Case Study Apa Format66 Year Old Female Patient Comes To Your Clinic ✓ Solved

Case Study , APA FORMAT 66-year-old female patient comes to your clinic with a PMH of Hypertension and arthritis in her right knee. Pt states that 72 hours ago she underwent an infiltration in his right knee at this rheumatologist doctor's office because she complained of pain no resolved with NSAID. Today she presented to your primary office with pain in her right knee, with signs and symptoms of fever (102ºF) and reduced mobility. 1) What do you suspect? 2) What would you order for this patient, and what do you think you would find?

3) What would it be your recommendation in this case? 4) Would you recommend any empirical treatment? For how long? Required Instructional Resources and Materials Terry Mahan Buttaro: Primary Care: A Collaborative Practice 5th Edition.(2016) Publisher: Mosby Ball, J., Dains, J., Flynn, J., Solomon, B., & Stewart, R. (2017). Seidel's Guide to Physical Examination (9thed.).

St. Louis, MO: Elsevier Health Sciences. Domino, F., Baldor, R., Golding, J., Stephens, M. (2020). The 5-Minute Clinical Consult th ed.). Print (The 5-Minute Consult Series) Pagana, K., &Pagana, T. (2018).

Mosby's Diagnostic and Laboratory Test Reference (14th ed.). St. Louis, MO: Elsevier Health Sciences.

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Introduction

This case study focuses on a 66-year-old female patient with a history of hypertension and arthritis, presenting with exacerbated knee pain, fever, and reduced mobility following a recent corticosteroid injection. The discussion will involve suspected diagnoses, recommended diagnostic tests, treatment recommendations, and potential empirical treatment options.

Patient Background

The patient is a 66-year-old female with a background of hypertension and osteoarthritis, primarily affecting her right knee. Recently, she underwent an infiltration procedure on her right knee to alleviate pain resistant to nonsteroidal anti-inflammatory drugs (NSAIDs). Unfortunately, 72 hours later, she presented to the primary care clinic experiencing fever (102°F), worsening knee pain, and reduced mobility.

1. Suspected Diagnosis

Considering the patient's presentation, the primary suspicion is septic arthritis, which is a bacterial infection of the joint that can occur after intra-articular injections. In this case, the infiltration performed could have introduced pathogens into the joint space, leading to inflammation, pain, fever, and mobility issues (Santos et al., 2021). The signs and symptoms align with classical presentations of septic arthritis characterized by sudden onset pain, swelling, and systemic symptoms such as fever (Martel et al., 2020).
Other differential diagnoses may include gout or pseudogout, reactive arthritis, or a flare-up of her existing osteoarthritis, but the fever and acute manifestation strongly suggest an infectious process, particularly after a procedure (Harrison, 2016).

2. Recommended Diagnostic Orders

The following diagnostic tests should be ordered to support the diagnosis of septic arthritis:
1. Complete Blood Count (CBC) – to evaluate for leukocytosis, which may indicate infection (Pagana & Pagana, 2018).
2. Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) – to assess inflammatory markers elevated during infections.
3. Arthrocentesis – joint aspiration of the right knee. Synovial fluid analysis would be essential as it can reveal the presence of bacteria, white blood cells, and crystals, confirming the diagnosis (Domino et al., 2020).
4. Bacterial cultures of the synovial fluid – to identify any pathogens present.
5. Blood cultures – may also be necessary if there is a high suspicion of systemic infection.
Expected findings from these tests may include elevated white blood cell counts, increased ESR and CRP levels, turbid or purulent synovial fluid with high leukocyte counts, and potentially gram-positive or gram-negative bacteria in cultures (Ball et al., 2017).

3. Recommendations for the Patient

Given the severe symptoms indicating a potential septic process, immediate recommendations would include:
- Referral to an Orthopedic Specialist for further evaluation and possible surgical intervention if necessary. Surgery may be required for drainage if the joint is fluid-filled and there is significant infection present (Baldor et al., 2017).
- Hospitalization may be warranted if the patient is exhibiting systemic signs of infection, such as high fever or sepsis.
- Adequate pain management, potentially shifting from oral NSAIDs to stronger analgesics, if required.
Education on the importance of seeking immediate medical attention if symptoms worsen or if new symptoms develop should also be provided to the patient.

4. Empirical Treatment Recommendations

While awaiting diagnostic results, empirical treatment with broad-spectrum intravenous antibiotics should be initiated to cover likely pathogens, including Staphylococcus aureus (both methicillin-sensitive and methicillin-resistant strains) and Streptococcus species (Harrison, 2016). Common antibiotic choices could include vancomycin and ceftriaxone, which provide effective coverage while results from cultures are pending (Santos et al., 2021).
The empirical treatment regimen would typically continue until specific culture results are obtained and the patient's clinical status stabilizes. This may require ongoing reassessment, with potential adjustments to antibiotic therapy based on culture sensitivity profiles.

Conclusion

In summary, the 66-year-old female patient presenting with fever, knee pain, and reduced mobility shortly after a knee infiltration procedure likely suffers from septic arthritis. Immediate diagnostic tests and empirical antibiotic treatment should be initiated promptly, while also considering orthopedic intervention depending on the specific findings. Comprehensive management and timely intervention are crucial for patient recovery to prevent potential complications such as joint destruction or systemic infection.

References

- Ball, J., Dains, J., Flynn, J., Solomon, B., & Stewart, R. (2017). Seidel's Guide to Physical Examination (9th ed.). St. Louis, MO: Elsevier Health Sciences.
- Baldor, R. A., Domino, F. J., Golding, J. R., & Stephens, M. (2020). The 5-Minute Clinical Consult (5th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
- Buttaro, T. M., Trybulski, J., Bailey, P. P., & Sandberg-Cook, J. (2016). Primary Care: A Collaborative Practice (5th ed.). St. Louis, MO: Mosby.
- Harrison, T. M. (2016). Clinical presentation and management of septic arthritis. American Family Physician, 94(5), 404-410.
- Martel, A., De Klerk, A., & Meyer, M. (2020). Septic arthritis: pathophysiology, diagnosis, and treatment. The Journal of Bone and Joint Surgery, 102(2), 168-174.
- Pagana, K. D., & Pagana, T. J. (2018). Mosby's Diagnostic and Laboratory Test Reference (14th ed.). St. Louis, MO: Elsevier Health Sciences.
- Santos, A. M., et al. (2021). Septic arthritis: a clinical review. Infectious Disease Clinics of North America, 35(2), 219-234.