Bertha/Bernard Sampson: Clinical Reasoning Pre-Work Definiti ✓ Solved

Bertha/Bernard Sampson: Clinical Reasoning Pre-Work Definition

Provide a definition and pathophysiology of the following disease processes/comorbidities in your own words: Rheumatoid Arthritis (RA), Osteoarthritis (OA), and Thrombophlebitis. Include anticipated assessment findings across various systems such as neurological, respiratory, cardiac, gastrointestinal, endocrine, infectious disease, integumentary, mobility, intake/output, psychological/social.

For a focused assessment, highlight which three systems would be your priority. Based on the patient's multiple disease processes, integrate all possible findings and provide rationale for each answer.

Identify priority assessment, interventions, labs and diagnostics, anticipated priority orders, medications, and education.

Explore the Healthy People 2030 objectives relevant to the patient's comorbidities. Choose one objective and describe how you would implement it in the patient's care and health promotion.

Paper For Above Instructions

Rheumatoid Arthritis (RA) is a chronic autoimmune disorder characterized by inflammation in the joints, particularly affecting the small joints of the hands and feet. The immune system mistakenly attacks the synovial membrane, causing pain, swelling, and potential joint destruction. As the disease progresses, it can erode bone and cartilage, leading to reduced mobility and significant disability (Firestein et al., 2018). On the other hand, Osteoarthritis (OA) is primarily a degenerative joint disease caused by wear and tear of cartilage, resulting in pain and stiffness in the affected joints. Unlike RA, OA is more common in older adults and is often linked to obesity and previous joint injuries (Hunter & Bierma-Zeinstra, 2019). Thrombophlebitis refers to inflammation of a vein due to a blood clot, which can occur in the arm or leg and is characterized by pain, swelling, and redness over the affected area (Kahn et al., 2020).

In terms of assessment findings for these comorbidities, one should anticipate neurological symptoms such as numbness or weakness due to joint pain leading to compensatory changes in movement. Respiratory findings may include decreased lung capacity due to restricted thoracic movement. Cardiac assessment might reveal elevated heart rates or asymptomatic arrhythmias related to inflammation. In the gastrointestinal and genitourinary systems, patients may experience alterations in appetite or urination patterns. Endocrinology may show alterations due to the stress of chronic illness, while infectious disease assessments can reflect decreased immune response. The integumentary system might show skin changes, such as rashes or changes due to medications. Mobility assessments will likely reveal limitations in movement, indirectly affecting the overall intake/output (I/O) balance due to decreased physical activity (Hochberg et al., 2019).

1. Priority Assessment:

- Neurological: To assess for any compensatory changes in movement.

- Integumentary: To evaluate skin integrity due to immobility.

- Mobility: To screen for range of motion and strength.

2. Priority Intervention:

- Administer medications for pain and inflammation control.

- Implement physical therapy to sustain mobility.

- Educate on joint protection strategies.

3. Priority Labs and Diagnostics:

- Complete blood count to check for inflammation markers.

- Imaging studies such as X-rays or MRIs to evaluate joint damage.

- D-dimer tests when assessing for thrombophlebitis.

4. Anticipated Priority Orders:

- Initiate anti-inflammatory medications.

- Refer to physical therapy.

- Order imaging studies to confirm diagnosis.

5. Priority Medications:

- NSAIDs for pain management.

- Disease-modifying antirheumatic drugs (DMARDs) for RA.

- Anticoagulants in cases of significant thrombophlebitis.

6. Priority Education:

- Instruct on recognizing signs of joint deterioration.

- Discuss the importance of maintaining mobility and muscle strength.

- Provide information on managing risk factors for thrombophlebitis.

With respect to Healthy People 2030 initiatives, one relevant objective would be to reduce the proportion of adults who experience arthritis-related limitations (Office of Disease Prevention and Health Promotion, 2020). Implementing this objective involves promoting regular physical activity tailored to the patient's capabilities, emphasizing weight management, and educating patients about joint-friendly exercises. Collaborating with physical therapists can enhance mobility while controlling pain, which ultimately supports improved overall well-being. Encouraging participation in support groups can address psychosocial needs and enhance social engagement, a crucial aspect of managing chronic diseases effectively (Gatchel et al., 2014).

In conclusion, the clinical reasoning for the care of patients with RA, OA, and Thrombophlebitis encompasses a multifaceted approach, considering the complexity of comorbidities and their respective assessments. The integration of Healthy People 2030 objectives further reinforces the essential collaboration within healthcare systems to promote optimal patient outcomes.

References

  • Firestein, G. S., McInnes, I. B., & Huber, B. R. (2018). Rheumatoid arthritis. In Harrison's Principles of Internal Medicine (20th ed.), McGraw-Hill.
  • Hunter, D. J., & Bierma-Zeinstra, S. M. (2019). Osteoarthritis. The Lancet, 393(10182), 1745-1759. doi:10.1016/S0140-6736(19)30417-9
  • Kahn, S. R., Morrison, D. R., & O'Rourke, K. (2020). Thrombophlebitis: Advances in diagnosis and management. Circulation: Cardiovascular Quality and Outcomes, 13(6), e006023. doi:10.1161/CIRCOUTCOMES.120.006023
  • Hochberg, M. C., Altman, R. D., & April, K. T. (2019). Guidelines for the management of osteoarthritis: 2019 update. Arthritis & Rheumatology, 72(2), 220-233. doi:10.1002/art.24783
  • Office of Disease Prevention and Health Promotion. (2020). Healthy People 2030: Objectives. Retrieved from https://health.gov/healthypeople/objectives
  • Gatchel, R. J., Peng, Y. B., Peters, M. L., & Fuchs, P. N. (2014). The biopsychosocial approach to chronic pain: Theory and practice. Psychological Bulletin, 140(4), 197. doi:10.1037/a0035798

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