Mrs.

Pickleweasel is a 42-year-old high school science teacher who began noticing unclear joint pain,
fatigue, poor appetite, and general malaise, which she first thought was a case of the flu. However, her
symptoms continued and she reports feeling very stiff in the mornings, often taking until 10:00 or 11:00
A.M. to begin to feel normal. She has begun to call this her. She then began to notice aching in her hands
and wrists, which she assumed was the quilting she loves to do in the evenings. She made an appointment
with her family physician when she noticed that her knuckles and finger joints are not just achy but also
swollen and hot. Noting that Mrs. Pickleweasel has lost 10 lb since her last visit and has mild anemia and a
significantly elevated sedimentation rate (ESR),the physician refers her to the rheumatology clinic for
further evaluation. Following examination, laboratory, and radiologic testing, the rheumatologist
establishes a diagnosis of rheumatoid arthritis and initiates a multidisciplinary team conference to plan the
management of Mrs. Pickleweasel’s rheumatoid arthritis.

Assessment Diagnosis Planning/Imple Evaluation

mentation
Mrs. Chronic pain Patient Mrs.
Pickleweasel related to joint teaching on Pickleweasel was
looks well inflammation relieving pain able to minimize
presented but Impaired and stiffness some of the pain
looks ill and home including equal with the help of
fatigued. Mrs. maintenance intervals of the ASA, rest,
Pickleweasel related to fatigue NSAIDs and exercise.
states that despite Activity throughout the However, full
the symptoms she intolerance day, ROM in reduction of her
continues to do related to shower or pain has not been
her job but does effects of bathtub achieved. She
not think she can inflammation Patient teach having hard time
continue because on how to give find rest break in
of her fatigue. some her work
Her Vital read as responsibilities to schedule and her
followed: B/P family members kids fight off
128/74, R 20, P Make ways chores they have
78, T 98.2 F. Has to have 30 min to do, so she does
hand swellings breaks into her them. She has
on both hands. work schedule been consistent
Cannot make a Patient teach on her
complete fist. ways to minimize medication and
Hands are red, joint stress while maintains her
hot, hard to performing ADLs appointments
palpate. Both Provide with her
knees are swollen research and care treatment team.
are limited in on arthritis
flexing.
References: http://wps.prenhall.com/wps/media/objects/737/755395/rheumatoid_arthritis.pdf