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Group Activity 6: Group 44, Review of System and Physical Exam, Sarah…

- - - - Interpretation: "Transverse sonogram shows hypoechoic effusion in suprapatellar bursa (black arrow heads) "Note femoral cortex (single white arrowhead) and patellar cortex (double white arrowheads)
        
        Source
        
        Using Sonography to Reveal and Aspirate Joint Effusions
        
        Imaging techniques for evaluation of the painful joint
- - - - Does your knee pain radiate to any other areas?
        
        No
    - - Moving around makes the pain worse, so I try stay off my feet
    - - Normal knee (left) and knee with septic arthritis (right)
  - - - No
  - - - Where is this pain located?
        
        Mainly around my knees and in my legs
- - - - there are not any hemorrhages or exudates in the PERRLA and fundi
        
        The skin appears dry and slightly inflammed but there is no rash
        
        The neck area does not have any cervical adenopathy
        
        The lungs allow good chest excursion
      - Clear pharynx
      - Normal tympanic membrane (left) and effected tympanic membrane (right)
  - - - no murmurs, rubs or gallops; RRR with distinct S1 and S2 sounds
- - - - both parents passed away in very tragic ways
      - got laid off from his job
      - lost his medical insurance and cant pay for his insulin he needs
    - - he has a past medical history of hyperlipidemia and type 2 diabetes
  - - - he stated that he had hypertension
    - - he said he had swelling and joint pain in both knees
- - - - he mentions it is hard to walk and that he cant walk for awhile without taking breaks
  - - - he has recently been diagnosed with diabetes
    - - drinks at family events, about 12 beers and recently during his trip drank a lot
- - - - we see this in his continuous knee pain
    - - has joint pain and swelling in both knees
  - - - he is 54
- - - - when examined his abdomen was soft without organomegaly; tender in lower quadrant bilaterally
  - - - we see this in his life with him being laid off, losing his medical insurance, and not being able to afford his upcoming insulin need
- - - - If methicillin resistant, use Vancomycin
  - - - Anticipate a reduction in swelling on knees as well as redness of skin.
      - Anticipate an increased ROM on knees bilaterally.
    - - This could be indicative of infection getting worse or a bacterial that has developed resistance to antibiotic Rx
- - - - Pain at the knee bilaterally
      - Change of color of skin to red
      - Swelling of knee bilaterally
    - - Age
        
        Being of his age he is at increased risk of RA
      - Being overweight increases risk
      - Having a history of HTN and Hyperlipidemia puts him at increased risk of RA
        
        Cardiovascular co-morbidity in patients with rheumatoid arthritis: a narrative review of risk factors, cardiovascular risk assessment and treatment
      - Mother having RA increases risk
  - - - Acute/Sudden onset of redness of knees, could be indicative of this
      - The swelling of his knee bilaterally as it can affect both joints
      - The redness he states could indicate tenderness of joint along with warmness of the skin which are key indicators of gout
    - - Diet: He stated that he loves to eat dark meat which contain high levels of purines. Which increases the risk for a gout flare up
      - Overweight also increases his risk
      - He stated that he drank a lot of alcohol recently at his family trip to Europe. This puts him at an increased risk
  - - - Localized swelling of the knee
      - Localized Pain of the knee, especially when ambulating
      - Reduced ability to walk due to the severity of the pain and swelling
    - - Male gender is more at risk
      - Being overweight
      - Eating a diet with meat increases carcinogenic exposure and thus increasing risk of cancer
  - - - Swelling at the knee join bilaterally
      - Voicing that he is feeling tired since his trip
      - Stating that his knee feel "stiff" is another sign as well
    - - Exposure to increased sunlight as he was at the beach often
      - Heavy alcohol consumption could have triggered a Lupus Flare up