A nurse is caring for a client.

Exhibits

Complete the following sentence by using the list of options.

After notifying the provider, the nurse should first

dropdown

and then

dropdown

Condition: Osteoarthritis

• The client reports pain in the right knee and left wrist over the last two years. OA typically presents with chronic, localized joint pain, particularly in weight-bearing joints (e.g., knees) and joints that experience repetitive use (e.g., wrists).
• Crepitus (a crackling or grating sound when the joint moves) is noted in both the right knee and left wrist, which is a characteristic finding in osteoarthritis due to cartilage breakdown and joint space narrowing.
• The absence of systemic symptoms such as rashes or other joint pain, as well as normal laboratory values (e.g., normal ESR, normal ANA), further supports a diagnosis of osteoarthritis rather than conditions like systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), which are associated with systemic inflammation.

Actions to Take for Osteoarthritis:

• Instruct the client to apply heat and cold:

Heat and cold therapy can help manage the pain and stiffness associated with osteoarthritis. Cold therapy can reduce inflammation, while heat therapy can improve blood flow and relax the muscles around the joint.

• Instruct the client to apply topical analgesics:

Topical analgesics (such as menthol or capsaicin creams) can provide localized pain relief for osteoarthritis. They are commonly used as part of the non-pharmacological treatment approach for joint pain.

Parameters to Monitor for Osteoarthritis:

• ESR (Erythrocyte Sedimentation Rate):

While osteoarthritis is generally not associated with systemic inflammation, monitoring the ESR can help ensure that there are no signs of additional inflammatory processes (such as rheumatoid arthritis) that might be missed. In this case, the client's ESR is within the normal range (20 mm/hr), which supports the diagnosis of osteoarthritis.

• Joint deformities:

Monitoring for joint deformities over time is essential in osteoarthritis to assess disease progression. OA can lead to the formation of osteophytes (bone spurs) and other joint deformities that might impair function.

Explanation for incorrect choices; Systemic Lupus Erythematosus (SLE):

SLE typically presents with a variety of symptoms, including a characteristic butterfly-shaped rash on the face, photosensitivity, and systemic involvement such as kidney or neurological issues. The client does not exhibit any skin rashes, systemic symptoms, or abnormal ANA (antinuclear antibody), which would be elevated in SLE.

Gout:

Gout involves the deposition of uric acid crystals in joints, leading to sudden, severe pain, usually in the big toe (but other joints can be involved). While the client has a mildly elevated uric acid level (7.2 mg/dL, which is within the upper limit), there are no signs of an acute gout flare (such as intense joint pain, redness, and swelling). Additionally, the client’s symptoms are chronic, which is more consistent with OA.

Rheumatoid Arthritis (RA):

RA is an autoimmune disease that causes inflammation and deformities in the joints, usually in a symmetrical pattern (e.g., both wrists or knees). The client’s presentation does not fit this pattern, and laboratory results (normal ANA, ESR) do not suggest an autoimmune inflammatory condition like RA.

• This is a concerning finding because the adult child reports cognitive and physical decline in the client, which could indicate severe memory loss, cognitive impairment, or potentially dementia or other mental health conditions such as depression or suicidal ideation.
• Significant weight loss and decreased appetite in an older adult can indicate serious conditions, including malnutrition, depression, or potentially serious medical conditions such as cancer or other chronic diseases. Immediate follow-up is needed to assess the cause of the weight loss, evaluate the client’s nutritional status, and address any underlying health concerns.
• This statement is concerning because it suggests the client may be experiencing depression or suicidal ideation. Older adults are particularly vulnerable to depression, and this expression of worthlessness is a red flag that the client could be at risk for suicide. The nurse shouldimmediately assess the client’s mental health status, ask about thoughts of self-harm, and potentially initiate a psychiatric evaluation.