Instructions :The leading diagnosis for this patient is ****. As evidenced by presenting symptoms of ***** (citation of reference supporting findings). Supporting physical assessment findings include ****** (citation).
Differential Diagnoses
Differential diagnoses for this patient include *** and ***. (must have 2 differentials)
Differential 1 (e.g. Influeza)
The first differential in this case is **** supported by patient presentation of *** (citation). The differential is further supported by physical exam findings of **** (citation). *** is less likely however due *(here you would present s/s, history physical exam findings that rule out differential)* (citation).
Differential 2 (e.g. Viral pharyngitis)
*** is the second possible differential in this case. Differential is supported by patient’s presenting symptoms of **** (citation). Patient’s physical assessment findings of *** further support the differential however, differential is less likely due to *** (citation).
Diagnostics
Based on current practice guideline recommendations, **this would be any pertinent diagnostic test(s) or exam(s) indicated for diagnosis** (must include citation of a Clinical Practice Guideline or Problem Specific Peer Reviewed Reference). Brief statement regarding why the test(s) is/are being used, e.g. Positive RADT results are confirmatory for GAS in pediatric patients (Clinical Practice Guideline or Problem Specific Peer Reviewed Reference citation).
Treatment Plan
*** is the first line treatment for *** (Clinical Practice Guideline or Problem Specific Peer Reviewed Reference) Any medications should include name, route, dose, and duration (Clinical Practice Guideline or Problem Specific Peer Reviewed Reference citation). Supportive measures recommended, including ***** (citation). Follow up **** (citation)
References
Include references cited documented per APA 7 guidelineEpidemiology/Patient ProfileMs. Roman is a 74-year-old female who presents to the clinic today with worsening of her chronic right knee pain over the last two weeks. There is no history of injury or trauma, no associated symptoms. She denies morning stiffness. PrioritizedCuesfromHxandPE.II.(Donotincludelab,x-?ray,orotherdiagnostictestresultshere.)• Tier 1: The cues (may be positive or negative) that contribute most to the diagnosis of the active problem.• Tier 2: These are cues of intermediate importance (list only positive cues).• Tier 3: Of least importance (list only positive cues).Tier 1Tier 2Tier 3Chronic right knee painOccasional pain in other joints History of GERDProgressively worsening over 2 weeksPain is worse through the day and improves Bengay helps with the painwith restGrinding sensationFemaleLives alone in a two-story homeNo history of injury or trauma74-years-olsShe gardens frequentlyNo erythema or skin lesions presentFamily history of OAEffusion and crepitus noted on right kneeROM is 120 degrees III. Problem StatementMs. Roman, 74, arrives with an exacerbation of her chronic right knee during the previous two weeks. There is no history of trauma, no constitutional symptoms, and no morning stiffness, according to the patient. Physical examination indicates a slightly reduced range of motion in the right knee, as well as crepitus and a little effusion, but no erythema or skin abnormalities.IV. Differential DiagnosisBased on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patient’s complaint(s). List your most likely diagnosis first, followed by two other reasonable possibilities. For some cases, fewer than 3 diagnoses will beappropriate. Then, enter the positive or negative findings from the history and the physical examination that support each diagnosis.Leading dx: OsteoarthritisHistory Finding(s)Physical Exam Finding(s)Chronic right knee painSmall effusion with milking of suprapatellar pouch of the right kneeProgressively worse over the last 2 weeksCrepitus noted with movement of right kneeGrinding sensationRange of motion is 120 degrees in right knee74-year-oldFemalePain worsens during the day and improves with restFamily history of OAOccasional pain in other jointsAlternative dx: Rheumatoid arthritis
History Finding(s)Physical Exam Finding(s)Chronic right knee painSmall effusion with milking of suprapatellar pouch of right kneeProgressively worse over the last 2 weeksCrepitus noted with movement of right kneeOccasional pain in other jointsRange of motion is 120 degrees in right kneePain worsens during the day and improves with restAlternative dx: Knee sprainHistory Finding(s)Physical Exam Finding(s)Chronic right knee painSmall effusion with milking of suprapatellar pouch of the right kneeProgressively worse over the last 2 weeksRange of motion is 120 degrees in right kneeNo history of injury or traumaV.Explanation of Diagnostic Plan and Treatment Plan in prioritized order:(including tests, labs, imaging studies, etc.) Diagnostic PlanRationalX-ray of right kneeRadiographs often show the growth of osteophytes and the narrowing of the joint space which indicating cartilage degradation (Katz et al., 2021). Erythrocyte sedimentation rate, C-reactive protein and complete These labs should be drawn in order to rule out the possibility of blood countinfection (Bunt et al., 2018). Rheumatoid factor or auto-antibodiesThese labs should be drawn in order to rule out an autoimmune condition such as rheumatoid arthritis (Bunt et al., 2018).Microscopic examination of arthrocentesis fluidThis test can be used to observe the arthrocentesis fluid for gouty crystals or evidence of infection (Bunt et al., 2018).Treatment PlanRationaleEducation on osteoarthritis This is beneficial so that the patient may learn more about the risk factors for osteoarthritis, as well as the treatment plan and pain reduction strategies. Exercise and weight loss planStructured exercise therapies, which primarily focus on strengthening lower limb muscles (Katz et al., 2021). Adding in weight loss techniques is also immensely helpful. When compared to exercise alone, a combination of diet and exercise can result in significant weight loss, pain alleviation, improved functional status, and a reduction in inflammatory markers (Katz et al., 2021).Referral to physical therapyPhysical therapy is beneficial in order to start a program or to treat lower extremity weakness or limits in knee range of motion (Katz et al., 2021).Non-steroidal anti-inflammatory drugsThe first-line pharmacologic therapy for OA is NSAIDs. In the case of this patient, topical creams might be more beneficial due to her GI issues. In general, topical NSAIDs have less gastrointestinal effects than oral NSAIDs (Katz et al., 2021).Intra-articular injections of corticosteroidsPatients who are incapable or do not respond to NSAIDs can be given intraarticular corticosteroid injections, which often reduce pain for a few weeks (Katz et al., 2021). I have adhered to the honor system: Student Signature
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