Question

Joan is a 73 year old woman of Italian descent. Joan migrated to Australia when she was 7 years old. Joan is the youngest of 7 children. 4 of her siblings have passed away from various cancers and heart disease. Joan walks for approximately 20 minutes each day, and does light weight training at her local gym 5 days per week. Joan volunteers at the local church and is an active member of her family, having 6 children and 10 grandchildren of her own. Joan suffered a shoulder injury several years ago after falling and dislocating her shoulder. She never regained full movement. She also has early signs of arthritis. Recently she has been experiencing more aches and pains and is hoping your service can support her.

Question:

1. Client Background

Provide a brief summary of the clients presenting condition including the pathophysiology and signs and symptoms of the condition/s presented.

2. Observations & Assessments

Outline the types of observations and assessment methods you would perform with this client (this can include the results of medical tests the client presents with).

3. Questioning

List at least 5 questions that you could ask this client to get a deeper understanding of the clients health status

4. Analysis

Based on the information provided in the case study, analyse the clients health information. (I.e. draw conclusions and highlight any other health risks that you may need to be mindful of with this client)

5. Considerations

List below anything you need to be mindful of when treating this client, i.e any potential risks, areas to avoid, treatment types to avoid.

6. Treatment Plan

Outline below your treatment plan for this client

Answer 1

1,Clinical Background:
Arthritis:
   Arthritis is a joint disorder or inflammation..Arthritis is accompanied by joint pain(arthralgia)..
causes of arthritis:
   Injury,metabolic abnormalities,heriditary factors,direct and indirect effect of infections
Signs and symptoms:
Arthritis include pain and limited function of joints..it charecterized by joint stiffness,redness,pain and warmth..For some patients symptoms include fever,gland swelling(swollen lymphnodes)weightloss,fatigue,feeling unwell and even symptoms from abnormalites of organs such as lungs,heart or kidneys..
Pathophysiology:
It have immunological and inflammatory pathways..
Synovial lining or intimal layer in RA condition this layer and lining greatly hypertrophied 8-10 cells thick..Subintimal area of synovium,here blood vessels are located with very few cells..In RA subintimal area will be infilterated with inflamatory cells,including T and B lymphocytes,macrophages,mast cells and mononuclear cells that will differ into multinucleated osteoclasts..In RA the hypertrophied synovium invades and erodes contiguous cartilage and bone..Cartilage composed of type II collagen and proteoglycans,it is resilient tissue that absorbs considerable impact and stress..In RA integrity,resiience and water content will be impaired..cytokines IL1 and TNF generation of reactive oxygen and nitrogen species it increasing chondrocyte catabolic pathways and matrix destruction,inhibit new cartilage formation..The role of B cells in RA with efficacy of ritumimab which eliminates circulating B cells through with limited impact on autoantibody formation..
2, Observation and assessment:
Observation:
   Osteoarthritis is the most common type of arthritis when cartilage in your joints breaks down..That time joint will swell..Age,obesity,injuries,family history and joint overuse can increase this risk..Patient may experience joint soreness,morning stiffness.lack of coordination,increasing disability..
Assessment:
The lequesne Algofunctional Index:
It is a 10question survey..5question with pain or discomfort,1question with maximum distance walked,4question with activites of daily living..total questionnaire scored 24scale..if it is less indicate less functional impairment..
The Western Ontatrio and MC Master universities Osteoarthritis Index(WOMAC):
    The WOMAC OA index composed of 24items with three subscales for evaluate pain,physical function and stiffness..
KATZ Index of independence in Activities of Daily living:
   Here bathing,dressing,toileting,transferring,continence and feeding will be assessed..There is 0-6 ranges are there,more than 6 is highest and indicate of independence..0indicate patient is very dependent..
Instrumental activities of daily living:
It assess the functional capacity..
The arthritis impact Measurement scale:
It measures physical,social and emotional well-being of patient..
Lab test: RA factor
X-ray,MRI
3,Questioning:
-Did any of your parents or your siblings having a history of Arthitis?
-Do you have any endocraine abnormalities?
-Since how long you have this pain and stiffness?
-Have you checked your heart,lung and kidney anytime?
-since how long you are working as a volunteers in your church?