SubjectiveChief Complaint: “I have pain in all of my joints, a swollen left knee, and stiffness every morning.”HPI: Janet Hobbs is a 58-year-old woman who presents to her rheumatologist with generalized arthralgias, a swollen left knee, and morning stiffness. These symptoms have been occurring with increasing severity for the past several weeks. She presented with similar symptoms 3 months ago, at which time her drug regimen was changed from methotrexate and NSAID therapy to her current regimen below.PMH: RA × 6 years S/P, hysterectomy 4 years ago, HTN × 10 yearsFH: Father died from complications after a traumatic fall at age 65. Mother died of a hip fracture and pneumonia at age 78. No siblings.SH: Housewife; married for 32 years; has two grown children with no known medical problems. Denies alcohol or tobacco use. Volunteers in the community extensively, but has been doing less in the past 2 months.Meds: Hydrochlorothiazide 25 mg PO Q AM, Norvasc 10 mg PO once daily, Nabumetone 750 mg = 2 tabs po Q HS, Prednisone 5 mg = 1/2 tab po Q AM, Methotrexate 2.5 mg = 6 tabs po once a week, Hydroxychloroquine 200 mg = 1 tab po BID, Sulfasalazine EC 500 mg = 1 tab po BID, Folic acid 1 mg PO once daily. The patient receives medications at a local community pharmacy. The medication profile indicates that she refills her medications on time on the first of each month.All: Penicillin (rash 25 years ago)ROS: Swelling in the left knee; decreased ROM in hands; morning stiffness every day for about 3 hours; fatigueexperienced daily during afternoon hours; denies HA, chest pain, SOB, bleeding episodes, or syncopal attacks; denies nausea, vomiting, diarrhea, loss of appetite or weight loss; reports minor visual changes corrected with stronger prescription glasses.Kindly answer patient therapeutic care plan. TYSM A. CASE ANALYSIS:Prepare a patient therapeutic care plan.Patient Name: Janet HobbsAddress: n/aMedical Condition:Tobacco/Alcohol/Substance Use:Allergies:Drug NameMedical ConditionPATIENT THERAPEUTIC CARE PLAN RECORDGender: FemaleIndicationAge: 58 y/oBirthdate: n/aRace: n/aWeight:Height:MEDICATION RECORDStrengthRegimenASSESSMENT, PLAN AND FOLLOW-UP EVALUATIONDrug-Therapy ProblemGoal, Current Status andInterventionsAdverse DrugReactionsFollow-up Plan ObjectivePHYSICAL EXAMINATIONGen: Pleasant, middle-aged white woman in moderate distress because of pain and swelling in left kneeVS: BP 138/80, P 82, RR 14, T 37.1°C; Wt 65.3 kg, Ht 5'6"Skin: No rashes; normal turgor; no breakdown or ulcersHEENT: Atraumatic; moon facies; PERRLA; EOMI; AV nicking visible bilaterally; pale conjunctiva bilaterally; TMsintact; xerostomia...Neck/Lymph Nodes: Supple, no JVD or thyromegaly; no bruits; palpable lymph nodesChest: CTABreasts: Normal; no lumpsCV: RRR; normal S1, S2; no MRGAbd: Soft, NT/ND; (+) BSGenit/Rect: DeferredMS/Ext: Hands: mild RA changes; swelling of the 3rd, 4th, and 5th PIP joints bilaterally; pain in the 3rd and 4thMCP joints on left; boutonnière deformity of the 3rd and 4th digits bilaterally; ulnar deviation bilaterally; decreasedgrip strength, L > R (patient is left-handed) Wrists: decreased ROM Elbows: good ROM; slight permanentcontracture on right; fixed nodule at pressure point Shoulders: decreased ROM (especially abduction) bilaterallyHips: decreased ROM on right; atrophy of quadriceps, L > R Knees: pain bilaterally; decreased ROM on left;effusion/edema on left Feet: no edema; full plantar flexion and dorsiflexion; 3+ pedal pulsesNeuro: CN II-XII grossly intact; muscle strength 5/5 UE, 4/5 LE, DTRS 2/4 biceps and triceps, 1/4 patellaLABORATORY EXAMINATIONTABLE 96-1 Lab ValuesNa 135 mEq/LK4.1 mEq/LCl101 mEq/LCO₂ 22 mEq/LBUN 12 mg/dLSCr 0.8 mg/dLGlu 103 mg/dLHgb 10.0 g/dLHct 31%WBC 13.0 x 10³/mm³Pit 356 x 10³/mm³Ca 9.1 mg/dLUrate 5.1 mg/dLTSH 0.74 mIU/LAST 15 IU/LALT 12 IU/LAlk phos 56 IU/LT.bili 0.8 mg/dLAlb 4.2 g/dLHbsAg (-)Anti-HCV (-)CK 20 IU/LANA negativeWes ESR 47 mm/hRF (+) 1:1,280Anti-CCP (+)aPTT 31 secINR 1.0Fasting Lipid Profile:T. chol 219 mg/dLLDL 106 mg/dLHDL 50 mg/dLTG 150 mg/dl.UA: NormalChest X-Ray: No fluid, masses, or infection; no cardiomegalyHand X-Ray: Erosion of MCP and PIP joints bilaterally; measurable joint space narrowing from previous x-ray 6months agoSynovial Fluid: From left knee; white cells 23.0 x 103 /mm³, turbid in appearanceDEXA scan of hip/spine: T-score reported as -2

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Subjective Chief Complaint: “I have pain in all of my joints, a swollen left knee, and stiffness every morning.” HPI: Janet Hobbs is a 58-year-old woman who presents to her rheumatologist with generalized arthralgias, a swollen left knee, and morning stiffness. These symptoms have been occurring with increasing severity for the past several weeks. She presented with similar symptoms 3 months ago, at which time her drug regimen was changed from methotrexate and NSAID therapy to her current regimen below. PMH: RA × 6 years S/P, hysterectomy 4 years ago, HTN × 10 years FH: Father died from complications after a traumatic fall at age 65. Mother died of a hip fracture and pneumonia at age 78. No siblings. SH: Housewife; married for 32 years; has two grown children with no known medical problems. Denies alcohol or tobacco use. Volunteers in the community extensively, but has been doing less in the past 2 months. Meds: Hydrochlorothiazide 25 mg PO Q AM, Norvasc 10 mg PO once daily, Nabumetone 750 mg = 2 tabs po Q HS, Prednisone 5 mg = 1/2 tab po Q AM, Methotrexate 2.5 mg = 6 tabs po once a week, Hydroxychloroquine 200 mg = 1 tab po BID, Sulfasalazine EC 500 mg = 1 tab po BID, Folic acid 1 mg PO once daily. The patient receives medications at a local community pharmacy. The medication profile indicates that she refills her medications on time on the first of each month. All: Penicillin (rash 25 years ago) ROS: Swelling in the left knee; decreased ROM in hands; morning stiffness every day for about 3 hours; fatigue experienced daily during afternoon hours; denies HA, chest pain, SOB, bleeding episodes, or syncopal attacks; denies nausea, vomiting, diarrhea, loss of appetite or weight loss; reports minor visual changes corrected with stronger prescription glasses. Kindly answer patient therapeutic care plan. TYSM

Phlebotomy Essentials

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

Section: Chapter Questions

Problem 1SRQ

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Subjective
Chief Complaint: “I have pain in all of my joints, a swollen left knee, and stiffness every morning.”

HPI: Janet Hobbs is a 58-year-old woman who presents to her rheumatologist with generalized arthralgias, a swollen left knee, and morning stiffness. These symptoms have been occurring with increasing severity for the past several weeks. She presented with similar symptoms 3 months ago, at which time her drug regimen was changed from methotrexate and NSAID therapy to her current regimen below.

PMH: RA × 6 years S/P, hysterectomy 4 years ago, HTN × 10 years

FH: Father died from complications after a traumatic fall at age 65. Mother died of a hip fracture and pneumonia at age 78. No siblings.

SH: Housewife; married for 32 years; has two grown children with no known medical problems. Denies alcohol or tobacco use. Volunteers in the community extensively, but has been doing less in the past 2 months.

Meds: Hydrochlorothiazide 25 mg PO Q AM, Norvasc 10 mg PO once daily, Nabumetone 750 mg = 2 tabs po Q HS, Prednisone 5 mg = 1/2 tab po Q AM, Methotrexate 2.5 mg = 6 tabs po once a week, Hydroxychloroquine 200 mg = 1 tab po BID, Sulfasalazine EC 500 mg = 1 tab po BID, Folic acid 1 mg PO once daily. The patient receives medications at a local community pharmacy. The medication profile indicates that she refills her medications on time on the first of each month.

All: Penicillin (rash 25 years ago)

ROS: Swelling in the left knee; decreased ROM in hands; morning stiffness every day for about 3 hours; fatigue
experienced daily during afternoon hours; denies HA, chest pain, SOB, bleeding episodes, or syncopal attacks; denies nausea, vomiting, diarrhea, loss of appetite or weight loss; reports minor visual changes corrected with stronger prescription glasses.

Kindly answer patient therapeutic care plan. TYSM

A. CASE ANALYSIS:
Prepare a patient therapeutic care plan.
Patient Name: Janet Hobbs
Address: n/a
Medical Condition:
Tobacco/Alcohol/Substance Use:
Allergies:
Drug Name
Medical Condition
PATIENT THERAPEUTIC CARE PLAN RECORD
Gender: Female
Indication
Age: 58 y/o
Birthdate: n/a
Race: n/a
Weight:
Height:
MEDICATION RECORD
Strength
Regimen
ASSESSMENT, PLAN AND FOLLOW-UP EVALUATION
Drug-Therapy Problem
Goal, Current Status and
Interventions
Adverse Drug
Reactions
Follow-up Plan

Transcribed Image Text:Objective PHYSICAL EXAMINATION Gen: Pleasant, middle-aged white woman in moderate distress because of pain and swelling in left knee VS: BP 138/80, P 82, RR 14, T 37.1°C; Wt 65.3 kg, Ht 5'6" Skin: No rashes; normal turgor; no breakdown or ulcers HEENT: Atraumatic; moon facies; PERRLA; EOMI; AV nicking visible bilaterally; pale conjunctiva bilaterally; TMs intact; xerostomia . . . Neck/Lymph Nodes: Supple, no JVD or thyromegaly; no bruits; palpable lymph nodes Chest: CTA Breasts: Normal; no lumps CV: RRR; normal S1, S2; no MRG Abd: Soft, NT/ND; (+) BS Genit/Rect: Deferred MS/Ext: Hands: mild RA changes; swelling of the 3rd, 4th, and 5th PIP joints bilaterally; pain in the 3rd and 4th MCP joints on left; boutonnière deformity of the 3rd and 4th digits bilaterally; ulnar deviation bilaterally; decreased grip strength, L > R (patient is left-handed) Wrists: decreased ROM Elbows: good ROM; slight permanent contracture on right; fixed nodule at pressure point Shoulders: decreased ROM (especially abduction) bilaterally Hips: decreased ROM on right; atrophy of quadriceps, L > R Knees: pain bilaterally; decreased ROM on left; effusion/edema on left Feet: no edema; full plantar flexion and dorsiflexion; 3+ pedal pulses Neuro: CN II-XII grossly intact; muscle strength 5/5 UE, 4/5 LE, DTRS 2/4 biceps and triceps, 1/4 patella LABORATORY EXAMINATION TABLE 96-1 Lab Values Na 135 mEq/L K4.1 mEq/L Cl101 mEq/L CO₂ 22 mEq/L BUN 12 mg/dL SCr 0.8 mg/dL Glu 103 mg/dL Hgb 10.0 g/dL Hct 31% WBC 13.0 x 10³/mm³ Pit 356 x 10³/mm³ Ca 9.1 mg/dL Urate 5.1 mg/dL TSH 0.74 mIU/L AST 15 IU/L ALT 12 IU/L Alk phos 56 IU/L T.bili 0.8 mg/dL Alb 4.2 g/dL HbsAg (-) Anti-HCV (-) CK 20 IU/L ANA negative Wes ESR 47 mm/h RF (+) 1:1,280 Anti-CCP (+) aPTT 31 sec INR 1.0 Fasting Lipid Profile: T. chol 219 mg/dL LDL 106 mg/dL HDL 50 mg/dL TG 150 mg/dl. UA: Normal Chest X-Ray: No fluid, masses, or infection; no cardiomegaly Hand X-Ray: Erosion of MCP and PIP joints bilaterally; measurable joint space narrowing from previous x-ray 6 months ago Synovial Fluid: From left knee; white cells 23.0 x 103 /mm³, turbid in appearance DEXA scan of hip/spine: T-score reported as -2

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