Osteoarthritis Case Study

Ms C is a 58 year old female who is seen at the community health clinic for routine annual evaluation. Ms C is 5’5” and weighs 150lbs. The LPN is assigned to take her vital signs, which are:

BP 140/84
Pulse 84
Resp 18
Temp 98.6 degrees Farenheit

On initial interview by an RN, Ms C reports increase in dull, aching pain around the joints of the digits of both hands. Observation of the hands finds evidence of early manifestations of Heberden’s and Bouchard’s nodes. On further assessment, she reports the use of aspirin to help relieve the pain, and antacids (TUMS), to decrease the discomfort in her stomach, which she believes is due to the constant use of aspirin. Continued gathering of data reveals lack of exercise and years of “vegan” diet, but the use of herbs and nuts as supplements. After the RN completes the history and physical, Ms C is then seen by the NP who corroborates data gathered by the nurse, discusses findings with Ms C, then orders serum labs to help confirm the presenting symptoms and subjective data. Serum labs are ordered and reveal:

WBC count: 10,000mm3
RBC count: 4.5 million/mm3
Hgb: 13g/dl
Hct: 38%
PLT: 250,000 cells/mm3
Calcium: 8.4mg/dl
Na: 135 mEq/L
K+: 4.4 mEq/L

Rheumatoid factor, antinuclear antibody, and erythrocyte sedimentation rate (ESR) are elevated. The labs are reviewed and the client is referred to the community hospital for a magnetic resonance imaging (MRI) of the hands and spine. Ms C is to return home and have the diagnostic test completed as scheduled, and to continue with follow-up care at the clinic. Ms C undergoes MRI of the hands and spine, which reveals degenerative changes, especially of the spine. The health care provider discusses the laboratory findings and the result of the MRI with Ms C, and a diagnosis of osteoarthritis (OA) is confirmed. The health care provider discusses the plan of care for OA, and the following medications are prescribed for her: aspirin (acetylsalicylic acid), topical capsaicin (Zostrix), celecoxib (Celebrex), and calcium (Os-Cal). Ms C is seen by an RN in the clinic who reviews the prescribed medications with her and allows her to ask questions pertaining to the plan of care as discussed by the health care provider. After dialogue between the client and the nurse, Ms C informs the nurse that she will fill the prescriptions at a pharmacy in her community. A follow-up appointment is scheduled for her and she leaves the clinic.

Questions
What is your understanding of the above situation (what are the causes of OA)?
What are some women’s health considerations for OA?
What is the significance of Heberden’s and Bouchards’s nodes and their relationship with OA?
What are the common nursing diagnoses for the client with OA?
Discuss the nonpharmacologic measures that can be used for clients with OA
What is the role of the physical therapist for clients with OA?

The following medications are prescribed:
Aspirin (acetylsalicylic acid) 1 g PO 3x per day
Capsaicin (Zostrix) apply to affected areas three to four times a day only
Celecoxib (Celebrex) 200mg PO two times a day
Calcium (Os-Cal) 1g PO in the morning and at bedtime

What are the purposes for the prescribed medications?
What are the most common adverse reactions of the prescribed medications?
Discuss the drug-to-drug and the drug-to-food/herbal interactions of the prescribed meds.
As the RN, design a specific pain management plan for the client with OA
What specific information should a nurse provide for the client who is discharged to home about topical capsaicin?

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