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Asked by BarristerBee2275

A 23-year-old female college student presents to student health service with a 2-week history of “aches and pains.” She has noticed stiffness in the morning lasting approximately 1 hour and affecting her hands, feet, ankles, and shoulders. She notes that 3 days ago she had some shaking chills and a fever. She is sexually active. Her sexual partner uses condoms.

CC: “I am very tired out from these aches and pains. What is wrong with me?”

 

Physical exam demonstrates tenderness in multiple joints. Specifically, tenderness is noted in several extra-articular locations, consistent with bursitis and tenosynovitis. Her right knee is swollen and warm with a large effusion. All other joints demonstrate full range of motion with no evidence of effusion, joint swelling, or deformity.
 

Questions:

1. What are the differential diagnoses to consider in this patient?

2. How would you distinguish whether this patient had myalgias, arthralgias, arthritis, bursitis, or tenosynovitis? Define and review these terms.

3. What other questions do you need to ask this patient? What other data are important? Is it possible that this patient has a potentially life or loss of limb function emergent condition and if so, how would you handle this?

4. What tests do you need to order (if any) and why? Will you order x-ray films and/or any other type of imaging and why?

5. How would you manage this patient? Include pharmaceutical and nonpharmaceutical 
treatment, diagnostic tests, patient/family education, and follow-up plan.

6. What health promotion strategies are especially important for this patient at this time and why?

7. What complementary therapies might be effective for this patient? 

SCIENCE
HEALTH SCIENCE
NURSING
NURS 2115

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