Esi Right Shoulder Pain Case Study

Satisfactory Essays

Reason for visit: s/p ESI Right Shoulder Pain.

Vital Signs -

S: TM missed 3 days of her ESI visit, related holidays, but she did continue with ice and plan of care as instructed at home. The TM reports her pain is 4/10, and the pain is described as aching type pain; the pain is intermittent. TM is currently taking Ibuprofen 800 mg tab, 1 tab 2 times a day and Acetaminophen 500 mg tab 2 tabs as needed for shoulder pain to manage her pain and it does help to decrease her pain to 2-3/10. TM denies any loss of ROM or sensation of the right arm; denies any tingling or numbness.
O: Inspection of the right shoulder, no redness or edema noted; palpation of the right shoulder there was no warmth noted; on deep palpation TM reports in some tenderness

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