Description

I HUMAN CAMILA BAKER CASE STUDY Problem Statement by Carmen Walton on case Camila Baker Camila Baker is a 76 yr old female with PMH of HTN, CKD, PUD with GI bleed due to NSAID use. She presents today with bilateral knee pain. Stated the pain started about 5 years ago, over the past 2 years has gotten progressively worse. Rates the pain 4-5, with exacerbations up to 7-8 on 0-10 scale. Pain worsens with walking, exercising and stair climbing. She is taking Tylenol 3000gm daily for pain which is no longer effective, also stated cold weather increases pain. Denies injury and fall. associated symptoms include swollen and painful finger joints. Management Plan by Carmen Walton on case Camila Baker ANA CBC ESR Lt and Rt knee X-ray Synovial fluid analysis uric acid, serum Diclofenac 1% Topical; apply 4 g QID for pain / check creatinine level prior to starting (Hollier, 2021). Inra-articular corticosteroid injection for exacerbation - limited to 4 times per year are recommended for knee shoulder and hips and conditionally recommended for hand OA (Hollier, 2021) Stop taking Tylenol - the use of acetaminophen as a first line agent for OA is no longer recommended due to safety concerns and lack of efficacy for musculoskeletal pain (Hollier, 2021) Refer to weight management - weight loss can lead to improvement of symptoms for patients with OA (Hollier, 2021). Refer to PT for strengthening - - organized program of supervised exercise strongly recommended, to include balance and strength training, OA is a chronic disorder requiring muscle strengthening to provide joint support (Hollier, 2021). wear knee braces for stabilizing the joint when exercising. non-pharmacological management for OA per Hollier, 2021. Apply heat and/or cold as needed for comfort (on 20 min/ off 20 min.) is also a non-pharmacological management intervention for OA per Hollier, 2021. Emphasis must be on non-pharmacological treatments to delay use of medications that have adverse effects. Camila has a history of GI bleed and should not be taking NSAIDS which is the first line pharmacological treatment for OA. Tai chi, acupuncture and yoga are alternative therapies that may be considered for management of symptoms (Hollier, 2021).