Student name is LaDerria Headache Headaches are one of the most common complaints of patients that are seen in the outpa
Posted: Mon Oct 04, 2021 8:08 am
Student name is LaDerria
Headache
Headaches are one of the most common complaints of patients that
are seen in the outpatient clinic and the emergency room. Pain
perception changes with age and varies among the very young and the
very old (Straube & Andreou, 2019). Headaches decline with age,
therefore when an older client presents with the complaint of an
acute headache the complaint should be taken very seriously (Duffy,
2019). Although the incidence of headaches decreases in the older
adult, headaches are still a complaint of 17% of older adults, with
most headaches being primary, tension, and migraine headaches
(Duffy, 2019).
The Patient
In clinical last semester, I had an 80-year-old Caucasian female
patient that presented to the clinic for a routine 3-month
follow-up visit. The patient had a history of migraines and had
been seeing a neurologist for management of her migraines. She was
due for a routine appointment at the clinic and presented the
information about her headache. She stated that this headache had
been going on for about two days and has been worse than the
others. She had been taking her prescribed medication from her
neurologist with no relief. A full neurological assessment was
completed on the patient and the patient was unable to recall her
birthday and the year. She was normally a fully oriented patient.
My preceptor ordered an emergent outpatient CT scan for the patient
since her medications had not been effective and there were
neurological deficits present. The Ct scan resulted in the patient
having a small spontaneous subarachnoid hemorrhage. She was
immediately sent to the ER where further treatment was
rendered.
Etiology, Possible causes, signs/symptoms, treatment,
and education
There are two categories of headaches which consist of primary and
secondary (Duffy, 2019). Primary headaches have an intrinsic
dysfunction of the nervous system or may be hereditary in nature,
which predisposes the older adult to headaches (Duffy, 2019). There
are several factors that can contribute to the development of a
headache, and they include poor posture, tooth pain, jaw disorders,
dentures that don’t fit correctly, side effects of medication,
depression, anxiety, diet, alcohol, genetics, and general pain
syndromes (Duffy, 2019).
The signs and symptoms of a headache change as patients become
older. Migraines in older individuals can present with sensory or
motor issues as well as increased neck pain, bilateral rhinorrhea,
and lacrimation (Duffy, 2019). Patients that present with confusion
or sensory deficits without a headache should also have an
immediate referral for evaluation completed as this may be
something more serious such as a TIA or intracranial hemorrhage
(Duffy, 2019). A thorough assessment and history should be gathered
on any patient presenting with a headache, especially if it is
noted as the worst headache of their lives. Diagnostic testing
usually consists of a CT as a baseline before an MRI and laboratory
testing for anemia, infection, or electrolyte imbalances (Duffy,
2019).
Treatment of a headache depends on the cause of the headache
(Duffy, 2019). Management typically consists of NSAIDs, Tylenol,
triptans, anticonvulsants, and behavioral interventions such as
relaxation techniques, hydration, biofeedback, physical activity,
and regular meals (Duffy, 2019). In the case of my patient in
clinical, the cause of her headache was a bleed; therefore, these
would not have been helpful. My patient needed emergent care from a
neurologist in a hospital setting. Education regarding headaches
would include medication management, nonpharmacological management,
and resources on headaches from organizations such as the American
Headache Society (Duffy, 2019). It will also be important to
educate the patient when a headache may be emergent such as when
the worst headache of their life is present or when neurological
deficits are present. After reading this chapter, I would have
changed the care of my patient. I would have immediately sent her
to the ER instead of the emergent outpatient scan. Although the
scan only took about an hour, immediate treatment due to the
headache and neurological deficits would have been provided in the
ER.
Reply to the this discussion board like the example
below using the Rise Model.
LaDerria,
R - Like you, my patient also complained
of headaches. I agree with you that headaches are one of the most
frequent reasons why individuals seek medical treatment. According
to Duffy (2109), a headache is a symptom that is located on the
head, neck, or face, which declines with age and new onset of
headaches should be treated serious until proven otherwise.
I – How would you have treated your
patient if the CT scan had return with no significant findings? How
would you treat her migraine? First-line treatment for migraine are
analgesics and antiemetics, and second line treatment includes
triptans (Lee, Ang, Soon, Ong, and Loh, 2018).
S - I would suggest when you answered the
question about how headaches are treated to give specific
medications, doses, and how often they are taken. Such as, migraine
treatment should consist of acetaminophen 1000mg four times per
day, non-steroidal anti-inflammatory drugs (NSAIDs) 600mg four
times per day, and triptans 200mg daily (Lee, et al., 2018).
E – I like how you recognized that you
would have changed your treatment plan. You talk about great points
that the patient presented with that should have alerted you to
make the decision to send her to the emergency room immediately.
Such as, her headache not relieved by her regular medication,
headache feels different from her norm, and has lasted two days
with no relief. Great job and recognizing that treatment options
can change, as this will all make us better clinicians.
Headache
Headaches are one of the most common complaints of patients that
are seen in the outpatient clinic and the emergency room. Pain
perception changes with age and varies among the very young and the
very old (Straube & Andreou, 2019). Headaches decline with age,
therefore when an older client presents with the complaint of an
acute headache the complaint should be taken very seriously (Duffy,
2019). Although the incidence of headaches decreases in the older
adult, headaches are still a complaint of 17% of older adults, with
most headaches being primary, tension, and migraine headaches
(Duffy, 2019).
The Patient
In clinical last semester, I had an 80-year-old Caucasian female
patient that presented to the clinic for a routine 3-month
follow-up visit. The patient had a history of migraines and had
been seeing a neurologist for management of her migraines. She was
due for a routine appointment at the clinic and presented the
information about her headache. She stated that this headache had
been going on for about two days and has been worse than the
others. She had been taking her prescribed medication from her
neurologist with no relief. A full neurological assessment was
completed on the patient and the patient was unable to recall her
birthday and the year. She was normally a fully oriented patient.
My preceptor ordered an emergent outpatient CT scan for the patient
since her medications had not been effective and there were
neurological deficits present. The Ct scan resulted in the patient
having a small spontaneous subarachnoid hemorrhage. She was
immediately sent to the ER where further treatment was
rendered.
Etiology, Possible causes, signs/symptoms, treatment,
and education
There are two categories of headaches which consist of primary and
secondary (Duffy, 2019). Primary headaches have an intrinsic
dysfunction of the nervous system or may be hereditary in nature,
which predisposes the older adult to headaches (Duffy, 2019). There
are several factors that can contribute to the development of a
headache, and they include poor posture, tooth pain, jaw disorders,
dentures that don’t fit correctly, side effects of medication,
depression, anxiety, diet, alcohol, genetics, and general pain
syndromes (Duffy, 2019).
The signs and symptoms of a headache change as patients become
older. Migraines in older individuals can present with sensory or
motor issues as well as increased neck pain, bilateral rhinorrhea,
and lacrimation (Duffy, 2019). Patients that present with confusion
or sensory deficits without a headache should also have an
immediate referral for evaluation completed as this may be
something more serious such as a TIA or intracranial hemorrhage
(Duffy, 2019). A thorough assessment and history should be gathered
on any patient presenting with a headache, especially if it is
noted as the worst headache of their lives. Diagnostic testing
usually consists of a CT as a baseline before an MRI and laboratory
testing for anemia, infection, or electrolyte imbalances (Duffy,
2019).
Treatment of a headache depends on the cause of the headache
(Duffy, 2019). Management typically consists of NSAIDs, Tylenol,
triptans, anticonvulsants, and behavioral interventions such as
relaxation techniques, hydration, biofeedback, physical activity,
and regular meals (Duffy, 2019). In the case of my patient in
clinical, the cause of her headache was a bleed; therefore, these
would not have been helpful. My patient needed emergent care from a
neurologist in a hospital setting. Education regarding headaches
would include medication management, nonpharmacological management,
and resources on headaches from organizations such as the American
Headache Society (Duffy, 2019). It will also be important to
educate the patient when a headache may be emergent such as when
the worst headache of their life is present or when neurological
deficits are present. After reading this chapter, I would have
changed the care of my patient. I would have immediately sent her
to the ER instead of the emergent outpatient scan. Although the
scan only took about an hour, immediate treatment due to the
headache and neurological deficits would have been provided in the
ER.
Reply to the this discussion board like the example
below using the Rise Model.
LaDerria,
R - Like you, my patient also complained
of headaches. I agree with you that headaches are one of the most
frequent reasons why individuals seek medical treatment. According
to Duffy (2109), a headache is a symptom that is located on the
head, neck, or face, which declines with age and new onset of
headaches should be treated serious until proven otherwise.
I – How would you have treated your
patient if the CT scan had return with no significant findings? How
would you treat her migraine? First-line treatment for migraine are
analgesics and antiemetics, and second line treatment includes
triptans (Lee, Ang, Soon, Ong, and Loh, 2018).
S - I would suggest when you answered the
question about how headaches are treated to give specific
medications, doses, and how often they are taken. Such as, migraine
treatment should consist of acetaminophen 1000mg four times per
day, non-steroidal anti-inflammatory drugs (NSAIDs) 600mg four
times per day, and triptans 200mg daily (Lee, et al., 2018).
E – I like how you recognized that you
would have changed your treatment plan. You talk about great points
that the patient presented with that should have alerted you to
make the decision to send her to the emergency room immediately.
Such as, her headache not relieved by her regular medication,
headache feels different from her norm, and has lasted two days
with no relief. Great job and recognizing that treatment options
can change, as this will all make us better clinicians.