wk 6 musculoskeletal

• Which anticipatory guidelines will you consult (if any) for this particular disease process?
• How will a proactive/anticipatory approach to diagnosing, treating, and managing this disease process affect your consideration of the following:
• Prevention of the progression of the disease or comorbid issues
• Empowerment of self-management for the patient
• Anticipatory guidance such as labs, vaccines, testing (Digital rectal exams, mammography, Pap smears, colonoscopy, etc.)
• Patient education and referral to interdisciplinary professionals (specialists, nutrition, rehab, physical therapy, support groups, etc.)

****NO INTRODUCTION OR CONCLUSION NEEDED****

Joanna McMillan is a 59-year-old, female patient with complaint of joint pain. For several years she has had stiffness in the morning and after she sits for a while, has a slight pain when getting up from sitting, but things have changed. Now she has begun having pain that is affecting her life. Her right hip and left knee are swollen and painful after even short periods of ambulation. She states, This is going to sound weird, but I feel like my right hip joint is loose. Like it just needs tightening up to work right. My left knee sounds like an old set of creaking stairs when I walk, and sometimes it feels like it is stuck. Can you help me?

Myrtle Stine is a 44-year-old, female patient with complaints of joint pain. She started noticing morning stiffness, increased fatigue, bilaterally swollen hand joints, and pain several months ago. It has started to get worse, and she now has hard bumps on 3 of her finger joints. She enjoys a number of crafts, such as crochet, and the issue has caused her to be unable to finish the blanket that she started for her daughter, due to the pain. She rates her pain during the day from 2 to 6/10.

Henry Schmidt is a 37-year-old, male, dock foreman who presents with a complaint of pain in his lower back. This is his third visit this year for the same complaint. He has had imaging that shows no bony issues, misalignments, or other diagnosable problems to which the pain can be attributed. He states that the scheduled ibuprofen, muscle relaxers, topical ointments, ice, and heat are not working. Your check of the Controlled Substances Monitoring Database (CSMD) shows that he has regularly received prescriptions totaling 60 MMEs per day from two different providers outside of your practice. Mr. Schmidt states that his pain ranges from 4 to 8/10 throughout the day.

Helene Michie is a 58-year-old female patient who is healing from a foot fracture sustained 6 weeks ago after tripping over her dog, Pepper. This is her second fracture in the last year, and she remarks that she never had a broken bone in her life until she was nearly finished with menopause symptoms.

Ryan Armstrong is a 40-year-old male patient who arrives with a complaint of bilateral hand pain. Ryan works as a welder in a wood burning stove factory. He completes 100s of welds per day in a very repetitive pattern. He has experienced pain with movement for about 6 months, but it is getting worse. It has begun to impact his precision and production in his job.

The disease processes for week six are as follows:

• Rheumatoid Arthritis
• Chronic Back Pain
• Osteoporosis
• Osteoarthritis
• Carpal Tunnel Syndrome.