Example: NSG 383 Connective Tissue Disorder_Case Study #4 by Lauren Stoltzfus

Increase in pain

lstoltzfus8 — 2025-09-22 01:02:12 UTC

The increased pain is interfering with her daily routines and may prohibit her from participating in her moderate daily exercise

Osteoarthritis

lstoltzfus8 — 2025-09-22 01:02:12 UTC

She complains of her knee being achy in the morning and also some discomfort with movement. She also has a history of overuse and prior injuries to to her right knee. There is +1 edema and decreased ROM to the right knee. She is also overweight with a BMI of 30.

-Obesity

-Excessive wear and tear

-Gender

Pain 3/10

Heart Healthy/Low Cholesterol

lstoltzfus8 — 2025-09-22 01:02:12 UTC

She is overweight. This is the single most modifiable risk factor of osteoarthritis. By eating a heart healthy diet (low salt, low cholesterol), she may be able to manage her weight more effectively. Limiting fast food for lunch is a start. Talk about meal prep and health options.

Medications

lstoltzfus8 — 2025-09-22 01:02:12 UTC

First choice: Acetaminophen! (analgesics)- for mild to moderate pain; can cause hepatic toxicity

NSAIDS - mild to moderate pain; can cause nephrotoxicity, GI bleeding; be careful if patient is on anticoagulation.

Opioids - moderate to severe pain; can cause nausea, constipation (give stool softener), confusion

Topicals: Intra-articular corticosteriods (steroid injections), Intra-articular hyaluronans (acts as lubricant/shock absorber), topical NSAIDS, Topical capsaicin

Lab Values

lstoltzfus8 — 2025-09-22 01:02:12 UTC

ESR and C reactive protein can help check for inflammation. With Osteoarthritis, there will be inflammation of the surrounding tissues due to the lack of cartilage and a narrowed joint space.

Liver enzymes: acetaminophen can cause hepatoxicity

CBC (hgb/hct): NSAIDs can cause GI bleeding

BUN/CR/GFR: NSAIDs can cause nephrotoxicity

Diagnostics

lstoltzfus8 — 2025-09-22 01:02:12 UTC

Xray will assess for any type of fracture

CT or MRI will get a more detailed picture of the surrounding tissues/joint.

Monitor VS and weight

lstoltzfus8 — 2025-09-22 01:02:12 UTC

Hypertension may occur if using chronic NSAIDS; can alter renal function, reduce sodium excretion and lead to fluid retention.

Administer Medications

lstoltzfus8 — 2025-09-22 01:02:12 UTC

Administer prescribed medications to assist with pain relief. Offer nonpharmacological therapy as well.

Pre-Treatment

lstoltzfus8 — 2025-09-22 01:02:12 UTC

Modify exercise to low weight bearing exercises; try swimming, for example.

Swimming is a non-weight bearing form of exercise that can still achieve cardio results as well as muscle building.

Post Treatment

lstoltzfus8 — 2025-09-22 01:02:12 UTC

Should the patient have an arthroplasty done, patient will follow orders as far as weight-bearing.

PT/OT will work with patient to get them back to their normal activity/exercise regimen; no deep knee bends post arthroplasty

Safety

lstoltzfus8 — 2025-09-22 01:02:12 UTC

Patient may have an unsteady gait; use fall precautions; may need assistive devices.

Nonpharmacological Treatments

lstoltzfus8 — 2025-09-22 01:02:12 UTC

Heat, Ice (to help with pain/swelling)

Elevate extremity

Take stool softener if sedentary and if taking opioids.

Monitor liver enzymes (Acetaminophen), and Kidney function (NSAID use)

Physical Therapy/Occupational Therapy to assist with movement/safety/exertion

Energy conservation: fatigue is common and managing energy is important to be safe

Glucosamine: supplement to help rebuild cartilage and synovial fluid

Report unusual symptoms

lstoltzfus8 — 2025-09-22 01:02:12 UTC

Report chest pain, abdominal pain, abnormal bleeding, and blood in the stool or emesis; these are all signs of NSAID toxicity or MI

Medication Education

lstoltzfus8 — 2025-09-22 01:02:12 UTC

Review what is noted under the Medication Education Section above.

Ensure patient is taking medications as prescribed and review the side effects of each.