Chief Complaint: Ann Baker
Subjective
Chief Complaint
“My knees are killing me, I’m tired all the time, and I’ve got horrible pain in my stomach.”
HPI
Ann Baker is a 32-year-old woman who has been having knee pain on and off for about 2 years. She has been to the doctor a few times since then with the same complaint. Workups showed no radiologic changes to the knees, and her family practice physician settled on a diagnosis of early arthritis. She was not evaluated by a rheumatologist. Despite scheduled APAP and ibuprofen throughout the day, the pain has not decreased much. The pain seems to be cyclical; it is very bad for a period of weeks, and then it wanes over time. It is also worse in the summer. She thinks the rashes she gets now and then on her face and arms have …show more content…
Does not match up with signs of osteoarthritis.
Negative anti-CCP antibody (-) indicates knee pain is less likely to be due to rheumatoid arthritis
Fatigue3
NSAID-associated iron-deficiency anemia and gastropathy
Iron-deficiency anemia
High TIBC levels
Low ferritin levels
Low iron levels
Low Hct levels
Low Hgb levels
Use of ibuprofen 800 mg po qid …show more content…
Take 1 hour before or 2 hours after meals.
Separate from esomeprazole.
If the patient experiences GI upset, she can take with a small amount of food.
Inform patient that iron supplement can cause constipation
Nonpharmacologic:
Monitor iron, hemoglobin, and hematocrit levels to evaluate the efficacy of therapy
Monitor for dark stools or obvious bleeding
Advise patient to reduce alcohol intake as concurrent use of NSAIDs and ethanol may increase risk of GI bleeds.7
Encourage patient to consume a diet rich in iron, including dark leafy green vegetables, cereal and grains with iron added, beans, raisins, tofu.9
Advise patient to maintain or increase fiber intake (whole grains, fruits, vegetables, fluids) to prevent constipation caused by iron supplement.
Hypertension
Goal:
BP ≤ 130/80 mmHg because patient has SLE3
Pharmacologic:
Continue hydrochlorothiazide 12.5 mg po daily and amlodipine 5 mg po daily until assessment of SLE with a rheumatologist, then re-evaluate drug therapy, considering hypertension is associated with SLE
Chief Complaint
“My knees are killing me, I’m tired all the time, and I’ve got horrible pain in my stomach.”
HPI
Ann Baker is a 32-year-old woman who has been having knee pain on and off for about 2 years. She has been to the doctor a few times since then with the same complaint. Workups showed no radiologic changes to the knees, and her family practice physician settled on a diagnosis of early arthritis. She was not evaluated by a rheumatologist. Despite scheduled APAP and ibuprofen throughout the day, the pain has not decreased much. The pain seems to be cyclical; it is very bad for a period of weeks, and then it wanes over time. It is also worse in the summer. She thinks the rashes she gets now and then on her face and arms have …show more content…
Does not match up with signs of osteoarthritis.
Negative anti-CCP antibody (-) indicates knee pain is less likely to be due to rheumatoid arthritis
Fatigue3
NSAID-associated iron-deficiency anemia and gastropathy
Iron-deficiency anemia
High TIBC levels
Low ferritin levels
Low iron levels
Low Hct levels
Low Hgb levels
Use of ibuprofen 800 mg po qid …show more content…
Take 1 hour before or 2 hours after meals.
Separate from esomeprazole.
If the patient experiences GI upset, she can take with a small amount of food.
Inform patient that iron supplement can cause constipation
Nonpharmacologic:
Monitor iron, hemoglobin, and hematocrit levels to evaluate the efficacy of therapy
Monitor for dark stools or obvious bleeding
Advise patient to reduce alcohol intake as concurrent use of NSAIDs and ethanol may increase risk of GI bleeds.7
Encourage patient to consume a diet rich in iron, including dark leafy green vegetables, cereal and grains with iron added, beans, raisins, tofu.9
Advise patient to maintain or increase fiber intake (whole grains, fruits, vegetables, fluids) to prevent constipation caused by iron supplement.
Hypertension
Goal:
BP ≤ 130/80 mmHg because patient has SLE3
Pharmacologic:
Continue hydrochlorothiazide 12.5 mg po daily and amlodipine 5 mg po daily until assessment of SLE with a rheumatologist, then re-evaluate drug therapy, considering hypertension is associated with SLE