Differential Diagnosis of Osteoarthritis: A Case Study, Assignments of Nursing

Download Differential Diagnosis of Osteoarthritis: A Case Study and more Assignments Nursing in PDF only on Docsity!

Differential Diagnosis: Osteoarthritis M19.9 is the most common form of arthritis and most likely diagnosis for this patient. It commonly affects joints that bear most of our weight, such as knees and feet. A joint has a tough but smooth coating with cartilage that is slippery. When osteoarthritis occurs, the surface becomes rougher and does not move as smoothly as it should. Risk factors include increased age, female sex, genetics, or major joint surgery (Katz, Arant, and Loeser. 2021). The knee x-ray reveals significant narrowing of the medial joint space of the right knee with sclerosis and osteophytes and significant narrowing of the medial joint space of the left knee with sclerosis and osteophytes, confirming the diagnosis. Rheumatoid arthritis M06.9 can cause pain, swelling, and deformity in joints. It is an autoimmune disease in which the immune system attacks the synovial membrane, in which it becomes inflamed and thickened, fluid builds up, and the joint begins to erode and degrade Simonsen et al (2020). A normal blood value of erythrocyte sedimentation rate makes this unlikely, as this is usually elevated in rheumatoid arthritis. Calcium pyrophosphate dihydrate deposition disease (CPPD)/pseudogout M11.20 is a painful form of arthritis that occurs suddenly. Calcium pyrophosphate crystals sit in the joint and surrounding tissues, causing pain, and swelling. Calcium deposits are typically seen on x-ray, which was not seen in this case. This diagnosis typically comes on suddenly but in this case, the pain has progressed over a few years, making this diagnosis unlikely. Gout M10.9 is a form of arthritis that causes severe pain, redness, and tenderness in joints when there is inflammation from too much uric acid crystallizes and deposit in the joints. Pain and redness occur in the joints, typically in the big toe and often at night. This patient presents with her worse pain in the morning, as well as a normal uric acid, making this diagnosis unlikely (Igel, Krasnokutsky, and Pillinger. 2017). Septic arthritis M00.861 is infectious arthritis that is typically caused by bacteria from another part of the body or a penetrating injury to the joint such as an animal bite or trauma. This can be diagnosed when there are signs of infection from a synovial fluid analysis. In this case, the synovial fluid exam was normal, and the patient had a normal white blood cell count, not showing any signs of infection (Long, Koyfman, & Gottlieb. 2019). Additional laboratory and diagnostic tests: Comparing the tests that I ordered versus the recommended tests, I could have ordered a synovial fluid analysis. However, with it being invasive, normal erythrocyte sedimentation was sufficient enough for me to rule out rheumatoid arthritis. An antinuclear antibody test could be added from my recommendations to make sure it is not an autoimmune problem. Consults: Orthopedic consult would be appropriate for this patient due to the patients’ progression of arthritis in the knees. They would decide if the patient would be a candidate for surgery or first try a steroid injection in the knees to help eases the pain. With being overweight with a BMI of 35, a referral to a dietician and fitness trainer could be made. The patient would need a specialized exercise program that did not involve any further stress on the knees.

Therapeutic modalities: Trying to decrease pain and improve quality of life would be the goal of treatment. Getting the patient an appropriate exercise program can help the patient lose weight, putting less pressure on the knees, therefore decreasing the pain. Physical therapy could be beneficial in maximizing the health of the joint to help decrease pain. Non-steroidal anti- inflammatory drugs are not ideal for this patient due to the history of peptic ulcer disease. Due to this, Tylenol and putting the patient on Duloxetine could help improve the pain. Short-term treatment with Duloxetine has shown to cause weight loss, which would be beneficial for the patient. However, long-term use has been shown to cause weight gain which would worsen the patient's condition. Use of a cane or most likely walker since pain is in both knees could be beneficial in taking pressure off the knees (Zhao et al. 2015). Health Promotion: With the patient being provided resources for weight loss such as a dietician and resources for a fitness trainer could help decrease the patients’ pain. By the patient losing weight, pain in the knees could decrease, as well as the bonus of improving the patients' blood pressure that is slightly elevated despite being on medication. Patient education: Avoiding repeated motions of the joint, weight loss, exercise, and adaptive devices such as canes or walkers can be taught to the patient to help decrease pain and improve activities of daily living. The patient can be instructed on using different methods of food intake tracking to help with weight loss. Disposition/follow-up instructions: The patient is instructed to follow up in 4-6 weeks. Also, make an initial orthopedic appointment as soon as possible. Report back with weight loss progress, as well as diet logs to review References Igel, T. F., Krasnokutsky, S., & Pillinger, M. H. (2017). Recent advances in understanding and managing gout. F1000Research , 6 , 247. Katz, J.N., Arant, K.R., & Loeser, R.F. (2021). Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA. 325(6). 568–578. Long, B., Koyfman, A., & Gottlieb, M. (2019). Evaluation and Management of Septic Arthritis and its Mimics in the Emergency Department. The western journal of emergency medicine , 20 (2), 331–341. Simonsen, L. P., Havelund, R. A., Yurtsever, A., Melgaard, D. (2020) Missing Diagnosis, Pain, and Loss of Function in Older Adults with Rheumatoid Arthritis and Insufficiency Fractures: A Qualitative Study of the Patient’s Perspective. Geriatrics. 2020. 5(4). 94 Zhao, Y. W., Sheng, Y. S., Shu J. L., Feng, C., Huang, C.,..(2015). Efficacy and Safety of Duloxetine on Osteoarthritis Knee Pain: A Meta-Analysis of Randomized Controlled Trials, Pain Medicine. 16(7). 1373–