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Unfolding Case Study

1.
The nurse would first assess the patient’s respiratory and circulatory systems (based on the ABCs of prioritization). The patient’s vital signs have improved since arriving at the emergency room and she is currently stable. At this point, it is most important for the nurse to recognize the patient is reporting moderate pain in the joints, rated 6/10 on the numerical scale.
2.
The nurse would want to gather more information about the patient’s pain. Using a mnemonic, such as OLDCARTES, the nurse will assess onset, location, duration, characteristics, aggravating factors, radiating, treatment, effect, and severity. The nurse may ask questions such as how long she has had the pain, if the pain is constant or intermittent, if anything makes it better, and if anything makes it worse. After obtaining that information, the nurse will be better prepared to initiate interventions for pain control.
3.
The nurse would hypothesize that the patient’s joint pain negatively impacts her quality of life and probably decreases her level of activity. Even though studies have shown improvement in joint pain from arthritis with increased exercise, patients often find that information to be counterintuitive, instead choosing to rest the joints in an effort to improve symptoms.
4.
The nurse should perform a functional assessment to gain a better understanding of the patient’s ability to perform ADLs. There are several assessments that can be used but it is most likely that the nurse will use the Katz Index of Independence in Activities of Daily Living.
5.
The nurse should first relay these findings to the provider. The provider may order medications to better control her osteoarthritis symptoms or initiate a referral to physical or occupational therapy. Additionally, the nurse should offer support and encouragement to the patient, as losing the ability to perform ADLs can have a significant impact on a patient’s mental health. The nurse should also connect the patient to other resources, such as support groups for individuals with osteoarthritis or access to companies that provide assistive devices.
6.
Findings that would indicate that interventions were effective and optimal outcomes were achieved include improvement in pain level, improved range of motion, and increased ability to perform or assist with ADLs. The patient should also express an understanding of the need for occupational therapy and be an active participant in her plan of care.
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