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Discussion: Week 9
The determination of the patient’s past exercise habits is crucial during a musculoskeletal examination. Different factors can lead to a musculoskeletal disorder. These factors include poor lifestyle habits, physical work overload and poor ergonomic facilities. Some exercise habits, such as weight lifting, entail subjecting the body to physical work overload, which can lead to the onset of a musculoskeletal disorder with aging (Wyss & Patel, 2012). Furthermore, this knowledge helps the physician in picking the most effective exercises for the patient. A 1-cm difference in the length of legs is a common occurrence. The patient should not worry about the discrepancy because it is less likely to cause a significant effect on the spinal column. However, the patient can correct the imbalance easily by elevating slightly the sole of the shoe for the affected leg. This elevation will help to offset the imbalance and eliminate the risks of static stress on the spinal column. According to Reece (2014), threadworms are the main cause of anal itching, which becomes worse at night. These worms are common in young boys. The itching worsens at night due to the migration of female threadworms out of the bowel to lay eggs in the perineal skin. According to Arulkumaran (2016), the fourth-degree perineal laceration involves laceration to the perineum, anal sphincter complex and the anal epithelium. It is the most severe category of the perineal lacerations suffered by pregnant women during vaginal delivery. Many patients with this type of perineal laceration develop anal incontinence and fistula. Therefore, an assessment of the patient’s anal sphincter function is crucial to determine the extent of the injury.
The lateral decubitus position is the most appropriate for an elderly patient who needs a rectal examination. The patient should lay on his side and ben his needs towards the chest. He should pull the right knee slightly higher than the left knee. This position ensures comfort and modesty preservation for the patient. The position is also suitable for obese patients or person with reduced physical functions (Thompson, 2017). A physician can use the lateral decubitus position during the physical examination of the 42-year old patient with fever and urinary symptoms. This position allows the physician to manipulate the patient’s buttocks easily and examine the anal sphincter, rectal mucosa, perianal skin, prostate, bladder and other relevant areas. I would ask the patient several past medical history questions to support the differential diagnosis of prostatitis. These questions would focus on determining the incidences of sexually transmitted infections, urinary tract infections and drug prescriptions. Patients with multiple sex partners are at high risk of STDs. Prostatitis is common among persons infected with such as gonorrhea, chlamydia and genital herpes. Homosexual men are at the greatest risk. Some of the antibiotics administered to treat particular infections can kill the helpful bacteria in the bowels leading to the growth of the harmful clostridium dificile. Urinary tract infection often leads to the development of acute prostatitis. The pathogens that cause acute prostatitis are similar to the pathogens found in urinary tract infections (Bickley & Szilagyi, 2012). I would expect several findings during the physical examination of a patient with acute prostatitis. The patient should have a fever. His prostate gland should feel tender, swollen and warm. He should show signs of abdominal pain and prostatic pain during rectal examination.
References
Arulkumaran, S. (2016). Best practice in labor and delivery. Cambridge: Cambridge University
Press.
Bickley, L. S., & Szilagyi, P. G. (2012). Bates guide to physical examination and history taking.
Philadelphia: Lippincott Williams & Wilkins.
Reece, A. (2014). Clinical cases in paediatrics: A trainee handbook. London: JP Medical Ltd.
Thompson, J. (2017). Essential health assessment. Philadelphia: F.A. Davis Company.
Wyss, J. F., & Patel, A. D. (2012). Therapeutic programs for musculoskeletal disorders. New
York: Demos Medical Publishing.
