Sample Answer for NUR 631 TOPIC 6 DQ 2 Included After Question
Use information provided and the “Discussion Forum Sample” to answer the following questions.
Scenario
J.R. presents to her PCP with a chief complaint of “pounding and throbbing” headache, and this is the fourth time this month she has experienced this type of headache. The patient is a 45-year-old Caucasian female who appears slightly overweight. She describes her headache at the right temple and having a pain score of 9/10. She denies any pain in the orbit or cheek. She denies lacrimation and rhinorrhea. She is sensitive to the lights in the clinic which make her feels nauseous and dizzy but has not vomited. She denies sensitivity to sound. Previous similar headaches have lasted about 6 hours, have not been responsive to any type of OTC medication, and do not appear to be associated with menses. In addition, she feels exhausted when the headaches finally subside and often fall into a long, deep sleep afterward. She has no known allergies, does not use alcohol or tobacco products, and denies the use of illegal drugs. She sleeps only about 5 hours every night and has rather poor eating habits. She eats “more chocolate than she should” and drinks three or four caffeinated soft drinks every day.
Blood Chemistry Panel
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Na+ = 144 meq/L
K+ = 3.7 meq/L
Ca+2 = 8.5 mg/dL
Mg+2 = 0.9 mg/dL
PO4-3 = 2.7 mg/dL
Cl- = 110 meq/L
HCO- = 30meq/L 3
Questions
List four potential precipitating factors or contributing factors for migraines in this patient. Explain your answer.
Identify the single abnormal finding in the blood chemistry panel above and explain its possible association with the patient’s migraine headaches.
Identify five features of the patient’s headache that help exclude cluster headache as a potential diagnosis.
A Sample Answer For the Assignment: NUR 631 TOPIC 6 DQ 2
Title: NUR 631 TOPIC 6 DQ 2
1. List four potential precipitating factors or contributing factors for migraines in this patient. Explain your answer.
Being overweight predisposes one to issues such as hyperlipidemia, which can lead to atherosclerosis and vascular disease. If this affects the cerebral vasculature, it can cause severe migraines and tension headaches due to vasoconstriction (McCance et al., 2019). Poor sleeping patterns and sleep quality have an impact on nervous system conditioning, which can lead to headaches. Because chocolate contains the amino acid tyramine, it is a migraine trigger. Caffeinated soft drink consumption induces vasoconstriction, which aggravates headaches. Increased neurotransmitter release and platelet aggregability are caused by hypomagnesemia (Ehrenpreis et al., 2022).
2. Identify the single abnormal finding in the blood chemistry panel above and explain its possible association with the patient’s migraine headaches.
Mg+2 = 0.9 mg/dL is hypomagnesemia, while the usual range is 1.7-2.2 mg/dL. Hypomagnesemia produces cortical spreading depression, affects nociceptive processing and neurotransmitter release, and promotes platelet hyper-aggregation, all of which are important factors in migraine development (McCance et al., 2019). It induces the production of excitatory neurotransmitters such as glutamate, which may contribute to the condition of brain excitability that results in migraines (Ehrenpreis et al., 2022).
3. Identify five features of the patient’s headache that help exclude cluster headaches as a potential diagnosis.
Cluster headaches occur in cyclical intervals, which can be ruled out by the fact that her headache was not related to her menstruation. Cluster headaches cause excruciating pain in, behind, or around one eye, as opposed to migraines, which occur in the temporal region (McCance et al., 2019). Excessive tearing relates to cluster headaches, but not to migraines. The patient is light-sensitive, which is not the case with cluster headaches. Cluster headache does not cause nausea, dizziness, or fatigue following an episode that requires sleep.
Ehrenpreis, E. D., Jarrouj, G., Meader, R., Wagner, C., & Ellis, M. (2022). A comprehensive review of hypomagnesemia. Disease-a-month : DM, 68(2), 101285. https://doi.org/10.1016/j.disamonth.2021.101285
McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S., & McCance, K. L. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier.
The single abnormal finding in the blood chemistry panel is hypomagnesemia, which is a low serum magnesium concentration. Hypomagnesemia can be associated with migraine headaches. Magnesium is involved in numerous physiological processes in the body, including the regulation of blood vessels and neurotransmitters.
In migraine pathophysiology, magnesium plays a role in modulating the excitability of neurons and regulating cerebral blood flow. It is believed that low levels of magnesium can contribute to increased neuronal excitability and vasoconstriction, both of which are implicated in migraine attacks.
Low magnesium levels have been found in some individuals with migraines, and magnesium supplementation has shown promise in the prevention and treatment of migraines. Magnesium supplementation can help restore the balance of magnesium in the body and potentially reduce the frequency and severity of migraine attacks. The patient’s hypomagnesemia may be associated with her migraine headaches, and addressing this abnormal finding through magnesium supplementation could potentially help alleviate her symptoms.
Based on the provided information, the following five features of the patient’s headache help exclude cluster headache as a potential diagnosis:
1. The patient’s headache is not primarily occurring on one side of the head. Cluster headaches typically occur on one side of the head.
2. The nature of the pain is not described as severe, stabbing, and throbbing, which are characteristic features of cluster headaches. Instead, the patient’s headache is described as pulsating and accompanied by nausea, sensitivity to light, and exhaustion, which are more indicative of migraines.
3. The patient’s headache does not occur in clusters of multiple attacks per day with short durations. Instead, the headache persists for 2-3 days at a time, which is not consistent with the episodic pattern seen in cluster headaches.
4. Cluster headaches have extreme pain intensity, often described as one of the most severe types of headaches. However, the patient’s headache is not described as having extreme intensity but rather moderate severity.
5. The absence of sensitivity to light, nausea, dizziness, or feeling exhausted is inconsistent with the symptoms commonly associated with cluster headaches. These symptoms are more commonly observed in migraines.
Considering these five features, it is unlikely that the patient’s headache is indicative of cluster headaches and instead suggests a migraine headache diagnosis. However, it is important for the patient to consult a healthcare professional for an accurate diagnosis and appropriate management.
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