Posted: January 26th, 2023

A 45-year-old male who had a history of hypertension and obesity

Describe your clinical experience for this week.

Did you face any challenges, any success? If so, what were they?
Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and at least 3 possible differential diagnosis with rationales.
Mention the health promotion intervention for this patient.
What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
Support your plan of care with the current peer-reviewed research guideline.
Post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources.
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This week, I was in the neurology unit of a hospital and had the opportunity to work with a patient who presented with a headache and neck pain. The patient was a 45-year-old male who had a history of hypertension and obesity.

The patient’s signs and symptoms (S&S) included a constant headache that was described as throbbing and localized to the occipital and frontal regions, neck pain that was described as a dull ache, and a decreased range of motion in the neck. On assessment, the patient’s blood pressure was elevated at 160/100 mm Hg and his neck was tender to palpation.

A differential diagnosis of the patient’s symptoms included migraine, tension-type headache, cervicogenic headache, and subarachnoid hemorrhage. The rationale for considering migraine was the patient’s history of headaches and the characteristic throbbing pain. Tension-type headache was considered due to the patient’s neck pain and elevated blood pressure. Cervicogenic headache was considered due to the patient’s neck pain and decreased range of motion. Subarachnoid hemorrhage was considered due to the sudden onset and severe nature of the headache and neck pain.

The plan of care for the patient included the initiation of a prophylactic medication for migraines, such as topiramate, as well as a referral to physical therapy for neck pain. A head CT was also ordered to rule out subarachnoid hemorrhage.

A health promotion intervention for this patient could include education on lifestyle modifications to manage hypertension, such as maintaining a healthy diet, regular exercise, stress management techniques, and avoiding triggers for migraines. Additionally, the patient could be referred to a weight management program to address his obesity.

From this week’s clinical experience, I learned the importance of conducting a thorough assessment and considering a differential diagnosis for patients presenting with headache and neck pain. I also realized the significance of considering lifestyle modifications and health promotion interventions in the management of patients with chronic conditions like hypertension and obesity.

In support of the plan of care, current peer-reviewed research guidelines suggest the use of prophylactic medications, such as topiramate, for the management of migraines (American Headache Society, 2018). Additionally, physical therapy has been shown to be an effective treatment for neck pain (Fernández-de-Las-Peñas et al., 2016).

In conclusion, as an advanced practice nurse, it is important to conduct a thorough assessment and consider multiple differential diagnoses in the management of patients with headache and neck pain. The initiation of prophylactic medication, referral to physical therapy, and health promotion interventions can play a significant role in the management of these patients.

References:
American Headache Society. (2018). Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting. American Headache Society. https://www.americanheadachesociety.org/wp-content/uploads/2018/03/AHS-Evidence-Based-Guidelines-for-Migraine-Headache-in-the-Primary-Care-Setting-3.pdf
Fernández-de-Las-Peñas, C., Cuadrado, M. L., Gerwin, R. D., & Pareja, J. A. (2016). Efficacy of manual therapy for the management of cervicogenic headache: A systematic review. Journal

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