Read the following information and answer the following questions
Following your recent qualifying as a Chiropractor you’ve decided to undertake some travel and work in a number of clinics throughout Australia. For the last two days you’ve been working in a well-established clinic in a small country town (population approximately 12 000 people).
Your first patient of the day (Evelyn) is new to the practice and a new arrival in town.
General Appearance in waiting room:
Evelyn a 52 year old, immaculately groomed lady of average height and weight appears very nervous in the waiting room. She has positioned herself on the chair in the corner of the waiting room away from everyone else. On being handed the completed patient history your jaded reception staff member whispers to you, “Good luck with this one, I think she’s a bit strange. She’s been looking down fidgeting in her hand bag the whole time”.
Reading through the history you find Evelyn has presented for ongoing headaches which commenced nine weeks ago following a fall at home. She has had plain x-rays and a CT- Scan which showed no fractures but she has had ongoing pain, today she rates it as 7 out of 10.
The original Doctor’s letter she presents provides you with a diagnosis of Uncomplicated Myalgia of the cervical para spinal muscle.
Studying the history further you note she has also ticked sleeping problems, anxiety and depression as well as the above.
Question 1 – 10 marks
Given the above information please detail:
Communication techniques you would use to place Evelyn at ease before commencing any further assessment and treatment.
Question 2 – 20 marks
On entering the treatment room Evelyn tells you the fall was down four stairs and occurred two days after her twin brother’s funeral. The cause was put down to stress following the funeral.
She also informs you four weeks ago she has been prescribed Endep (Amitriptyline) and Tramadol both of which she has been taking intermittently. She is reluctant to take the Tramadol “too often” and at differing times Evelyn breaks down crying telling you “it’s hard at the moment but I’m coping. Sorry I don’t know what these tears are all about, I don’t normally cry”.
In order of priority outline any questions and actions you would ask/perform when assessing the patient. This should include:
• Completing the Chiropractic Case History which would assist you to assess the severity and nature of the patient’s current condition. This should include questions you would ask related to the information provided so far.
• Completing a Mental State Examination using the information provided. If information isn’t provided describe what actions you would undertake and/or what you would observe to perform this.
** These should be specific questions and make use of the questioning techniques outlined in your prescribed text and Moodle site. The aim of these questions should be to further assess the severity and nature of the patient’s current condition.
This relates to specific management of your patient.
Following successfully calming the situation Evelyn allows you to undertake a full physical assessment. The results of which are as follows:
• Postural analysis: the patient has a forward head carriage.
• Range of motion: the patient has a slight restriction in right rotation and left lateral flexion.
• Muscle palpation: The patient displays sub-occipital muscle tension bilaterally with associated muscle tension in the right upper cervical spine neck area.
• Static spinal palpation – (RP , PL, Left Rotation Restriction, Right Rotation Malposition)
Question 3 – 15 Marks
Given the above information it is obvious there are multiple aspects to managing Evelyn’s current situation which would require an open and professional discussion on options.
Within this question you are required to complete the following:
• Develop a structured plan for how you would approach the conversation with Evelyn and provide justification on why you have undertaken it. Note there is no one right answer to this section, it’s about you providing a plan and justifying why? For example would you discuss her anxiety, depression and sleeping problems first or Chiropractic care?
Within this plan you would need to:
• Discuss various options you would advise for dealing with her anxiety/depression/sleeping problems.
Question 4 - 5 marks
Outline how your management priorities would change if Evelyn told you she had planned to kill herself. Please include in your answer:
• How you would determine if she posed an imminent threat to her own life?
• The management option/s you would take if you determined the threat was imminent.
• The management option/s you would take if you determined the threat was not imminent.
This segment may be in dot point form but should outline the above information.