Question

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? (5) 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? Questions7 Develop a plan of care for this patient with 5 nursing intervention be specific, no generalizations.

Answer 1

1.Diagnostic consideration of knee pain:

. inspection of knee for swelling, pain,tenderness,warmth and visible change in Color.

. check for the extent of movement in various directions.

Push/pull joint to evaluate the integrity

Differential diagnosis:

.Gout

.septic arthritis

. osteoarthritis

.baker's cyst

.patellofemoral pain syndrome

2.septic arthritis:

septic arthritis is invasion of joint by infection which can be bacterial,viral,mycobacterial or fungal in origin but mostly bacterial.

out can be superficial or deep.In adults and children common bacteria causing septic arthritis are staphylococci and streptococcus

sign and symptoms:

intense pain

swollen joint

fever

chills

inability to move limb

fever

warmth and redness of joint

Its cause can be best differentiated by performing arthrocentesis I.e surgical puncture to take out synovial fluid and culturing it to find out the culprit.

3.Sign and symptoms of shingles ,Bell's palsy any Lyme disease

shingles Bell's palsy lyme's disease reactivation of chicken pox virus painfully rash appear as a stripe of blisters on the torso known as shingles band Usually unilateral Weakness ,chills,muscle aches and nausea before developing rash Sudden weakness in one half of the face in reaction to viral infection Resolves on its own Rashes Fatigue Achy stiffnesswollen joints Night sleep disturbance Cognitive decline

4 symptoms indicative of Lyme's disease are

Swollen stiff joints

Rashes and night sleep disturbance