Differential Diagnoses would Require an Additional Assessment
Instructions
Choose 2 questions to answer.
Respond to two of your classmates.
Make sure you are checking when your classmates respond to your answers, so you can reply if needed.
Prompt:
Dr. Jenn's 40-year-old sister complains of joint pain in her hands and ankles which is worse in the morning. List your differential diagnosis. What additional assessments would you perform?
Dr. Jenn's 80-year-old neighbor complains that she can’t sleep unless she has some alcoholic beverages before bed. Her husband died last month. Her children came in town for the funeral but have since returned to their homes out of state. What risks might you be concerned about? What would you include in your treatment plan?
Dr. Jenn's eight-year-old niece comes in with a sore throat and fever. What is your differential diagnosis? What assessments and tests would you perform and why?
Dr. Jenn's uncle is now 68 years old and has smoked one and a half packs of cigarettes every day since he was fifteen. How many "pack-years" should be reported? What would you expect to find in his respiratory assessment? How would this affect your oxygenation goals for this patient?
Dr. Jenn's 68-year-old aunt struggles with controlling her hypertension and high cholesterol. What concerns might you have concerning her body systems, and how would this change your assessment? What teaching points would you review with Dr. Jenn's aunt?
Dr. Jenn's 10 year old niece vomits every morning before school. What additional assessments would you perform, and what might you discuss with her? Why?
The symptoms presented by the patients are characteristic of rheumatoid arthritis. However, joint pains affecting the hands of an individual in the morning is a typical clinical presentation for diverse healthcare issues. According to Baker (2022), healthcare providers should consider other diagnoses through the differential diagnosis of the condition. Some of these comprise:
Infection by a Viral disease such as rubella, hepatitis B, and parvovirus B19. This infection can trigger a severe polyarthritis syndrome that healthcare practitioners can mistake for the rheumatoid arthritis presentation (Baker, 2022). The only difference is that the clinical manifestations of the infections are short-lived and can persist for up to six weeks.
Systemic rheumatic illnesses. Healthcare providers face the challenging issue of differentiating arthritis of systemic lupus erythematosus (SLE), dermatomyositis, antisynthetase, and Sjцgren’s syndrome from rheumatoid arthritis (Baker, 2022). However, these disorders distinguish themselves from rheumatoid arthritis through dry eyes and mouth, rashes, nephritis, or myositis.
Osteoarthritis. One can confuse this disease with rheumatoid arthritis in older or middle-aged patients, especially when clinical presentations involve hands’ small joints (Baker, 2022).
Palindromic rheumatism. It highlights joint inflammation episodes affecting these areas for several days (Baker, 2022).
Carpal tunnel syndrome. Although joint pains do not exclude rheumatoid arthritis, the disease frequently occurs in diabetes patients (Baker, 2022).
The presence of these differential diagnoses would require an additional assessment to confirm rheumatoid arthritis. For instance, it would be critical to ensure the patient satisfies diverse evaluation factors, including inflammation affecting three or more central joints, a rheumatoid factor (RF) classified as positive, and a protein antibody (ACPA) (Baker, 2022). Others include elevated C-reactive protein (CRP), over six weeks of disease duration, and exclusion of illnesses with similar signs.
Dr. Jenn’s 80-year-old neighbor complains that she can’t sleep unless she has some alcoholic beverages before bed. Her husband died last month. Her children came to town for the funeral but have since returned to their homes out of state. What risks might you be concerned about? Wha...