Case Study:
G.J. is a 71 year old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. However, the pain in her knees has not improved this summer. Discomfort is greater in the left knee than the right knee. She is having difficulty using the stairs in her home.
Her knee pain got significantly worse after she gained 20 pounds over the past 9 months. Her joints are most stiff when she has been sitting or lying for some time and they tend to "loosen up" with activity.
The patient has tried a variety of NSAIDs for pain control, which gave her some relief but also caused significant intolerable stomach discomfort. G.J. has NKDA. Her medications include: atorvastatin 20 mg qhs, atenolol 25 mg bid, lisinopril 40 mg qd, metformin 500 mg bid, and aspirin 81 mg qd.
PMH: Hypertension, dyslipidemia, T2DM, joint pain (especially knees), VS: BP: 155/88, P: 72, RR: 16, T: 98.6F, Ht: 63 inches, Wt: 175 pounds.
PE: MS/extremities: Full ROM of left shoulder, right hip, bilateral elbows and ankles. Mild left hip discomfort with flexion > 90 degrees and with internal and external rotation > 45 degrees.
Bilateral knee crepitus and enlargement, Left > Right. Slight ROM and both Bouchard and Heberden nodes observed bilaterally during hand examination, no tenderness in finger joints. No redness, heat or swelling in joints. Feet without breakdown, ulcers, erythema or edema.
X-rays: Left hip: moderate degenerative changes with osteophyte of femoral head, slight narrowing of the joint space. Right and Left knees: moderate degenerative changes with joint space narrowing, subchondral sclerosis, and bone cysts. No osteoporosis or joint effusions. Right
shoulder: Mild degenerative changes with bone spurs at head of humerus, slight narrowing in the joint space.
Complete the sections of the worksheet, save to your computer, then submit the worksheet to:
Canvas > NURS 521 > Assignments > Module 10 - Clinical Judgment Worksheet.
What is the relevant objective and subjective assessment data from the case study?
What does this data indicate? What conclusions can you make? Using Martel-Pelletier et al. (2019), "A new decision tree for diagnosis of osteoarthritis in primary care: International consensus of experts" what additional diagnostic testing is indicated? What is your preliminary diagnosis(es)?
What is the underlying pathophysiology that produce the clinical manifestations in this case study? You can use text, flowchart or outline to provide a detailed discussion. Please use your own words and do not "cut and paste" from a reference.
Based on the pathophysiology, what clinical course and complications could you anticipate What patient education and follow up is required for the case study patient?