Question

CASE STUDY MUSCULOSKELETAL A 68 year old woman had a swollen painful knee. The pain woke her up out of a sound sleep. She has not had any major health problem except essential hypertension. She takes Avalide 10 mg daily. She travels to Martha's Vineyard every year and walks the beach without shortness of breath or joint pain. She did not recall being bitten by a tick. She has no evidence of any of neuralgia such as Shingles, Bell's Palsy or CNS infections. Upon physical examination, her knee is warm to the touch, and the pain is unbearable at times. Currently she can barely walk on the leg. Last month, her other knee had the same symptoms but subsided in about 10 days. On physical examination, the temperature was 100 degrees Fahrenheit and the blood pressure was 170/90. The general examination was normal. The right knee examination showed a small effusion but examination of the left knee showed a large, warm effusion with painful range of motion. The knee was stable, without any evidence of mechanical derangement. Laboratory studies showed a uric acid of 9.3 mg/dl, a negative ANA and RF and a normal CBC and creatinine. Plain films of both knees showed linear calcification in the medial compartments of both knees. Question 1 What diagnostic considerations come to mind with this patient's pattern of arthritis () What is septic arthritis? Question 2 How can you best differentiate the causes? (3) Question 3 Contrasts and compare the signs a symptom of Shingles, Bell's Palsy, and lime disease. Question 4 Which features of this patient's disease support Lyme disease? Question 5 Describe the methods used to make the diagnosis of Lyme disease. Question 6 Synovial fluid analysis showed a white count of 35,000. What other tests would you perform on the synovial fluid? Questions Develop a plan of care for this patient with 5 nursing intervention be specific, no generalizations

Answer 1

1.The diagnostic considerations for this patient are

• Blood investigations:elevated uric acid levels
• Joint fluid aspiration and testing it
• X ray
• CT Scan
• Ultrasound

2.The cause can be best differentiated by investigations report (uric acid level,ANA results)

3.Shingles is an infection which is visibly seen on skin which are painful ,blisters,fever ,rash,headache

The lyme disease has fever ,joint pain ,mylagia,stiffness 9f knee ,a bull eyed rash is a specific symptom

The Bell's palsy is the disorder of CNS and often shows facial droppings to one side of the face,drooling ,found sensitivity

4.The features of fever ,joint pain ,swollen painful knees ,fever support the Lyme disease