G.J. is a 71 year old overweight woman who presents to the Family Practice Clinic for the first ti. Question
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G.J. is a 71 year old overweight woman who presents to the Family Practice Clinic for the first
time complaining of a long history of bilateral knee discomfort that becomes worse when it rains
and usually feels better when the weather is warm and dry. However, the pain in her knees has
not improved this summer. Discomfort is greater in the left knee than the right knee. She is
having difficulty using the stairs in her home.
Her knee pain got significantly worse after she gained 20 pounds over the past 9 months. Her
joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up”
with activity.
The patient has tried a variety of NSAIDs for pain control, which gave her some relief but also
caused significant intolerable stomach discomfort. G.J. has NKDA. Her medications include:
atorvastatin 20 mg qhs, atenolol 25 mg bid, lisinopril 40 mg qd, metformin 500 mg bid, and
aspirin 81 mg qd.
PMH: Hypertension, dyslipidemia, T2DM, joint pain (especially knees),
VS: BP: 155/88, P: 72, RR: 16, T: 98.6F, Ht: 63 inches, Wt: 175 pounds.
PE: MS/extremities: Full ROM of left shoulder, right hip, bilateral elbows and ankles. Mild left
hip discomfort with flexion > 90 degrees and with internal and external rotation > 45 degrees.
Bilateral knee crepitus and enlargement, Left > Right. Slight ROM and both Bouchard and
Heberden nodes observed bilaterally during hand examination, no tenderness in finger joints. No
redness, heat or swelling in joints. Feet without breakdown, ulcers, erythema or edema.
X-rays: Left hip: moderate degenerative changes with osteophyte of femoral head, slight
narrowing of the joint space. Right and Left knees: moderate degenerative changes with joint
space narrowing, subchondral sclerosis, and bone cysts. No osteoporosis or joint effusions. Right
shoulder: Mild degenerative changes with bone spurs at head of humerus, slight narrowing in the joint space.
1- What is the relevant objective and subjective assessment data from the case study?
2- What does this data indicate? What conclusions can you make? What is your preliminary
diagnosis(es)?
3- Search the literature using databases, and select a clinical practice
guideline (CPG) to guide your prescribing for these diagnosis(es). Which CPG did you
select? (Include the reference for the CPG). Why did you select it?
4- Based on the CPG you have selected, what non-pharmacologic and pharmacologic
interventions will you use for your treatment plan? How does each intervention treat the
pathophysiology of the diagnosis(es)? What is the priority for each intervention (which
interventions are first versus later)?
5- What are the important prescribing considerations for the pharmacologic interventions?
6- write prescription for each medication you would prescribe, including all elements of a
prescription.
7- What outcomes would you anticipate – therapeutic effects and adverse effects? How will
you evaluate for these outcomes?
8- What patient education and follow up is required for the medications you have prescribed?
SCIENCE
HEALTH SCIENCE
NURSING
NUR 3420
G.J. is a 71 year old overweight woman who presents to the Family Practice Clinic for the first ti
