Case Study #1 Osteoarthritis
Patients Chief Complaint:
I’m having difficulty walking, my joints have been killing me for the past 3 months. My knees and lower back hurts.
History of Present Illness:
B. is a 71 yo overweight male who presents to your clinic for the first time complaining of months to years of bilateral knee pain that becomes worse with rain and feels better when the weather is warm and dry. He is now concerned because the arthritis symptoms have not an improved this summer. The pain in the right knee is greater than the left knee. He is also concerned about back pain he has had for several years that has recently become worse. He has difficulty using the stairs in his home.
The patient has recently visited an orthopedic provider who treated him with a variety of NSAIDs to help control the pain. The medication did provide mild relief, but also caused a lot of G.I. upset, nausea and stomach pain. The pain has previously been relieved with oxycodone, but he did require increasing doses of this medication. The provider who was treating him with the oxycodone, told him he may need surgery, and that they could not prescribe any further doses of oxycodone. He is now seeking medical care at your practice.
The knee pain started to get significantly worse after he gained 30 pounds over the past eight months. He complains of joint stiffness that is worse when he has been sitting or laying for a period of time, and the joints seem to loosen up with activity.
Past Medical History:
Previous left knee injury, secondary to MVA without surgical intervention.
Left hip fracture 11 years ago with ORIF.
Osteoarthritis
Hypertension
Hyperlipidemia
Diabetes
Current Medications:
Ambien 10 mg PO QHS PRN.
Atorvastatin 20 mg PO QHS
Atenolol 25 mg PO daily
Lisinopril 40 mg 40 daily
Metformin 500 mg b.i.d.
Glipizide 2.5mg po daily
Ibuprofen 400 mg PO Q6hr PRN
Tylenol 1000 mg PO Q8hr PRN
Allergies:
NKDA
Family History:
Father died from MI age of 53.
Mother died from breast cancer age of 80
Brother age 68 with hypertension
Sister age 74 history of rheumatic heart disease with valve replacement and hx of OA
Social History:
Married lives with his wife in a two-story townhouse. Exercises by walking dog daily, but short distances down the block due to pain. Diet is high in processed foods but does try to incorporate fruits and vegetables. Eats a lot of sweets.
Non-smoker.
Alcohol use socially
Denies drug use.
Review of Systems:
General: Denies fever, sweats or chills. Denies weakness, fatigue. Endorses weight increase.
Skin: denies rashes, lumps, sores, itching, dryness, changes in color, changes in hair or nails, changes in sizes or color of moles
HEENT: No use of glasses. Denies headache, head injury, dizziness, lightheadedness. Denies use of contact lenses, denies eye pain, redness, excessive tearing, double or blurred vision, spots, specks or flashing lights. Endorses good hearing. Denies tinnitus, vertigo, frequent ear infections. Denies frequent colds, nasal stuffiness, discharge or itching. Denies hay fever, nose bleeds. Endorses good dentition. Denies bleeding gums. Denies sore tongue, dry mouth, frequent sore throat or hoarseness
Neck: denies swollen glands, goiter, lumps, pain or stiffness
Breast: denies lumps, pain, discomfort or nipple discharge
Respiratory: denies cough, sputum, shortness of breath, wheezing, pleuritic pain
CVS: Endorses high blood pressure, denies heart murmurs, chest pain, shortness of breath, Orthopnea
GI: Endorses diarrhea. denies trouble swallowing, heartburn, changes in appetite. Denies nausea. Denies changes in bowel habits, rectal bleeding or black or tarry stools, hemorrhoids, constipation. Denies abdominal pain
Peripheral Vascular: Denies claudication, leg cramps, varicose veins. Denies history of DVT. Denies swelling in calves, legs or feet,
Urinary: denies increase frequency of urination, polyuria, nocturia, urgency, burning or pain during urination, hematuria. Denies frequent urinary infections, kidney or flank pain, kidney stones, ureteral colic, suprapubic pain, incontinence
Msk: Endorses right shoulder pain with lifting, carrying. Endorses low back pain with occasional radiculopathy. Endorses bilateral knee pain right greater than left. Denies joint swelling. No wrist or elbow pain.
Psych: Denies nervousness, tension, depression, memory change, suicidal ideation, plans or attempts.
Neuro: Denies headache, dizziness, vertigo, fainting, blackouts; weakness, paralysis, numbness or loss of sensation, tingling or pins and needles, tremors or other involuntary movements, denies seizures.
Hematology: denies anemia, easy bruising or bleeding
Endocrine: Denies heat/cold intolerance, excessive sweating, excessive thirst
Psych: Denies changes in mood, attention, or speech; denies changes in orientation, memory, insight or judgement.
Physical Exam:
Vital Signs: 37.2, 72, 15 unlabored, 155/88, 99% RA
Ht 5 ft 10 inches Wt 260 lbs BMI 37.3
General: Alert, oriented, ambulatory, appears stated age.
Skin: warm, dry, normal cheddar, no petechiae, no ecchymoses, no rash.
HEENT: Head: NCAT; Eyes: PERRLA, EOMI, no scleral icterus; Ears: external ear, no tragus tenderness, TM gray, intact; Nose: mucous membranes are moist, no polyps. Mouth: mucous membranes, moist, no pharyngeal edema or edema
Neck/Lymph Nodes: Neck supple, trachea is midline, no masses. No lymphadenopathy.
Heart: Regular, normal S1 & S2
Lungs: Respirations are regular, easy, lungs are clear bilaterally, no wheezes.
Abdomen: No rashes or lesions noted, bowel sounds are positive, no tenderness, no rebound or guarding
Musculoskeletal/Extremities: there is no focal, midline, cervical, thoracic, or lumbar spine tenderness. There is bilateral paraspinal tenderness of the lumbar spine in the area of L3, extending towards the sacrum, which is not focal. Worsening pain with forward flexion of the spine. Right lower extremity straight leg raise is positive. Upper extremities with full, non-painful range of motion of the shoulders, elbows & wrist.
Lower extremities: Right hip pain with flexion to 90°, as well as internal and external rotation of the hip. Right knee with diffuse tenderness anteriorly without erythema or edema. There is crepitus noted with right knee range of motion. Right ankle is normal. Left hip without pain. Left knee does have mild tenderness with flexion as well as extension of the knee. No joint laxity is noted.
Neuro: A&O X’s3, CN II-XII intact, sensation is intact, +2 patellar reflexes bilaterally. Strength is 5/5 upper extremities and 4/5 of both lower extremities.
Based on the case information you were given, and this patients diagnosis of osteoarthritis answer the following eight (8) questions:
- A brief introduction of the disease process and the significance of the problem across the lifespan.
- Pathophysiology of the disease process.
- History and physical findings related to the disease.
- Discuss crepitus as it relates to osteoarthritis.
- Incidence and prevalence of disease
- Identify four risk factors that have predisposed this patient to osteoarthritis.
- Role of APRN and the use of pharmacological and non-pharmacological treatments specific to patient’s condition.
- Prognosis and long-term care considerations.
Review current evidence-based treatment guidelines related to research findings specific to the disease process. If you choose to use a resource in addition to your text you must use a peer-reviewed source that is current and published within the past 5 years. Information from this source must be cited per APA guidelines.
For each answer please use the topic of the question as a heading prior to answering, so that it is clear what question you are answering. Your paper should have a total of eight (8) headings as there are eight (8) questions noted above.
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