Carson Mayer Case Study-Plan of Care

Carson Mayer Case Study-Plan of Care

Primary Diagnosis

The patient described in the case study has a positive diagnosis of testicular torsion. Testicular torsion is an acute condition that results from spontaneous twisting of the spermatic code and the consequential impediment of testicular blood flow. This condition is non-common, usually occurring in males 25 years and below. It is characterized by sudden onset acute pain and swelling of the testicular area. A positive diagnosis of testicular torsion should be made upon assessment using the testicular workup for ischemia and suspected (TWIST) score. This assessment tool assigns scores to various listed components, and the summative score is said to be predictive of testicular torsion or non-torsion. These components include the presence of testicular swelling and hardness assigned a score of 2 apiece, absence of cremasteric reflex, high riding testis, and nausea and vomiting, each assigned a score of 1. A summative score of 0 is often predictive of non-torsion, while testicular torsion will be very likely when a score of 6 or 7 is attained

Whereas this tool gives a high indication of the likelihood of testicular torsion, a positive diagnosis does not depend solely on the findings from this tool. Patient history, including risk factors such as trauma, undescended testicles, and prior intermittent torsion, considerably aids the diagnosis (Keays & Rosenberg, 2019). The patient described in the case study presented with acute testicular pain. History and physical examination revealed a swollen left hemiscrotum, absent left cremasteric reflex, high-riding left testicles, and vomiting. This gives a TWIST score of 5, which is highly predictive of testicular torsion.

Differential Diagnosis

The differential diagnosis for this patient was an inguinal hernia, torsion of the testicular appendage, and testicular neoplasm, among others. Torsion of testicular appendage refers to the twisting of tissue above the testicle. It often presents with pain that worsens over time. This condition is common in younger males, often preadolescent males. Scrotal swelling, soreness, and redness are almost always present. The presence of vomiting in the patient, absent cremasteric reflex, and high riding testis are often consistent with testicular torsion and not torsion of the testicular appendage (Fujita, Tambo, Okegawa, Higashihara & Nutahara, 2017). This formed the exclusion criteria for torsion of testicular torsion of the appendages. 

Inguinal hernia results from the protrusion of a tissue sample through the abdominal muscle. It also presents with pain that is made worse by cough reflexes and bending, as well as a bulge in the area of protrusion. If the scrotum is involved, pain and swelling in the testicular area may be apparent (Kulacoglu & Köckerling, 2019). Inguinal hernia is, however, excluded from this diagnosis by history that reveals that nothing aggravates the symptoms. The pain is also continuous and irradiating to the left groin. Testicular neoplasm, on the other hand, defines cancers of the testicles. It often presents with pain and swelling of the testicles. It is, however, excluded from this diagnosis due to the acute onset of the pain in the patient presented in the case study, as opposed to testicular neoplastic pain, which is often gradual (Coursey Moreno et al., 2015). No other symptoms presented by the patient or history were predictive of a testicular neoplasm.

Whereas the TWIST assessment tool and the patient history reveal high predictability towards diagnosing testicular torsion, diagnostic tests may be required to accurately confirm the diagnosis. A positive diagnosis of testicular torsion often requires a scrotal ultrasound as well as a Doppler ultrasonography. Doppler ultrasonography forms the hallmark for testicular torsion diagnosis. This diagnostic test reveals the presence or absence of blood flow to the testicles. A positive diagnosis is made when testicular blood flow is absent (Yin & Trainor, 2016). This test alienates testicular torsion from other differentials. Scrotal ultrasound may as well be helpful as it produces images that can be examined independently by a specialist.

Consults

Testicular torsion is a medical emergency that requires surgical intervention. Referral to a urologist is thus required. Interventions done may include orchiopexy or manual detorsion. Manual detorsion involves using the hands to untwist the spermatic code, while orchiopexy is a complex surgical procedure that requires general anesthesia (Yin & Trainor, 2016). The goal is often to restore blood flow to the testicles to prevent testicular hypoxia and ischemia. In the referral notes, the pain onset should be indicated to inform the urgency of the required medical intervention since blood floor impediment for more than 6 hours may lead to tissue ischemia.

Therapeutic Modalities

The mainstay treatment in testicular torsion is to untwist the spermatic code. This can be achieved by manual torsion or orchiopexy (Yin & Trainor, 2016). However, other accompanying symptoms, such as pain, can be managed by pharmacological agents. Pain observed in testicular torsion is often acute and requires stronger analgesics. Morphine is regarded as a generally safe drug that can be used in pain management in these patients. Antianxiety drugs such as sertraline can also be used to calm down the patient. Nausea and vomiting that are characteristic of testicular torsion can effectively be managed by antiemetics such as domperidone. Phosphodiesterase inhibitors increase blood flow to the testicles and may as well be administered (Yin & Trainor, 2016). Examples of drugs in this category include vardenafil and tadalafil, among others.

Health Promotion

Several factors predispose individuals to testicular torsion development. These risk factors for testicular torsion include undescended testicles, prior intermittent torsion, underlying bell clapper deformity, and trauma, among others (Keays & Rosenberg, 2019). Individuals falling in these risk groups, as well as their caretakers, should therefore be informed of their higher propensity to develop testicular torsion. In this regard, they should always be on the lookout to enable the early identification and consequent treatment that may be necessitated by this medical emergency.

Patient Education

Patients at high risk of testicular torsion and those recovering from the condition, as well as their families and caretakers, need to be educated on testicular torsion. Those at high risk should be educated on the importance of being on the lookout. They should also be educated on the presentation of this condition to enable them to identify it fast whenever it occurs. Patients with testicles that are rotatable within the scrotum should be advised on the importance of surgery to reattach them to the scrotal wall as a way of preventing testicular torsion. According to Friedman, Ahmed, Gitlin & Palmer, 2016, a lack of parental knowledge on testicular torsion has been heavily implicated in preventable orchiectomy among their children. Adequate education is therefore important to prevent such occurrences.

Disposition/Follow-Up Instructions

The patient should be told to call their provider in case of the occurrence of any complication. Immediate complications that may arise include infection from gangrenous tissue that may not have been removed. This often leads to sepsis when not adequately addressed. The patient should also be advised to maintain proper hygiene around the incised area to prevent infections. Pain medication can be used in the management of post-operative pain (Yin & Trainor, 2016). Home remedies such as the use of ice packs also confer beneficial effects in pain relief. The patient should also be advised on the importance of adequate rest during the recovery phase to prevent any injury that may result from routine household activities.

Testicular torsion is a medical emergency that often requires prompt medical care. The condition results from twisting of the spermatic code and is characterized by acute pain. Treatment requires manual detorsion or orchiopexy. Patients should be educated on the risk factors and advised on the importance of seeking prompt healthcare.

 References

Coursey Moreno, C., Small, W., Camacho, J., Master, V., Kokabi, N., & Lewis, M. et al. (2015). Testicular Tumors: What Radiologists Need to Know—Differential Diagnosis, Staging, and Management. Radiographics, 35(2), 400-415. DOI: 10.1148/rg.352140097

Friedman, A., Ahmed, H., Gitlin, J., & Palmer, L. (2016). Standardized education and parental awareness are lacking for testicular torsion. Journal Of Pediatric Urology, 12(3), 166.e1-166.e8. DOI: 10.1016/j.jpurol.2016.01.008

Fujita, N., Tambo, M., Okegawa, T., Higashihara, E., & Nutahara, K. (2017). Distinguishing testicular torsion from torsion of the appendix testis by clinical features and signs in patients with acute scrotum. Research And Reports In Urology, Volume 9, 169-174. DOI: 10.2147/rru.s140361

Keays, M., & Rosenberg, H. (2019). Testicular torsion. Canadian Medical Association Journal, 191(28), E792-E792. DOI: 10.1503/cmaj.190158

Kulacoglu, H., & Köckerling, F. (2019). Hernia and Cancer: The Points Where the Roads Intersect. Frontiers In Surgery, 6. https://doi.org/10.3389/fsurg.2019.00019

Yin, S., & Trainor, J. (2016). Diagnosis and Management of Testicular Torsion, Torsion of the Appendix Testis, and Epididymitis. Clinical Pediatric Emergency Medicine, 10(1), 38-44. DOI: 10.1016/

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Case study:
C. M is a 13-year-old Caucasian male who presents to the center with a complaint of sudden left testicular pain that occurred two hours ago while he was playing basketball. His medical condition is described as an acute, continuous pain radiating to his left groin. The patient describes his testicular pain as similar to being punched. He asserts that nothing aggravates or exacerbates his symptoms. On his way to the center, the patient claims to have vomited once. He denies any trauma, fever, blood in his urination, or pain treatment. He states that his pain is a 9 out of 10. During the physical examination, the patient appears acutely distressed and restless. He also has tachycardia and is mildly diaphoretic. The genitourinary exam reveals his left testicle appears higher than the right and tender to touch; his left hemiscrotum is swollen and erythematous; and his left cremasteric reflex is absent. The patient is negative for Prehn’s sign.

Carson Mayer Case Study-Plan of Care

Management Plan Template:

(Every section of your management plan must have in-text citations to support your plan).

Instructions: Answer the following questions.

– Why? What made you select each one as a primary and differential diagnosis?

– How did you rule out each differential diagnosis? This would be a good area to include references.

Primary Diagnosis: Testicular torsion (N44.00)

Differential Diagnosis:
1. Torsion of testicular appendage (N44.03)
2. Inguinal hernia (K40.91)
3. Testicular neoplasm (C62.90)

Additional laboratory and diagnostic tests May be necessary to establish or evaluate a condition. Some tests, such as MRI, may require prior authorization from the patient’s insurance carrier.

– Diagnostic tests and results used to determine the diagnosis: (Explain)
1. Scrotal ultrasound, Doppler: It shows absent blood flow to the affected left testicle.
2. CT abdomen/ pelvis without contrast: Negative CT scan of abdomen and pelvis.

Consults: referrals to specialists, therapists (physical, occupational), counselors, or other professionals. If you were sent to the hospital, what orders would you write for direct admission?

Therapeutic modalities: pharmacological and nonpharmacological management. Give specific medications, dosing, and duration. Include anticipated therapeutic modalities/symptomatic treatment for patients if they are sent to ED or directly admitted.

Health Promotion: Address risk factors as appropriate. Consider age-appropriate preventive health screening.

Patient education: Explanations and advice given to patient and family members.

Disposition/follow-up instructions: when the patient is to return sooner and when to go to another facility such as the emergency department, urgent care center, specialist, or therapist.

Scholarly references (minimum of 3, timely, that prove this plan follows the current standard of care).