Monday, March 22, 2010

Rheumo Case Review

Patient details
Male, 28years
Lives with Wife and One Year old Child
He use to work as a chef, but cannot work at the moment due to pain and immobility
His wife works and studies

Diagnosis: Polyarticular Gout

Polyarticular Gout. If more than one joint is affected, it is known aspolyarticular gout. Multiple joints are affected in only 10 - 20% of first attacks. Older people are more likely to have polyarticular gout. The most frequently affected joints are the foot, ankle, knee, wrist, elbow, and hand. The pain usually occurs in joints on one side of the body and it is usually, although not always, in the lower legs and feet. People with polyarticular gout are more likely to have a slower onset of pain and a longer delay between attacks. People with polyarticular gout are also more likely to experience low-grade fever, loss of appetite, and a general feeling of poor health.

An untreated attack will typically peak 24 - 48 hours after the first appearance of symptoms, and go away after 5 - 7 days. However, some attacks last only hours, while others persist as long as several weeks.


Reason for admission - Methylprednosone Pulses 3x


Reason for Referral Assessment - Splinting, Education, RTW, equipment/aids

  • Intial Hand Assessment
  • ADL tasks sheets- self report of difficulties
  • Assessment of Hands


Presenting Problems/Complains

  • Pain and reduced ROM in R) Wrist - also decreased strenght in R) hand
  • Swan neck deformity in R) LF
  • Pain in TMC/CMC joint - thumb
  • Difficulties with multiple ADLS
  • Reduced mobility due to pain in L) knee; both ankles and feet.
  • Poor sleep and fatigue
Current/Pre admission occupational performance/mobility
  • Mobilising with gutter crutch L) arm
  • Independent with personal ADL's on ward, concerns re: showering at home
  • Unable to carry heavy items or carry items in R) hand
  • No completeing heavy housework tasks
  • Difficulty with but independant with multiple actions/tasks at home relating to hand function, strenght, pain and immobility
Intervention
  • Education re: sleep cycles, factors linking to poor sleep, strategies and use of relaxation, sleep diary and routine/environmental setup
  • Wrist splint - D ring splint for stability
  • Issued a BB and K-trolley
Plan
  • Book in O/P clinic to review splinting of R) LF - swan neck deformity, and resting slint for wrist.