R.W. is a married, 34-year-old Hispanic female with two young children who presents to her primary care provider with a productive cough, stiffness and pain in her hands and feet that comes and goes. She states, "It moves around from joint to joint. I'm worried I've got RA like my sister.” Her PCR test for COVID-19 has come back negative.
History of Present Illness
Five years ago, R.W. went to her PCP after four months of rashes that appeared on her arms and legs whenever she went into the sun. She had lost several small patches of hair on her scalp and stated she thought it was related to stress. She also complained of fatigue that required her to take daily naps. She had mild arthritic pain in her fingers and elbows but thought it was related to aging. A tissue biopsy of one of the multiple rash-like lesions from her arm revealed vasculitis (white blood cells within the walls of blood vessels). Her CBC indicated mild anemia, but microscopic examination of a peripheral blood smear revealed that red blood cells were normal in shape size and color, ruling out iron, folate and vitamin B12 deficiencies. A two-month course of prednisone caused all signs and symptoms to resolve.
Past Medical History
Unremarkable, current with all vaccinations including influenza.
Family History
She has two brothers and one sister. Her older sister has rheumatoid arthritis, and an aunt has pernicious anemia. Her mother has Graves' disease.
Social History
No smoking or drinking
Medications
Naproxen for joint pain, antacid for heartburn, no other over the counter drugs
Allergies
NKA
Vital Signs
BP 141/90 sitting, RA
HR 105
RR 20
T 100o F
HT 5'6"
WT 105 lbs
Review of Systems (only abnormal values presented)
Specializes in Education, Informatics, Patient Safety.
First official follow up post (I've summarized some of my responses to your questions):
The patient has been married for 10 years to the same man, prior to that two partners-no history of STDs. She sells real estate for a large real estate company. Weight at most recent annual doctor’s visit 8 months ago: 120 lbs. No travel outside US
Antinuclear antibody test (ANA): positive
ESR: 25 mm/hr
Chest X-ray: mild pulmonary edema with no white blood cell infiltrates in the terminal airways
The PCP is thinking bronchitis but is worried about the development of pneumonia.
R.W. asks, “So do you think I have RA?”
Urinalysis: abnormal protein concentration with significant red and white blood cells. A 24-hour urine protein revealed excretion of 2.5 g protein in 24 hr. Elevated blood urea nitrogen (21 mg/dL), and elevated creatinine (2 mg/dL)
CMP: WNL
Thyroid panel: WNL
Liver panel: AST 42 U/L; ALT 60 U/L; bilirubin 1.1 mg/dL, Albumin 3.0 g/dL
Glucose: WNL
CBC
Hct 23%
Hgb 11.0
RBC 3.5 million/mm3
WBC 1,200/mm
75% neutrophils
15% lymphocyte
5% monocytes/macrophages
4% eosinophils
1% basophils
Plt 160,000/ mm3
I will post the final result on Tuesday! Thanks for your patience:)
Specializes in Education, Informatics, Patient Safety.
11 hours ago, CommunityRNBSN said:
I hate all these case studies because they make me feel like a complete idiot. ?
Oh! please don't feel that way! I get it, but seriously - this is supposed to be a fun way to learn. Feel free to Google symptoms. Our hope at allnurses is that you become better at spotting worrisome symptoms.
Kooky Korky, BSN, RN
5,216 Posts
OK, do the revelation now. I've been waiting long enough.