Three days after a cholecystectomy for cholelithiasis, a client reports persistent upper abdominal pain that radiates to the back. The client has vomited three times in the last 12 hours and has a temperature of 101.8° F (38.7° C). Serum amylase and lipase are twice the normal value. Based on these findings, the nurse should observe the client for which pathophysiological condition?

Chronic osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of joint cartilage and underlying bone changes. The pathophysiological process of OA involves various factors contributing to joint pain and inflammation. Here's why option C is the correct choice:

A) Inflammation results from deposition of crystals in the synovial space of joints producing irritation:

This statement is more characteristic of crystal-induced arthritis, such as gout or pseudogout, where crystals (e.g., urate or calcium pyrophosphate crystals) deposit in the joints and cause acute inflammation and irritation. While inflammation may occur in OA, it is primarily a result of mechanical stress and cartilage degradation rather than crystal deposition.

B) Inflammation is caused by immune complex and autoantibody deposition in connective tissue:

This statement is more characteristic of autoimmune diseases such as rheumatoid arthritis (RA), where immune complex deposition and autoantibody production lead to chronic inflammation and joint damage. In OA, inflammation is not primarily mediated by immune complex deposition or autoantibodies.

C) Joint inflammation occurs when chondrocyte injury destroys joint cartilage, producing osteophytes:

Correct. In osteoarthritis, joint inflammation occurs as a result of chondrocyte injury and cartilage breakdown. Over time, the degenerative changes in the joint lead to the formation of osteophytes (bone spurs) at the joint margins. These changes can irritate surrounding tissues, including the synovium, ligaments, and tendons, contributing to joint pain and inflammation.

D) Joint destruction happens due to an autoimmune inflammation involving IgG response to an antigen:

This statement is more characteristic of autoimmune arthritis, such as rheumatoid arthritis (RA), where autoantibodies (e.g., rheumatoid factor, anti-citrullinated protein antibodies) target joint tissues, leading to chronic inflammation and joint destruction. In OA, joint destruction primarily results from mechanical stress and wear-and-tear on the joint structures rather than autoimmune mechanisms.

Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig's disease, is a progressive neurodegenerative disorder affecting motor neurons in the brain and spinal cord. Understanding the pathophysiological process of ALS is crucial for providing accurate information about the disease prognosis to the client. Here's why option B is the correct choice:

A) It occurs as a complication of a spinal cord injury:

This statement is incorrect. ALS is not a complication of a spinal cord injury. While both conditions involve motor neuron dysfunction, they have different etiologies and pathophysiological processes. ALS is characterized by the degeneration of motor neurons in the brain and spinal cord, leading to muscle weakness and atrophy, whereas spinal cord injury results from trauma to the spinal cord.

B) Muscle weakness is progressive, degenerative, and fatal:

Correct. ALS is characterized by progressive degeneration of motor neurons, leading to muscle weakness, atrophy, and eventual paralysis. The disease is relentless and fatal, typically within 2 to 5 years of diagnosis, although survival can vary widely among individuals. As motor neurons degenerate, voluntary muscle control is lost, eventually affecting the ability to speak, swallow, breathe, and move. Respiratory failure is the most common cause of death in ALS patients.

C) Mental status changes occur late in the disease:

While cognitive and behavioral changes can occur in some individuals with ALS, particularly in the later stages of the disease, they are not universal. ALS primarily affects motor neurons, leading to progressive muscle weakness and paralysis. However, some individuals may experience frontotemporal dementia (FTD), a type of cognitive impairment characterized by changes in behavior, personality, and language.

D) Autonomic nervous system and sensory changes occur:

ALS primarily affects motor neurons rather than sensory neurons or the autonomic nervous system. Sensory symptoms such as numbness, tingling, or loss of sensation are not typical features of ALS. Autonomic dysfunction, including changes in heart rate, blood pressure, or bowel and bladder function, is not a prominent feature of ALS.