Dorothy Grant is a married, 48-year-old, white woman who has
Dorothy Grant is a married, 48-year-old, white woman who has come… Dorothy Grant is a married, 48-year-old, white woman who has come to the office of the school nurse with what she describes as a migraine headache. She is employed by the school system as a music teacher for grades Kinder to 8. She has had a long history of migraine headaches and experienced her first episode at the age of 16. Her father also had migraine headaches until his mid-50s. She is employed full time and is a mother of two school-aged children. She states that she is 162.5 cm (5 ft 4 in) tall and weighs 63.5 kg (140 lb). Dorothy relates that she has severe throbbing pain in the right temporal region. On a scale of 0 to 10 (with 10 being the worst), she rates her pain as a 9. She says she feels nauseated but denies vomiting. Although she is not currently experiencing visual disturbances, she did experience some about 2 hours ago. She describes them beginning with loss of her central field of vision, followed by flashing lights and then “orange and blue triangles moving from left to right” across her visual field. About an hour later, she experienced the pain. She also reports feeing “a little lightheaded.” She took 600mg of Ibuprofen about 20 minutes ago. She states that sleeping for several hours is the best remedy. Although she sleeps well for 7 hours a night, lately she has not been getting adequate sleep and has been eating “cheeseburgers on the run.” This is a departure from her usual habit of eating three healthy meals a day with a snack of fruit or popcorn. Dorothy routinely attends a Zumba class four to five times a week, although she has not attended any classes for the past 2 weeks because of late practices for the annual Christmas program. There is no other history of head or neck problems. Physical assessment reveals that her skin is warm, pale, and dry to touch. Her voice trembles slightly when she is speaking. Her pulse is 78 beats/minute, her respirations are 24 breaths/minute, her blood pressure is 128/74 mmHg, and her temperature is 37.1 C (98.8 F). Her head and face are round and symmetric, with her head in a central position; no masses are noted. The client demonstrates normal range of motion of the head and neck, with no abnormal movements. The trachea is in the midline; the thyroid gland is nonpalpable. The cervical and supraclavicular lymph nodes are nonpalpable and nontender. The temporal area is tender to touch; the temporal artery is palpated. Test results of cranial nerves V, VII and XI are normal. Her posture is erect, but she is holding her head with her hand. Health Science Science Nursing NURSING 134
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