Rheumatoid Arthritis Case Study
Joy G. is a 48-year old married mother of 3 active boys, ages 12, 15, and 18. She enjoys attending her
sons’ sporting events and providing “Mom-Taxi” services for her sons and their friends. She also loves her part-time job as a hairdresser at a popular salon. Seven months ago, Joy began noticing stiffness in both hands in the morning that lasted longer and longer. Stiffness now lasted more than 1 hour every morning and included hands, wrists and ankles. She also had increasing difficulty standing for long periods at work or at home due to foot and ankle pain. She began taking ibuprofen 800mg 3 times daily and found it helped her get through her day with less pain and stiffness. Three months ago, Joy noticed pain in her right and left shoulders when she would cut or blow
dry her client’s hair. She also began feeling extremely tired and short tempered. She had no energy to do her usual activities. Ibuprofen was no longer very effective for her pain or stiffness.
One morning, Joy could not lift her arms at all without extreme shoulder pain. She knew it was time to get help. She had been speaking with her friends and they encouraged her to see a doctor. She saw her Primary Care Physician (PCP), who examined her and ran a few preliminary blood tests. The blood tests revealed positive rheumatoid factor, CCP antibodies, elevated ESR and C-reactive protein. Joy was informed of these results and her PCP referred her to a Rheumatologist to be seen as soon as possible. In order to facilitate a timely consultation, Joy was scheduled with the rheumatology Nurse Practitioner (NP) for her new patient appointment.
Upon arrival at the rheumatology office, Joy was asked to provide a complete medical history. At her scheduled appointment time, the Certified Medical Assistant (CMA) escorted Joy into the exam room, where her weight and height were measured and vital signs taken. The CMA reviewed her medications and their dosages with her and documented them in the electronic medical record.
The NP introduced herself and proceeded to take a complete history. She asked about Joy’s parents’ and grandparents’ medical histories, family illnesses, Joy’s medical and surgical history and information about her family and work lives. A thorough physical examination was conducted, including examination of all of Joy’s joints, many of which were tender and swollen. Her Rapid 3 Score was 21.8, consistent with severe impairment and significant disease activity. The NP discussed the examination findings with Joy, and reviewed the laboratory tests from her PCP. The NP ordered x-rays of Joy’s feet, hands and shoulders. Additional laboratories were
ordered and drawn by the CMA.
1. Formulate a concept map on the case presented.
Extracted text: spiritual distress 4) List possible nursing diagnoses Spiritual Distress r/t the loss of connection to a spiritual and social support source 5) Check for defining characteristics Major: Direct comments correlating the lack of treatment adherence to the loss of motivation and support. Minor: Tone relays stress incurred from broken ties 6) Confirm or rule out dlagnoses Confirm the diagnosis. Encouraging the client to reconnect to tried sources of social and spiritual support, or to seek new sources, may improve the client's health condition through health promotion activities 7) Document conclusions Nursing diagnoses that are appropriate for this client include: • Spiritual Distress
Extracted text: I) Identify abnormal findings and client strengths Subjective Data Objective Data • Blood pressure elevation between • Lack of adherence to the treatment regimen • The in formation is not easily divulged • Loss of previous strong ties to the religious group • Cient describes lack of motivation to participate in health promoting activities • Heightened sense of stress due to the lost visits • Weight increased 5 pounds from the previous visit • Facial expressions changed to ones of concern as the conversation moved toward the client's struggles connections 2) Identify cue clusters • Loss of strong social ties Motivating force in health has been squelched • 3) Draw inferences Presented information implies displaced relation- ships are in need of addressing. Previous inform- ation of social ties to the religious organization suggests intervention related to the client's spiritual distress 4) List possible nursing diagnoses Spiritual Distress r/t the loss of connection to a spiritual and social support source