Free Essay: Case Analysis Exercise

The patient encounter that is being analyzed in this case analysis was chosen because of the prevalence of the problem, and the importance to manage that condition to improve the quality of life of the patient. As illustrated in the SOAP note, the patient is an eight years old girl named Jasmine. Jasmine has been having issues with her maxilla, which has triggered further analysis and clinical consultation. In this regard, the study seeks to help Jasmine to identify the clinical challenges that she is experiencing and provide the best management strategies. One of the goals of the practicum was to manage conditions with the patients for a better quality of life. It should be noted that the patient was diagnosed with epileptic seizures, which necessitated the prescription of drugs. Epilepsy is a condition of the central nervous system, where human brain activity becomes abnormal, thereby causing seizures and periods of unusual behavior, sensations, and even loss of awareness in some cases (Engel & Pedley, 2008). Epilepsy is the fourth most prevalent neurological disorder, which can be devastating, especially for stronger seizures that can cause uncontrollable muscle twitches. In this regard, considering that such a condition can have adverse complications that can lead to falling, car accidents, emotional health issues, and pregnancy complications, among others, it is necessary to analyze the symptoms critically and clinically identify the best therapeutic treatment for the patient.

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SOAP

Patient Description

Jasmine is an eight years old girl who has been having problems with her maxilla. Born on 10 January 2012, she is the older of the two siblings. Having experienced continuous problems with her maxilla, she was taken to the clinic for clinical consultation. At the clinic, she was diagnosed with mild epileptic seizures. In this regard, she was prescribed Keppra 20 mg/kg in 2 divided doses (10 mg/kg twice daily). After two weeks, she was brought back at the clinic for a follow-up, where she was advised to continue with the medications and make a follow-up plan with the EKG. With her increased conditions and problems, she needs medical help to manage the problem effectively.

• Subjective: Symptoms: COLDSPA
• Characteristics: Some of the prevalent characteristics include maxillary pain, lightheadedness, headache, chest pains, palpitations, and visual changes.
• Onset: The symptoms that have been observed on the patient were at first mild regarding the maxilla problems. However, there has been an observed gradual onset of the problems, which have increased with intensity.
• Location: The patient mostly complains of the maxilla, which has been experiencing pain problems and tremors on the face.
• Duration: The symptoms have persisted on the patient since she was a young girl.
• Severity: The patient depicts some baseline left-sided weakness as well as some facial nerve palsy that may have been as a result of the mild seizures. However, the patient can normally perform ADLs.
• Pattern: The pattern for the seizures are on and off, although they cannot be identified properly considering that the patient is a young girl. However, she has been complaining regularly in the last couple of months.
• Associated factors: Seizures, observable confusion, racing heart, fatigue, dizziness, palpitations, fever, and a loss in sensation.
• Objective: Cooperation and Behavior
• System Review
• General: fever, fatigue
• Head: dizziness, headache, trauma
• Eyes: changes in vision
• CV: palpitations, chest uneasiness
• Urinary: polyuria, dysuria
• Neurological: seizure, loss of sensation, headache, weakness
• Skin: lesions
• Endocrine: intolerance of cold

Appearance:

The patient demonstrates a slightly abnormal gait, who is unable to maintain a very upright posture for long. She was well-groomed properly by the caregivers, and appears well-kempt and has proper hygiene. She is an oriented child, with a normal bowel sound, moderate tenderness, with slight swelling observed on her maxilla. The patient depicts a slightly slurred speech, especially with eye contact. Immediate memory is present although she appears anxious and irritable

Assessment and Plan:

Diagnostic:

The diagnostic procedure will require a neurological exam. In this case, a neurological exam may include the examination of the patient's behavior, mental functions, motor abilities, and the others that are imperative to diagnose and determine the possible type of epilepsy (Meinardi, Cramer, Baker, & Silva, 2012). Blood tests may also be needed by the doctor to examine the signs of possible infections, the presence of genetic conditions, as well as other conditions that could be associated with seizures. Another diagnostic procedure to evaluate the abnormalities is the electroencephalogram (EEG) to obtain the brain functions of the patient (Koutroumanidsi, 2018). Depending on the findings, the analysis may also necessitate magnetic resonance imaging (MRI), computerized tomography scans (CT), and positron emission tomography (PET).

Specific Treatment:

The treatment will be based on the diagnosis. Mostly, treatment of epilepsy starts with medication; however, the doctors can also propose surgery and other types of treatment. Treatment may be based on anti-seizure medication (Koutroumanidsi, 2018). Therapies can include vagus nerve stimulation to reduce seizures. A ketogenic diet is also an option for children as it reduces seizures when a strict diet is followed. Also, deep brain stimulation may be offered to send electrical pulses to the patient's brain as it has been noted to reduce seizures.

Disposition

Disposition includes the next source of patient care, with follow-up plans as well as back-up plans, considering that seizures can be disturbing, especially when they do not respond appropriately to medication.

Differential Diagnoses

In medical practices, differential diagnoses refer to distinguishing a particular disease or a condition from other conditions that present similar clinical manifestations. In this regard, the patient presents symptoms that present numerous considerations from a clinical perspective. One of the clinical manifestations is epilepsy. Epilepsy involves the arrest of activity in a patient, loss of awareness, and facial automatisms. From the information provided in the SOAP analysis, the patient depicts head trauma, fever, unresponsiveness, and alterations to the sense of taste. Although the symptoms have not been adverse, they have become prevalent in the last couple of months. The complaints of maxilla pain have also increased, presenting a symptom for mild epilepsy. However, the patient does not depict seizures, twitching limbs, and major problems with the sight, which may be categorical for epilepsy diagnoses. Therefore, other considerations for clinical manifestations should be made.

Cardiac disorders are the other consideration for the symptoms depicted by the patient. Most of the cardiac problems present with prodromal features that resemble simple syncope, chest pains, and shortness of breath (Elliott, Lambiase, & Kumar, 2011). The transient heart block attacks are short and abrupt. Although the patient has demonstrated some of the symptoms, there is no clear evidence of an attack, that is characterized by fainting and chest pains. Another consideration is the panic attacks. Panic attacks mostly present feelings of fear and anxiety that are mostly associated with autonomic changes as well as hyperventilation. Panic attacks can be demonstrated by dizziness, lightheadedness, twitching, nausea, and peripheries (Burns, 2006). However, the patient has not demonstrated a clear lack of awareness or blurred vision, which is common with the condition.

The last consideration is the maxillary sinus. This is the inflammation of the maxillary sinuses, which is characterized by headaches mostly around the sinuses, fever, weakness, and chronic pain. Therefore, it is imperative to analyze the presentations of the client to make a differential diagnosis. From the SOAP analysis and tests, it is evident that the differential diagnoses are mild epilepsy. Some of the prevalent characteristics include maxillary pain, lightheadedness, headache, chest pains, palpitations, and visual changes. To ensure the accuracy of the diagnoses, a neurological exam will be conducted that includes the examination of the patient's behavior, mental functions, motor abilities, and the others that are imperative to diagnose and determine the possible type of epilepsy. Also, blood tests were conducted to examine the signs of possible infections, the presence of genetic conditions, as well as other conditions that could be associated with seizures. Finally, the EEG would be essential to obtain the brain functions of the student.

Epidemiology

Epilepsy is a chronic disorder that affects people of all ages, although it has a prevalence of children and the elderly (Beghi & Guissani, 2018). According to Beghi and Guissani (2018), the association of epilepsy with age can be explained concerning the predominance of the brain diseases that have an epileptogenic potential, especially stroke and dementia. In this regard, the process of aging impacts on the molecular mechanisms that involve the neuron networks and a diffuse distribution. According to Beghi and Guissani (2018), the active prevalence of epilepsy is 6.4 in every 1000 people, while the lifetime prevalence is about 7.6 cases in every 1000 people. This prevalence is noted to increase with age, with the oldest depicting the highest prevalence. Also, epilepsy shows a high prevalence of 61.4 for every 100,000 annually. Beghi and Guissani (2018) also noted that the disease has a bimodal distribution with peaks at the youngest and the oldest populations. However, it has been demonstrated that epilepsy affects both sexes, although with a slight prevalence in men than women, and people of all ages implying that all the measures undertaken to study and control the condition should consider this perspective.

Etiology and Pathophysiology

Epilepsy depicts numerous traits due to diversity. The pathophysiology of the condition and the seizures is diverse, as it accounts for different types of seizure disorders. However, studies have demonstrated commonality in all epilepsies is a disrupted balance between the excitatory and inhibitory. Therefore, the pathophysiology of epilepsy is essentially considered as a shift that takes place between the inhibitory and the excitatory neurotransmission that favors glutamate (Squire, 2011). The shift of the balance can take place due to the selective loss of the inhibitory GABA-ergic neurons, which takes place after the insult of the precipitating epileptogenic. Some of the insults may include stroke, brain injury, and status epilepticus (Squire, 2011). Also, the condition is characterized by the reorganization of the neuronal circuits that facilitate the hypersynchrony of the neuronal populations.

In this regard, it is evident that while there is a difference between the pathophysiology of most of the epileptic encounters, all of them depict commonality regarding the increased neuronal excitability and synchronicity and the mechanisms that are involved in the transition of interictal-ictal (Squire, 2011). Recent studies have also demonstrated emerging insights regarding the behavior of the condition which regard the alterations of the synaptic functions and the intrinsic properties of the neurons (Squire, 2011). Epilepsy may be caused by a wide range of events such as brain malformations, poor oxygen distribution during birth, low blood sugars, and other vital chemicals such as blood magnesium and calcium (Squire, 2011).