A 78-year-old female resident of a skilled nursing facility has a diagnosis of o
ID: 121987 • Letter: A
Question
A 78-year-old female resident of a skilled nursing facility has a diagnosis of osteoarthritis. The patient complains of pain with increased walking. She describes the pain as improved after resting. She denies she has noted redness or increased warmth.
The nurse on admission assessment noted bony overgrowth of both knees and the small joints of the fingers.
1. What is the pathophysiology of osteoarthritis?
2. If this patient had rheumatoid arthritis what would the nurse note on physical examination?
3. How does the pathophysiology of rheumatoid arthritis explain the clinical manifestations the nurse notes on exam?
Explanation / Answer
1. ANS: Osteoarthritis: Gradual deterioration and loss of articular cartilage with thicken of the subchondral bone leading to loss of normal joint structure and function. Osteoarthritis affects the articular cartilage of joints. Osteoarthritis affects the Fingers, Hips, Knees, Feet and Spine joints.
Pathophysiology of osteoarthritis:
Decreased water in cartilage with age decreases resilience
Products of cartilage break down and cause inflammation
Bone spurs form
Tissue damage can leads to more tissue damage
loose bodies: chunks of bone floating in a joint
2. ANS:
A. Physical examination should address the following:
Upper extremities (metacarpophalangeal joints, wrists, elbows, shoulders)
Lower extremities (ankles, feet, knees, hips)
Cervical spine
B. During the physical examination, it is important to assess the following: Stiffness, Tenderness, Pain on motion, Swelling, Deformity, Limitation of motion, Extra-articular, manifestations and Rheumatoid nodules.
3. ANS: Rheumatoid arthritis clinical manifestation:
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by progressive damage of synovial-lined joints and variable extra-articular manifestations.
The most common clinical manifestations of vasculitis are small digital infarcts along the nail beds.
The symptoms of arthritis can affect the patient’s capacity to perform the activities of daily living.
Ex: Walking, stairs, dressing, use of a toilet, getting up from a chair, opening jars, doors, typing and their ability to do their job.
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