Description
please add to the case study the following for each disease condition.
- Be specific and CITE your sources using APA. every diagnosis nees a lab or exam and a solid rationale why it’s worth ordering
- Medical Work up - Plan for each condition needs to include: ****Pharmacologic, Nonpharmacologic, Labs, Diagnostics, Referrals, Patient Education, Follow up****
- This is a COMPREHENSIVE case study and you need to look at this patient’s issues and problems from all angles. Do NOT assume it is a simple case study. This is a complex patient just like what you will see in practice.
I am attaching the original document you worked on and the teachers addition to it and grading rubric. please carefully look at the previous feedback.
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Running head: RHEUMATOLOGY CASE
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Rheumatology case
Course name
Student’s name
Professor’s name
University affiliation
Date
RHEUMATOLOGY CASE
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Rheumatology Case
Patient background information
The patient that has been highlighted in this case is a 55-year-old married female. She
presents to the primary care office with a history of 6 weeks of joint pain. She states that the pain
starts from her lower back then moves to the knees, hips, wrists, fingers, and toes. Some of re
medications she has been taking to relieve her symptoms are Motrin, Tylenol, and Aleve but
does not take prescribed medications. She also lacks sleep at night but has no medical history.
She also has no allergies to medications.
Subjective Data
•
Joint pain: The patient has been having joint pain for the past 6 weeks. Kim Lee described
that her pain started from her lower back and progressed to her knees, hips, wrists, and now
fingers and toes. This indicates that the disease has progressed as the symptoms have
progressed to other parts of the body. The patient will be asked if she feels pain when she
stretches and at what range of motion does the pain occur mostly.
•
Fatigue: Kim also states having constant fatigue. Reflexes will be tested to see if the patient
is weak and checking of muscle strength.
•
Loss of appetite: The patient will also be asked to mention she has experienced any loss of
appetite which is common in Rheumatology.
•
Joint stiffness, symmetrical: The paint admits that there has been some stiffness in her hands
for the past 6 weeks. She will be asked if joint stiffness occurs in the morning. She cannot
sleep at night due to inactivity.
Physical exam
RHEUMATOLOGY CASE
A thorough physical examination is essential, as many multifaceted rheumatological
disorders are multi-systematic. The patient must be dressed in an examination gown. The
musculoskeletal exam, as done by subspecialists or carried out as a separate unit, can be
integrated into the general examination. However, due to the associated pain and difficulty
the patient's movement should be kept to a minimum. Swelling and redness: This is one of
the objective data that will be important in assessing the patient for the disease.
Rheumatology usually destroys the immune system. There is some swelling in her hands
especially the joints. She has been using some medications like Motrin, Tylenol, and Aleve
to lessen the symptoms. Warmth and tenderness of the joints: This data can be obtained by
touching the affected joints. In musculoskeletal tests, the convention is "STL" which stands
for S = swelling, T =tenderness, and L = limitation.
The grading for swelling will be from 0-3 where 0 represents none, 1 for mild, 2
for moderate while 3 is marked. Swelling can reflect synovial (pannus) or fluid
proliferation (Doherty, 1992). The evident swelling will indicate signs of a bony
enlargement as well as the thickening of overlying structures or the atrophy of
surrounding tissues (skin / subcutaneous fat). (Except for elderly skin/muscles) Also
tenderness will be graded from 0-3 where 0= none, 1 shows that the joints are tender, 2
indicates that they are tender and winces while 3 means that they are tender, winces, and
withdraws. The pressure on the patients swelled will show whitening on the thumbnail.
During the tenderness assessment, there should be no lateral movement on the
thumb(Lawry, 2012). Tenderness is developed by motion instead of direct palpation of
deep joints like the shoulders and hips. The limitation of Movement will also be graded
from a range of 0-5, in which 0 will represent a full range of motion [ROM], 1 will
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RHEUMATOLOGY CASE
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indicate a loss of motion by 0-9% loss of ROM, 2 shows a loss of ROM by 10-19%, 3
indicates a 20-49% loss of ROM, 4 shows a loss of ROM by 50-99% while 5 will
represent ankylosis. Hand ROM can be assessed by quickly recording the percentage fist
formation and grip strength recorded as good/fair/poor. For occupational therapy (OT) a
detailed hand assessment can be requested.
This overview of the musculoskeletal exam is also a basis for a proper general
evaluation. It is possible in 15 or fewer minutes. However, more precise diagnostic
testing is needed based on the initial findings and a more reliable measurement of the full
range of movement will be required (Fam et al., 2010). These skills can only be gained
through practice and knowing when to apply them. To prove a full physical examination
was conducted and to understand the exact findings, a complete description of the MS
exam is essential (Malanga & Nadler, 2006). The billing code will also be impacted. In
terms of joints swelling, range of motion, tenderness, and function, every area evaluated
must be addressed.
Differential diagnoses for polyarticular pain
1.Rheumatoid Arthritis (RA)
2. The systemic lupus erythematosus (SLE)
3. Psoriatic arthritis
4. Ankylosing Spondylitis
(1) Rheumatoid Arthritis (RA)
It is a progressive autoimmune disorder that initially causes signs and symptoms, such as
joint pain and the swelling of the hands and the feet (Goodman & Fuller, 2011). Chronic
inflammation of the RA can permanently damage and cause the deformation of the joint. RA is
RHEUMATOLOGY CASE
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associated with the onset of disease flares and disease progression. Rheumatoid arthritis (RA)
affects various people in various ways. It may be mild, moderate, or severe, and individual
symptoms vary. For RA development there is no exact timeline. Otherwise, the disorder becomes
compounded over time and progresses through specific stages without effective treatment. Many
new therapies have succeeded in slowing or even blocking the progression of RA. More energy
will be spent on treating the conditions effectively and on looking after the patient's health if the
care delays the progression of RA.
Multiple joints in rheumatoid arthritis are typically (polyarthritis) affected in a
symmetrical pattern, but not always (Goodman & Fuller, 2011). Joint damage can occur early
and is not always related to the severity of RA symptoms. The 'rheumatoid factor' is an
antimicrobial antibody that 80% of rheumatoid arthritis sufferers in the blood. A simple blood
test detects the rheumatoid factor. Possible risk factors for rheumatoid are genetic history,
smoking, inhalation of silica, and bowel microbes (good bacteria). There is no cure for RA. The
optimal treatment of rheumatoid arthritis includes patient education, rest and exercise, joint
protection, medicines, and sometimes surgery.
(2) The systemic lupus erythematosus (SLE)
The systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by
nuclear and cytoplasmic antigens anti structures, multi-system inflammation, clinical protein
manifestations, and relapse and remissions More than 90 % of cases of SLE occur in women,
often from childhood. See the following picture. The immune system usually combats hazardous
infections and bacteria to maintain a healthy body (Lahita, 2004). When the immune system
attacks the body, the autoimmune disease occurs because something strange is confusing it.
Many autoimmune disorders, including systemic erythematous lupus (SLE), occur.
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A proportion of immune conditions with similar physiological presentations as well as laboratory
aspects have been identified with the name Lupus, however, SLE is perhaps the most normally
utilized kind of lupus. SLE is a chronic illness that can have deteriorating symptoms alternating
with mild symptom periods. Most SLE people can live with treatment a normal life. Systematic
photosensitive rash (SLE) occurs typically on the faces or limbs of areas exposed to the sun. The
meta-carpophalanges (MCP) and proximal interphalangeal (PIP), interphalangeal, and distal
interphalangeal joints (DIP), are spared even though interphalangeal are affected(Lahita, 2004).
The basis believes that the number of persons with the condition is considerably higher and is not
diagnosed in many cases. Symptoms may vary with time and may change. Common signs
include joint pain, severe fatigue, headaches, joint swelling, anemia, hair loss, blood clotting, and
fingers turning white (Lahita, 2004). Lupus symptoms are also the symptoms that make
diagnosis difficult for many other diseases.
(3) Psoriatic arthritis
Psoriatic arthritis is a type of arthritis that has psoriasis in some people — a condition that
has red, silvery-shaped skin patches. The majority of people are first diagnosed with psoriatic
arthritis and are then treated with it, but joint pains will sometimes be seen before patches occur.
Its major signs and symptoms are joint pain, swelling, and stiffness. Individuals can be affected
mildly severely by this disorder on any part of their body which may include the spine and
fingertips. Disease flares can alternate with remission times in both psoriasis and psoriatic
arthritis. There is no treatment for psoriatic arthritis but the symptoms can be relieved and joints
damage is prevented. Psoriatic arthritis can cause a disability if treatment is not administered.
4. Ankylosing Spondylitis
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Ankylosing Spondylitis is a disorder that causes inflammation and the fusion of smaller
spine bones over tim...