Question

5 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 Questions Develop a plan of care for this patient with 5 nursing intervention be specific, no generalizations

Answer 1

Assessment

Subjective data:

• Pain in knee

Objective data:

• Effusion in knee
• Swelling
• Warmth in the knee
• Vitals:100°F (fever), elevated blood pressure

Diagnosis

Pain in the knee related calcification of the knee as evidenced by swelling ,effusion, elevated uric acid levels

Goal/outcome

• To relieve pain
• To prevent recurrence

Nursing Intervention and rationale

• Assess the pain level, provides baseline information to plan for care
• Administer analgesis to relieve pain ,NSAIDS to reduce inflammation and medication to reduce uric acid levels
• Ice application to reduce inflammation and pain
• Elevate the limb to reduce swelling or edema
• Provide a low purine diet ,this can reduce the production of uric acid

Evaluation:

The patient is able to walk free and have relief from pain