bear weight on the affected joint (Strauss et al, 2011).  Supination-external rotation fractures are the most common type of ankle fracture (Strauss et al, 2011).  

Unimalleolar – involving one side of the ankle

Bimalleolar – involving medial and lateral malleolus

Trimalleolar – Involving three areas of the malleolous.

Treatment:

Treatment of an ankle fracture is contingent upon several factors “A patient is treated nonoperatively if he/she sustains a nondisplaced, stable fracture with an intact syndesmosis or if stable anatomic reduction is achieved after a displaced fracture. ORIF is indicated in open and/or unstable fractures, and when closed reduction fails. Unstable fractures may cause widening of the mortise or displacement of the talus. The method of stabilization utilized during ORIF depends on the anatomical location of the ankle fracture and associated soft tissue injury” (Urruela et al, 2011)

Strauss, E. J., M.D., & Egol, K. A., M.D. (2011). Identifying and managing ankle fractures in older patients. The Journal of Musculoskeletal Medicine, 28(4), 137-140,145-147. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/863651469?accountid=167104

 Urruela, A., & Egol, K. (2011). Foot and ankle fractures in the elderly patient. Aging Health, 7(4), 591-605. doi:http://dx.doi.org/10.2217/ahe.11.45

van Rijn, R.,M., Willemsen, S. P., Verhagen, A. P., Koes, B. W., Bierma-Zeinstra, S., & Hush, J. M. (2011). Explanatory variables for adult patients’ self-reported recovery after acute lateral ankle Sprain/Invited commentary. Physical Therapy, 91(1), 77-84. Retrieved from https://prx-herzing.lirn.net/login?url=https://search.proquest.com/docview/846755272?accountid=167104 (Links to an external site.)Links to an external site.

Reply to Dee

Patients can have ankle pain for a variety of reasons. To formulate an accurate diagnosis and differentials, providers must be able to accurately assess physically and with assessment questions. Assessing when the pain started, exacerbating and alleviating factors, and any possible precipitating injuries. An ankle sprain, for example, is caused by sudden stress on one or more of the ligaments of the ankle (Uphold & Graham, 2013). Assessing if the patient twisted the ankle and experienced pain immediately or within the hour of the insult, an inversion injury should be suspected (Uphold & Graham, 2013). Asking the patient exactly how the injury occurred, the positioning of the foot when the injury occurred, if there was any swelling, to describe the type of pain, if ADL’s are affected, if there is any limping or night pain can aid in formulating an accurate diagnosis and treatment plan (Dains, Baumann, & Scheibel, 2016).

Physical assessment should include observing the patient’s gait for any limp, assessing for any deformities, inspection of the skin and nails (for inflammation or the possibility of ingrown toenails causing gait abnormality) (Dains, Baumann, & Scheibel, 2016); measuring limb circumference and length to assess for atrophy and to ascertain if this is a chronic or acute problem; palpation of the joints and performing range of motion is also important in formulation of the diagnosis and treatment.

Performing the anterior drawer test, to assess the anterior talofibular ligaments of the lateral side of the ankle; the talar tilt test to assess the stability of the calcaneofibular ligament; and the squeeze test to assess if medial or lateral damage has occurred (Uphold & Graham, 2013). Differentials include muscle strain, tendonitis, peroneal tendon dislocation, tendon rupture, fracture, gout or arthritis (Uphold & Graham, 2013). Diagnostics that should be included are xray, if there is pain near the malleoli, inability to bear weight, bone tenderness, according to Ottawa rules (Uphold & Graham, 2013). CBC can be obtained to rule out infection, uric acid to rule out gout, RA, ANA and CRP to rule out rheumatoid arthritis, arthritis, and infection, respectively (Dains, Baumann, & Scheibel, 2016).

Treatment is dependent upon diagnosis. If patient has a strain/sprain, rest, ice, compression, and elevation is the appropriate treatment. Patient can also be treated with short term NSAID’s for pain relief. If there is no improvement within 2-3 weeks, or if symptoms worsen, patient may need to be referred to an orthopedist (Uphold & Graham, 2013).

References

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced Health Assessment and Clinical Diagnosis in Primary Care (5th ed.). St. Louis, MO: Elsevier.

Uphold, C. R., & Graham, M. V. (2013). Clinical Guidelines in Family Practice (5th ed.). Gainesville, FL: Barmarrae Books, Inc.

While the implementation plan prepares students to apply their research to the problem or issue they have identified for their capstone change proposal project, the literature review enables students to map out and move into the active planning and development stages of the project.

A literature review analyzes how current research supports the PICOT, as well as identifies what is known and what is not known in the evidence. Students will use the information from the earlier PICOT Statement Paper and Literature Evaluation Table assignments to develop a 750-1,000 word review that includes the following sections:

1. Title page
2. Introduction section
3. A comparison of research questions
4. A comparison of sample populations
5. A comparison of the limitations of the study
6. A conclusion section, incorporating recommendations for further research

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. Please refer to the directions in the Student Success Center.

 This written assignment requires the student to investigate his/her local, state and federal legislators and explore their assigned committees and legislative commitments. The student is expected to investigate current and actual legislative initiatives that have either passed or pending approval by the house, senate or Governor’s office. The student will draft a letter to a specific legislator and offer support or constructive argument against pending policy or legislation.  The letter must be supported with a minimum of 3 evidence based primary citations. (See Rubric)

Submission Details:

• Support your responses with examples.
• Cite any sources in APA format.

Respond to the Post that is bellow using one or more of the following approaches:

Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.

Validate an idea with your own experience and additional sources.

Make a suggestion based on additional evidence drawn from readings, or after synthesizing multiple postings.

                                           Initial Discussion Post

                                             Literature Searches

          Nursing is a field filled with numerous  policies and procedures.  To understand these policies and procedures,  the practice of research and knowledge acquisition is essential.  The  method of incorporating proper research into daily practice is called  evidence-based practice (Polit & Beck, 2017).  The goal of using  evidence-based practice is to move away from traditions and ritual by  incorporating tested research evidence that supports clinical practices  (Polit & Beck, 2017).

Summary of Article Search

            Based on the  evidence hierarchy by Polit & Beck (2017), and the levels of  evidence presented in class I was able to evaluate research articles  (Walden University, 2018).  When looking for specific research for my  topic, I searched for the highest level of evidence.  There are three  types of research which are: primary, synthesized or secondary, and  others such as expert opinions or practice questions (Polit & Beck,  2017). 

            My PICOT  question is: In patients with acute pain in the emergency department,  what is the effect of Ketamine use for the reduction of pain compared to  opioid medications during their ED visit? To begin the search, I used  the keywords Ketamine, analgesia, sedation and emergency medicine.   Using these words, I was able to find 408 results.  I further limited my  search to ten years which yielded 297 results.  Finally, I used  systematic reviews, meta-analysis and randomized control trials (RCTs)  for my final search narrowing the articles to 111.  Upon examination of  the articles, I found the articles based on systematic reviews,  meta-analysis and RCTs provided detailed research including abstracts,  methods of trials, results, discussion, limitations, and conclusion.   Each of these sections specifies the purpose of the study in detail. 

          Using this framework for literature review  ensures relevant research is used to answer evidence seeking questions.   Davies (2011) comments, “detailed knowledge of the frameworks enables  the searcher to refine strategies to suit each particular situation  rather than trying to fit a search situation to a framework” (p. 79).   By using a timeframe such as the past ten years, it is easier to see the  relevance of the information to clinical practice today.  An active  literature search will yield the most appropriate information for the  question being posed.

References

Davies, K. S. (2011). Formulating the evidence-based practice question: a review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75-80. Retrieved from https://ejournals.library.ualberta.ca/index.php/EBLIP/article/viewFile/97418144

Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.

Walden University Library. (2018). Levels of evidence. Retrieved from http://academicguides.waldenu.edu/c.php?g=80240&p=52322

• Type of paperCritical Thinking
• SubjectOther
• Number of pages4
• Format of citationAPA
• Number of cited resources7
• Type of serviceWriting

Purpose The purpose of this individual assignment is to critically analyze drug policy approaches: Criminalization of use, possession and distribution of illict drugs Decriminalization of use, possession and distribution of illict drugs Legalization of use, possession and distribution of illict drug Skills: Access and collect needed information from appropriate sources Assess sources for credibility List research findings Knowledge: Current policies across the nation and in select states The impact of these policies The effects of the drug Tasks You will write a 4-page paper that describes current drug policy approaches in the United States. In addiiton you will describe an imaginary society and its responses to the use of drugs of potential abuse. The paper will describe the rationale for your approach, the impact of drug use on society in contrast to current approaches used. The paper will be fact based and supported with citations. The paper will cover the following topics (see rubric for more details): An desсrіption of the societal consequences of illicit drugs and drug use patterns over time A desсrіption of two drug policies discussed in class An analysis current drug policy approaches with regard to their impact on drug use and other impacts to communities and individuals. Your stance on the statement ″Illicit drugs like heroin and cocaine should be decriminalized″ and an analysis of the pros and cons of this approach You will propose to either use decriminalization, or an alternative drug policy (criminalization or legalization) for an imaginary society where you are the policy maker. You will state which drugs are legal/illegal (if applicable), the unintended consequences of those policies. You will also discuss why you think the approach might work in your imagined society You should read the paper rubric before commencing and before submitting your paper. The subric contains specific details needed within your paper. What are empirically-supported arguments? Empirical evidence is information that justifies a belief in the truth or falsity of a claim. This evidence is obtained from knowledge is obtained through observation and experimentation. Each argument must be supported by evidence from credible sources. Examples of credible sources often include peer-reviewed articles (e.g., research articles) and government agencies (NIDA, SAMHSA, CDC, etc). Wikipedia, blogs, and Reddit are not appropriate sources. Format The paper should be fact-based, so use sources to support your claims Lenght: 4-page paper maximum Double spaced 12 point times 1 inch margins Contains an introduction, body and conclusion Contains in-text citations and a reference page, which is not part of the 4 page