NSG 5003 Abnormal Physical Exam Discussion

NSG 5003 Abnormal Physical Exam Discussion

Sample Answer for NSG 5003 Abnormal Physical Exam Discussion Included After Question

NSG 5003 Abnormal Physical Exam Discussion

Description

Respond to at least two of your classmates. Participate in the discussion by analyzing each response for completeness and accuracy and by suggesting specific additions or clarifications for improving the discussion question response. Follow APA

question 1

Duane Hostetler

Review the symptoms and abnormal physical exam above and review readings from Chapter 45, Alterations of Musculoskeletal functions, and support your interpretation of the most likely diagnosis with evidence.

Based on the symptoms and the abnormal physical exam of our patient, I believe the patient has the beginning diagnosis of Rheumatoid Arthritis (RA). A proper and physical exam are critical in the workup of RA. In most patients, RA will present with the slow progression of polyarthritis. These vague symptoms of joint tenderness and swelling can be present for awhile before patients seek medical advice. The important predictor of the diagnosis is the presence of painful hand joints (Badghaish et al, 2018).

I first thought of carpal tunnel syndrome, but all the symptoms didn’t fit. The patient didn’t complain of any numbness or tingling of the thumb, index, and middle fingers. There may be swelling or not. Her current employment did make it a possibility, but soon proved to be not the determining factor in the diagnosis (NIH, 2020).

List all the symptoms from the above that support this diagnosis.

• Wrist pain and swelling that developed 3 months ago and has been progressive worsening
• Tenderness across the balls of her feet with weight bearing (worse with inactivity, improves with activity)
• Morning stiffness of the feet and ankles
• Increased fatigue and weakness in activities
• Moderate synovitis (swelling) of the MCP, PIP, & MTP joints bilaterally
• Oral temp, 100 degrees

A Sample Answer For the Assignment: NSG 5003 Abnormal Physical Exam Discussion

Title: NSG 5003 Abnormal Physical Exam Discussion

The joints involved more frequently are the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the hands, wrists, and small joints of the feet including the metatarsophalangeal (MTP) joints. Nonspecific symptoms of fatigue, and malaise commonly precede other symptoms by weeks to months. A fever occasionally occurs and is almost low grade (99-100 degrees). A higher fever may suggest illness and/or infectious cause. Morning stiffness lasting more than an hour but often lasting several hours is characteristic of RA. In contrast, patients with degenerative arthritis complain of stiffness lasting but a few minutes. Symmetrical joint swelling is characteristic of RA. Careful palpation of the joints can help to distinguish the swelling of joint inflammation from the bony enlargement seen in osteoarthritis, with the swelling often described as being doughy or spongy in RA in contrast to firm knobby enlargement in osteoarthritis (Ruffing & Bingham, 2020).

Briefly describe the pathophysiology of the disorder and the impact of environmental and genetic factors on this disorder.

The pathophysiology of RA is facilitated by antibodies against self-antigens and inflammatory cytokines that stimulate other inflammatory cells and cause tissue injury. The inflammatory cytokines transform the synovium into a thick, abnormal layer of granulation tissue known as pannus. The pannus acts like a locally invasive tumor. The inflammatory and immune process causes the attraction of several leukocytes into the synovial membrane and damages the synovial membrane. The synovial membrane undergoes thickening and becomes abnormally large. It eventually involves the blood vessels of the synovial tissue and causes hypoxia and metabolic acidosis (Huether, & McCance, 2018).

On the genetic side of RA, an important system associated with the development and prognosis of RA is the human leukocyte antigen (HLA) system. The strong association led to the suggestion of peptide binding involvement in the pathogenesis of the disease. The HLA type not only predicts the disease occurrence, it also can predict the severity, complications, and mortality. Characteristic antibodies that are present in patients include autoantibodies against IgG. Another important marker is autoantibodies against citrullinated peptides (ACPAs) that are more specific than the rheumatoid factor. The environmental factors that have been associated with RA are low educational level, low socioeconomic status, and smoking. Periodontal disease association hasn’t been well established. Some organisms associated with RA are E-coli, Proteus mirabilis, and Epstein-Barr virus (Badghaish et al, 2018).

Badghaish, M. M. O., Qorban, G. N. M., Albaqami, A. S., Nemer, A. A., Alali, A. J., Al Yaqoub,

R. F. H., Alshamrani, H. A., Badahman, O. H., Ansaif, R. A., Alasmari, M. A.,

Alghamdi, A. Y., Alshareef, H. A. S., Aljadeed, A. M., Almohammed, A. A., Filmban,

D. M., & Alaql, A. S. (2018). Rheumatoid Arthritis, Pathophysiology and Management.

Egyptian Journal of Hospital Medicine, 70(11), 1898–1903.

https://doi-org.su.idm.oclc.org/10.12816/0044839

Huether, S., McCance, K. (2018). Pathophysiology, The biological basis for disease in adults

and children, 8th Edition. St. Louis, Missouri. Elsevier. [[VitalSource Bookshelf

version]]. Retrieved from vbk://9780323583473

NIH: National Institute of Neurological Disorders and Stroke. (2020, March). What are the

symptoms of carpal tunnel syndrome? Carpal Tunnel Syndrome Fact Sheet. Retrieved

from https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/

carpal-tunnel-syndrome-fact-sheet

Ruffing, V., & Bingham, C. O., (2020). Rheumatoid arthritis sign and symptoms. John Hopkins

Arthritis Center. Retrieved from https://www.hopkinsarthritis.org/arthritis-

info/rheumatoid-arthritis/ra-symptoms/

question 2

Derender Bailey

The Symptoms and Abnormal Physical Exam

Rheumatoid arthritis is a chronic inflammatory and progressive disease that affects the body joints. Being an autoimmune disorder, rheumatoid arthritis causes joint pain, especially on the hands, wrists, and knees. This disease targets the immune system of an individual by attacking the healthy organs and tissue in the body (The Healthline Editorial Team, 2020). For people diagnosed with rheumatoid arthritis, they might experience pain in the joints, stiffness in joints, weight loss, swelling of the joints, and fatigue among others. From the readings in chapter 45, we learned that rheumatoid arthritis is brought about by the movement of white blood cells into the membranes around the joints hence causing inflammation around the joints (McCance & Huether, 2019). The white blood cells are meant to attack any foreign agents in the bloodstream. Once a foreign agent attacks the membranes around the joints, the white blood cells move towards the membrane to fight back the antigen but end up causing joint swelling. The disease is characterized by joint swelling, synovial inflammation, ankylosis, and damaging of articular cartilage. The rheumatoid disease first affects the synovial membrane that is around the joint cavity.

Symptoms from the Above That Support This Diagnosis

A 30-year-old Latino woman presents herself for evaluation of wrist pain and swelling. The patient asserts that the wrist pain developed 3 months ago and has been getting worse since that time. She also notices some tenderness across the balls of her feet with any weight-bearing. The pain gets worse when she is inactive and reduces when she takes part in an activity. She also reports stiffness in her feet and ankles. She adds that she has been having 4 hours of stiffness in the mornings but gets better for the rest parts of the day. The patient has also experienced increased fatigue and weakness in daily activities. I tend to believe that the patient is suffering from rheumatoid arthritis due to her health history and the symptoms described by the patient.

The rheumatoid arthritis disease begins with general manifestations including inflammation, fever, body weakness, fatigue, stiffness, anorexia, weight loss, joint pain, and stiffness. After a few months, the local manifestations start to develop. Local manifestations are characterized by painful joints, tenderness, and body stiffness that can last for more than an hour in the morning. This can be caused by synovitis. The metacarpophalangeal, proximal interphalangeal, and wrists are the most common joints to be affected by this disease (McCance & Huether, 2019). However, the first joints to be affected are the smaller joints like knuckle joints in the fingers and toes. As the disease progresses, the damage spreads to the ankles, knees, elbows, shoulders, and hips.

Pathophysiology and the Impact of Environmental and Genetic Factors

Rheumatoid arthritis is marked by symptoms of inflammation and pain in the joints. The pathophysiological process of the rheumatoid arthritis disease involves dysregulated inflammation with the presentation of antigens, T-cell activation, and production of antibodies all acting as elements in the inflammatory process. The activation of both the synovial cell hyperplasia and endothelial cell occurs at the early stages of the pathological process that proceeds to uncontrolled inflammation and later cartilage and bone destruction. The B cells and the CD4 T cells perform a great role in this process. In addition, the mononuclear phagocytes, osteoclasts, fibroblasts, and neutrophils enhance the cellular process in the pathophysiology of this disease (Gibofsky, 2014). The B cells are important in the production of antibodies. The proliferation and inflammation of synovium cause damage to various tissues like tendons, cartilages, ligaments, bones, and blood vessels around the affected parts. It is also important to understand that the articular structures are the primary sites involved by rheumatoid arthritis disease though other body tissues are affected.

Rheumatoid arthritis is conceptualized to develop when a genetically prone person goes through an external trigger. External triggers can include smoking, trauma, and infection that causes the production of antibodies to fight the antigens in the body (Mallia & Coleiro, 2016). Smoking and alcohol drinking might also contribute to the risk of RA since they affect the birth weight of newborns, breastfeeding, and affect the socio-economic condition and area of birth. Women are more susceptible to this disease as compared to men. It is thus important to note that the disease can be prevented by changing the environmental factors since the genetic factors cannot be changed.

References

Gibofsky, A. (2014, May 31). Epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis: A synopsis. AJMC. https://www.ajmc.com/view/ace017_may14_ra-ce_gibofsky1_s128

The Healthline Editorial Team. (2020). Everything you want to know about rheumatoid arthritis. Healthline. https://www.healthline.com/health/rheumatoid-arthritis

Mallia, C., & Coleiro, B. (2016). Understanding rheumatoid arthritis. Pharmaceutical Care Issues of Patients with Rheumatoid Arthritis, 1-18. https://doi.org/10.1007/978-981-10-1421-5_1

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The Biologic Basis for Disease in Adults and Children (8th ed.). St. Louis, MO: Mosby Inc; ISBN-13:978-0323583473.

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Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
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• Follow APA 7th edition
• Points will be deducted if the above is not followed
• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• Student paper example
• Citing Sources
• The Writing Center is a great resource