Musculoskeletal Case Study : A 30 year old Latino woman presents for evaluation of wrist pain and swelling – Best Nursing Assignment Solutions(2022)

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Musculoskeletal Case Study:

A 30 year old Latino woman presents for evaluation of wrist pain and swelling. She developed symptoms about 3 months ago and has noted progressive worsening since that time. In addition, she has tenderness across the balls of her feet with any weight bearing. The pain is worse when she is inactive and improves with activity.

The symptoms have significantly affected her ability to perform her job as a receptionist in a busy office. She denies any recent trauma to her hands or feet or other joint pain. She reports stiffness in the feet and ankles as well as 4 hours of overall morning stiffness that improves only marginally for the rest of the day. She has noted increased fatigue and weakness in activities significantly. She does not recall being bitten by any insects recently.

PMH: Non-contributory

SH: Receptionist, single, barely supports herself without assistance from close by family. Denies smoking history, social drinker on the weekends with friends.

Medications: Birth control pills and MV

…

Solution

Musculoskeletal Case Study

Index Case

A 30-year-old Latino woman presents for evaluation of wrist pain and swelling. She developed symptoms about 3 months ago and has noted progressive worsening since that time. In addition, she has tenderness across the balls of her feet with any weight-bearing.

The pain is worse when she is inactive and improves with activity. The symptoms have significantly affected her ability to perform her job as a receptionist in a busy office. She denies any recent trauma to her hands or feet or other joint pain. She reports stiffness in the feet and ankles and 4 hours of overall morning stiffness that improves only marginally for the rest of the day.

She has noted increased fatigue and weakness in activities significantly. She does not recall being bitten by any insects recently.

Most Likely Diagnosis of the Patient in the Case Study

A review of the patient’s symptoms and the abnormal physical exam where the provider found a moderate bilateral swelling of the metacarpophalangeal (MCP) and proximal interphalangeal (PIP), as well as the bilateral synovitis of the metatarsophalangeal (MTP) joints, are typical manifestations of rheumatoid arthritis (RA).

Considering the patient’s relatively young age, the individual has young-onset rheumatoid arthritis (YORA) as the elderly onset of rheumatoid arthritis is considered when the patient’s symptoms begin at 60 or more years (Horiuchi et al., 2017). According to Limala et al. (2014), RA is a chronic inflammatory disease that is a progressive, destructive condition of the joints causing decreased physical function, a quality of life that is impaired, increased risk of co-morbidity, and premature death if not treated and effectively managed.

Like any other conventional RA case, the patient’s symptoms began insidiously for weeks, which turned into three months before the individual presented for a clinical evaluation. The patient initially notices stiffness in one or more joints exacerbated by pain on movement and joint tenderness. The patient reports joint stiffness in the morning, which lasts up to four hours, and the physical exam revealed moderate synovitis of the MCP wrist, PIP, and MTP of both hands. The RA is in the early stages (Stage 2).

The Patient’s Symptoms that Support RA Diagnosis

The patient has several clinical manifestations of RA that include but are not limited to wrist pain and swelling which developed over three months together with tenderness across the balls of her feet at the slightest bearing of any weight. The pain gets worse with inactivity but improves when engaged (Qorban et al., 2018).

Another characteristic symptom of RA that the patient is joint stiffness that lasts up to four hours of the morning slightly improves as the day progresses. Bullock et al. (2018) further note that other nonspecific symptoms like fatigue and general malaise are common features before the onset of RA’s clinical features.

The physical exam abnormalities like moderate synovitis in the MCP, PIP, and MTP joints in both upper and lower extremities are RA indicators. The limited range of motion also points towards the same RA diagnosis.

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Pathophysiology of Rheumatoid Arthritis and the Impact of Environmental and Genetic Factors on the Disease

Castro- Santos & Diaz-Pena (2016) observe that RA is an autoimmune inflammatory rheumatic illness that attacks many tissues and organs, the main ones being synovial joints. The disease leads to the progressive destruction of articular cartilage and joints ankyloses.

The resulting pannus formation may destroy the underlying cartilage and erosion of the bones. The risk factors associated with RA include a genetic predisposition where there is sex-linked RA though the triggering mechanism to the sex-linked deformities is not clearly understood (Pradeepkrin, 219).

Additionally, nongenetic factors like smoking and air pollution are some of the environmental risk factors which, according to Pradeepkrin (2019), double the risk of developing RA. It is essential to acknowledge that RA is a progressive disease with no cure, meaning that treatment goals should target to slow the disease’s progression by decreasing the rate at which the destruction of cartilage and bone occurs.

The joint damage varies depending on the patient’s genetics, gender, and environmental pollutants (Scherer et al., 2020). Treatment exists that improves patient quality of life. Pharmacological, nonpharmacological, and emerging targeted therapy significantly improve the patient’s outcomes if adhered to.

References

Bullock, J., Rizvi, S. A., Saleh, A. M., Ahmed, S. S., Do, D. P., Ansari, R. A., & Ahmed, J. (2018). Rheumatoid arthritis: a brief overview of the treatment. Medical Principles and Practice, 27(6), 501-507.

Castro-Santos, P., & Díaz-Peña, R. (2016). Genetics of rheumatoid arthritis: a new boost is needed in Latin American populations. Revista Brasileira de Reumatologia (English Edition), 56(2), 171-177.

Deane, K. D., Demoruelle, M. K., Kelmenson, L. B., Kuhn, K. A., Norris, J. M., & Holers, V. M. (2017). Genetic and environmental risk factors for rheumatoid arthritis. Best practice & research Clinical rheumatology, 31(1), 3-18.

Horiuchi, A. C., Pereira, L. H. C., Kahlow, B. S., Silva, M. B., & Skare, T. L. (2017). Artrite reumatoide do idoso e do jovem. Revista Brasileira de Reumatologia, 57(5), 491-494.

Innala, L., Berglin, E., Möller, B., Ljung, L., Smedby, T., Södergren, A., & Wållberg-Jonsson, S. (2014). Age at onset determines severity and choice of treatment in early rheumatoid arthritis: a prospective study: arthritis research & therapy, 16(2), R94.

Pradeepkiran, J. A. (2019). Insights of rheumatoid arthritis risk factors and associations. Journal of Translational Autoimmunity, 2, 100012.

Qorban, G. N. M., Badghaish, M. M. O., Albaqami, A. S., Nemer, A. A., Alali, A. J., Yaqoub, A., … & Alasmari, M. A. (2018). Rheumatoid arthritis, pathophysiology, and management. The Egyptian Journal of Hospital Medicine, 70(11), 1898-1903.

Scherer, H. U., Häupl, T., & Burmester, G. R. (2020). The etiology of rheumatoid arthritis. Journal of Autoimmunity, 110, 102400.

Question

Musculoskeletal Case Study:

A 30 year old Latino woman presents for evaluation of wrist pain and swelling. She developed symptoms about 3 months ago and has noted progressive worsening since that time. In addition, she has tenderness across the balls of her feet with any weight bearing.

The pain is worse when she is inactive and improves with activity. The symptoms have significantly affected her ability to perform her job as a receptionist in a busy office. She denies any recent trauma to her hands or feet or other joint pain.

She reports stiffness in the feet and ankles as well as 4 hours of overall morning stiffness that improves only marginally for the rest of the day. She has noted increased fatigue and weakness in activities significantly. She does not recall being bitten by any insects recently.

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PMH: Non-contributorySH: Receptionist, single, barely supports herself without assistance from close by family. Denies smoking history, social drinker on the weekends with friends.Medications: Birth control pills and MV

ROS:

• Constitutional: Denies fever or chills, denies weight loss
• Eyes: Denies dry eyes or visual changes
• ENT: Denies dry mouth
• Respiratory: Denies difficulty breathing
• Cardiovacsular: Denies chest pain
• Genitourinary: Denies bladder changes
• Gastrointestinal: Denies any bowel changes
• Endocrine: Denies polyuria, polydipsia, or polyphagia
• Musculoskeletal: Denies neck or shoulder stiffness
• Skin/Integument: Denies rashes, lesions, ulcers, changes in hair, skin or nails

Physical Exam:

• General: Appears in no acute distress
• Vitals: 110 lbs, height 63 in., temp orally of 100 degree F, BP is 120/70. HR 64. RR 12 and regular.

All other exam findings normal except:Neuromuscular: There is moderate synovitis (swelling) of the MCP and PIP joints bilaterally and of the MTP joints bilaterally. The patient has limited ROM of the UE and LE digits due to the pain. There are no nodules noted on any extremities. The Phalen’s, Finkelstein’s, and Tinel’s tests are negative. There is no warmth or redness of any joint. DTR’s are 2+ throughout.

Question answers should be based on evidence found in readings and from peer-reviewed literature. At least two sources must be used and cited in APA format for each question. Only one source can be a textbook. Resources should generally be within 5 years unless you are explaining the pathophysiology of a disease or providing pertinent background information

Discussion Questions:

1. Review the symptoms and abnormal physical exam above and review readings from Chapter 45, Alterations of Musculoskeletal functions, and support your interpretation of the most likely diagnosis with evidence.
2. List all the symptoms from the above that support this diagnosis.
3. Briefly describe the pathophysiology of the disorder and the impact of environmental and genetic factors on this disorder.

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