Question

S.R. is a 42-yr old woman who has been experiencing unexplained weight loss in the last few months. She feels like she is tired all the time and her appetite is not very good. Today she is being seen at the outpatient clinic because joint stiffness in the mornings has become an increasing problem. She has also noticed that her left wrist is especially painful and swollen today, though she doesn't remember injuring it. 1. What diagnostic tests do you expect the nurse practitioner to order for S.R.? For what purposes? S.R. is diagnosed with rheumatoid arthritis (RA) and is referred to a rheumatologist for consultation. After the consultation in which the doctor has described the common disease trajectory and medical treatments, the nurse follows up offering to answer any questions. S.R. says that she is glad that her condition can be cured by the medications and asks what the doctor means by exacerbations and remissions. 2. What misunderstanding does the nurse see in S.R.'s response? How can the nurse explain this concept in lay language? S.R. asks if she will need to see her nurse practitioner or the rheumatologist again about this same disease. 3. How should the nurse respond?

Answer 1

1) : Diagnostic test include

ESR, to find out elevated erythrocytic sedementaion rate to find out presence of inflamatory process

CRP to figure out elevated C reactive protein in blood

Anti CCP antibody to look for rheumatoid factor

X ray or MRI of left wrist to find out rheumatoid arthritis.

2) : Nurse notice thar SR misunderstood that her condition can be cured by medication completely and ask about the meaning of exacerbation and remission. The nurse explained that there is no complete cure of rheumatoid arthritis and your doctor told you that an increase in severity of the disease (Exacerbation) may occur and your disease will be less severe for a period of time under the effect of medicine (remission).

3) : Nurse explain the client that follow up is necessary for this condition after completion of your medication to figure out whether further treatment required or not.