Looking at Jonathon’s basic information, his weight indicates that he is obese. His vital signs indicate hypertension due to the blood pressure of 197/112. His lab work shows hyperlipidemia. The physical assessment demonstrates swelling and inflammation of his knee. This seems to be his chief complaint. While his hypertension, obesity, and hyperlipidemia do need to be addressed, the cause of his knee pain will need to be diagnosed.
Differential Diagnoses:
Osteoarthritis (OA): Knee OA and obesity are chronic conditions that are extremely common in individuals between the ages of 50 and 84 (Losina et al., 2011). OA affects joint lining, cartilage, ligament, and bone (Alshami, 2014). Knee OA occurs due to the destruction of joint function,
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Nonsteroidal anti-inflammatory drugs, both topical and oral, are another treatment consideration for OA (Alshami, 2014). More aggressive treatment includes the use of opioids or corticosteroid injections (Alshami, 2014). Acetaminophen has a maximum daily dose of 4g/day (Mazaleuskaya et al., 2015a). The mechanism of action in acetaminophen remains unclear (Mazaleuskaya et al., 2015a). However, what is known is that the primary mechanism of action is to inhibit the synthesis of prostaglandins (Mazaleuskaya et al., 2015a). Prostaglandins originate from the arachidonic acid pathway (Mazaleuskaya et al., 2015a). This pathway promotes inflammation, fever, and pain (Mazaleuskaya et al., 2015a). I would recommend the patient take the maximum dosage of 4g/day. This would allow the patient to take 1,000 mg every 6 hours. I would also recommend that the patient alternate with ibuprofen. Ibuprofen can be taken over-the-counter (OTC) with a dosage of 800-1200mg/day or as a prescription with a dosage of 1800-2400mg/day (Mazaleuskaya et al., 2015b). Prescription dosages are typically used for long term management of OA (Mazaleuskaya et al., 2015b). Adults on a prescription dosage are recommended to take 200-800 mg every six to eight hours (Mazaleuskaya et al., 2015b). Ibuprofen acts to inhibit two cyclooxygenase enzymes, COX-1 and COX-2 (Mazaleuskaya et al., 2015b). For Jonathon, I would prescribe 800 mg of ibuprofen to be taken alternatively with acetaminophen every 6 hours. In order to maximize therapy, I would suggest that if Jonathon takes acetaminophen at 9 am then at noon he should take ibuprofen. This way he is able to take medication every three hours and stay within safe dose
When patients are prescribed to a medicine for low amounts of pain, they are usually prescribed daily use of anti-inflammatory pills such as ibuprofen or tylenol. For more severe pain, patients are often prescribed these pills in higher dosages, or even prescribed opiates such as vicodin or oxycontin (Meisel & Perrone). Anti-inflammatory pills are not as powerful as drugs such as opioids, but they present the risk of cardiovascular problems
Acetaminophen 500 mg tab 2 tabs by month every 8 hours as needed for pain
The problems that are identified in 56-year-old Jonathon are painful, swollen, erythematous of the knee with periarticular involvement, high blood pressure of 191/112, high cholesterol of 300 mg/dl, and obesity. The differential diagnoses for Jonathon are osteoarthritis, acute monoarthritis, and Gout. I believe that Jonathan’s primary diagnosis is osteoarthritis. Osteoarthritis is a degenerative joint disease that affects cartilage between bones, which may restrict movement and leads to pain, stiffness, swelling, and inflammation (Thakur, Mande, & Mitra (2014). According to Kullich, Overbeck, & Spiegel (20130, osteoarthritis is associated with pain with weight bearing, but it can be experienced during rest as the disease become more advanced. Being that Jonathan is a retired mechanic, his knee problem could have stemmed from his previous occupation and his knee possibly developed normal wear and tear due to frequent required bending from his last job. Jonathan weighs 310 lbs, his problem could have
Osteoarthritis indicates joint disorders, characterized by symptoms of pain and stiffness. It includes metabolic processes of destruction and reparation. Osteoarthritis is classified as primary (idiopathic) or secondary, according to the American Academy of Orthopaedic Surgeons. primary OA of the knee is a process of degeneration of the articular surface occurs without an obvious underlying abnormality. The manifestations of OA arise from high stresses on the normal joints or normal stresses on weakened joints, increasing in severity and frequency with age. The most commonly affected joints with osteoarthritis are large, weight-bearing joints, such as the knee and hip, and also smaller joints in the hands, feet. Unfortunately, treating articular
Any potential reduction in weight can also help reduce the pain from OA. When the patient is walking, the downward pressure on their knees is not just equal to their body weight, but is multiplied. The pressure going down on the knee on average is 4.85 lbs. extra exerted per pound of body weight. This means that if the patient is able to lose around 6 lbs. of body weight, there would be a reduction of around 29.1 pounds of pressure on the joint. This pressure was found to be reduced in the posted by the Osteoarthritis Research Society International. To note, the pressure the pressure was lowered upon altering the speed of gait. Researches had found that due to the reduction in irritation from less pressure, patients were speeding up their gait, which was amplifying pressure. The results of this study can be beneficial in helping the patient realize that the sooner they can take control of their situation, the more control they can have over their diagnosis. Often, it is not uncommon for the patient to just be thinking of the reduction of weight influencing secondary conditions like hypertension and diabetes, but do not take into consideration the positive impact it can have on their joints. Inflammation can also be altered by helping reduce the chemicals in circulation. Weight reduction has been shown to help reduce the circulation of IL-6 and CRP, which are two main components in contributing to
Joint pain often indicate the beginning of arthrosis, or wear of cartilage, and knees are particularly vulnerable. At every step of the knee depreciated approximately triple body weight.
The etiology (cause of disease) of Osteoarthritis (OA) is due the events of primary osteoarthritis and secondary osteoarthritis Primary osteoarthritis (idiopathic) results due to natural aging of the joints. OA causes pain, swelling, and reduced motion in your joints. As you get older water content of cartilage increases and the protein makeup of cartilage will degenerate. Cartilage will begin
Osteoarthritis (OA) is a chronic condition that affects the joints leading to inflammation and joint degeneration. The disease prevalence has been proportionally rising over the past decades in relation to the growing older adult population and the epidemic of obesity (Haroyan et al., 2018). Moreover, it is the most common type of arthritis that cause significant physical, psychosocial, and financial impact on millions of lives.
The articular cartilage is another structure that is commonly injured. Osteoarthritis is a chronic condition characterized by the breakdown of the joint’s articular cartilage. This breakdown in cartilage affects the lubrication proses within the knee and results in direct contact between the bone, causing stiffness, pain, and loss of kineticism. It additionally reduces the shock absorbing capacity of the knee, leading to micro fractures of the subchondral bone. Osteoarthritis is the most prevalent joint disorder associated with major disabilities, affecting more than 27million Americans. The risk of developing this disease increase with age and is estimated that by 2030,20% of Americans(about 2milion people), will be at a high risk for this
Non-pharmaceutical treatments involve educating the patients about their disease condition and help them manage pain by prescribing muscle strengthening and stretching exercises (54). As losing weight can help affected individuals reduce the stress on their weight-bearing joints, they are advised on how to improve their standard of living to lead healthy and active life (53,54). Although non-pharmaceutical approaches are affective in the long run, they do not help alleviate pain immediately and people with OA have restricted mobility. The most used medications for OA are the non-steroidal anti-inflammatory drugs (NSAIDs) which include aspirin, ibuprofen, etc. and pain relieving analgesics like acetaminophen (4). Non-invasive surgical options, such as intra-articular injections with corticosteroids, hyluronic acid (HA), have been used to improve joint lubrication. Hyaluronic acid (HA) injections could be beneficial for both knee and hip OA, however, it has been found that HA efficacy is very low(3). Corticosteroids are anti-inflammatory drugs that are used to alleviate pain (1). All of these drugs have pain-relieving effects, however, the core issue of the constant degeneration of the articular cartilage remains unmodified. In addition, constant
Osteoarthritis is the most common form of arthritis and is the result of the wearing down of the protective articular cartilage that covers the end of bones in major joints of the body such as the knees, hips, and spine.
Osteoarthritis (OA) is a degenerative condition which mainly affects the knees and hips as a result of damaged articular cartilage in these areas (Adatia, Rainsford, & Kean, 2012 p.618). This is known to be exacerbated by diabetes, cardiovascular diseases, and age, which are known in this case study. In addition, the common manifestations of OA Ethel experiences include chronic pain, restricted ADLs, and reduced quality of life (Adatia, Rainsford, & Kean, 2012 p.617).
Whether OA (osteoarthritis) is a new subject you wish to learn about, or whether you want to refresh/further extend your knowledge on this subject, here are two different websites that each provides the adequate amount of information. You will be able to use the information provided on each website to choose the one that takes your educational needs to the max.
Another condition that is further contributing to body deterioration is the Osteoarthritis. This particular kind of illness attack specific joints such as joints in the hands, knees, hips and spine. However, this kind of illness may be slowed down due to increased physical activity. Barbara Osteoarthritis condition has been slowed down over the years due to her engagement in activities with her husband. Consequently, after the husband passed away the condition has covered more ground due to increased inactivity (Silveira Kempfer,
Hypertension is widely considered to be one of the most important risk factors of cardiovascular diseases (angina, arrhythmia, etc.). It is the second leading disease that causes mortality in the world. Hypertension is the condition when there is an increase in the force of blood on the walls of vessels. It can also be defined as an arterial blood pressure that is raised above 140/90 mm Hg (systolic/ diastolic BP). Hypertension can be classified into Secondary hypertension and Essential hypertension. When specific cause is evident but heredity, and various physiological parameters play a role in increasing blood pressure is known as Essential Hypertension. Secondary Hypertension is one where the cause is known. According to WHO guidelines between 2006 and 2015, deaths due to cardiovascular diseases are expected to increase by 17% while the deaths from infectious diseases, nutritional deficiencies, maternal and prenatal conditions are projected to decline by 3%. The main causes of hypertension includes the age ,hereditary, gender, extra weight, alcohol consumption, stress life, lazy life etc.