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A community-based nurse performs a home visit on a client the nurse first met in the clinic last week. Joan is a middle-aged woman who lives with her extended family in a rural area that is 3 hours away from the closest health care facility. Joan came to the clinic due to pain, stiffness, fatigue, and feelings of anxiety. She said she had the flu and since then has “just felt terrible.” On assessment, Joan has a BMI of 18.1, HR of 90 beats per minute, BP 110/60 mmHg, RR 18. Joan states that for the past 6 to 9 months, she hasn’t felt well. She has noticed increasing stiffness in both hands in the morning that lasts longer and longer. Stiffness now lasts more than an hour every morning and includes hands, wrists, and ankles. She states that she works as a cashier at the grocery store and is having increasing difficulty standing for long periods at work due to ankle pain. Since getting the flu, she feels completely “wiped out.” On examination, her fingers, wrist, and ankle joints bilaterally are warm, tender, and swollen. Blood work reveals a positive anti-cyclic citrullinated peptide (CCP), an elevated C-reactive protein (CRP)
SCIENCE
HEALTH SCIENCE
NURSING

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