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R. T. is a 44-year old black female, born in Aba, Abia state in Nigeria. She moved to the United States of America in 1998 and presently resides in Las Vegas, Nevada. She’s divorced and has 3 children. R. T. works as a physician assistant at a prominent hospital in the city. Her primary language is English with a French background. During the time of this interview, she was well groomed, alert and had an upbeat personality, with no signs of nervousness.
The patient works in the medical field and has a good understanding of what health should be. This understanding of what health should be, is centered around the holistic viewpoint. The holistic viewpoint refers to the perception of health as a whole, that is human whole, which includes the body, mind and soul taken together as human existence. The holistic perspective addresses the whole person’s physical, mental and emotional health, and not ignoring social factors. The patient also identifies that good health also emanates by taking care of the body by exercising regularly depending of her work schedule. Furthermore, she controls what she eats with the help of a nutritionist. The patient gave a subjective data of her workout routine and diet plan
Patient has a past medical history of rheumatoid arthritis. Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory disease that primarily affects the articular structures and synovial membranes of the joints. It is usually manifested by joint pain, swelling, tenderness and deformity. The patient stated that she always sought urgent medical attention because of increased pain and discomfort. The patient further said that she was advised to minimize symptoms by incorporating good diet, stress management and low impact exercises like Yoga into her daily life. One of the risk factors of RA includes family history. The patient mentioned that her parents had RA when they were alive and her parents had the following symptoms, fatigue, morning stiffness, generalized muscle aches, loss of appetite, weight loss and weakness. The patient also mentioned that one of his brothers that has rheumatoid arthritis and experiencing similar symptoms. Another important risk factor worthy of mentioning, is that women are three times more likely to suffer from RA than men and the peak age of onset of RA is 35-50 years. Her medications are often disease-modifying antirheumatic drugs (DMARDs) and non-steroidal anti-inflammatory drugs (NSAIDs) that helps to relieve the symptoms but doesn’t alter the progression of the disease.
RA is an autoimmune disease in the general family of lupus. It is a chronic disease characterized by inflammation of synovial tissues and hyperplasia or swelling. This causes cartilage, fibrosis and bone destruction. In view of this, I will be reviewing the musculoskeletal system. The musculoskeletal system comprises of the bones, joints and muscles in the body. Its primary function is to provide supports. RA affects systemic joints, and the pain associated with RA is worse in the morning when arising and unlike other musculoskeletal diseases, movement in RA decreases pain. In examining the musculoskeletal system, it is imperative to obtain subjective data about the joints, including stiffness, swelling, pain or limitation of movement. Objective data can be obtained by accessing each joint, taking note of the size and contour of the joint. The skin and tissue can be inspected, taking note of the color, swelling, and any deformities or masses. Each joint should be palpated for skin temperature, articulation of the bones as well as the condition of the joint capsule. R. T. stated regrettably that she was an introvert during her younger age and it affected her relationships with boys and ultimately with her ex-husband. She mentioned that she rarely attended social functions, went to all female schools and met her ex-husband through a mutual friend. They got married within a short time of meeting each other. She blamed introversion for the failure of her marriage. This is so true based on Erikson’s stages of psychosocial identity development, which states that young adults must decide whether they will engage in intimate relationship with others. Individuals who lacked that sense of identity, often refrain from creating friendships and resort to emotional stress and isolation. The common knowledge of the family history of RA, R. T. said that the family rallied around each other providing support on how to manage the symptoms of the disease. In RA, severe joint damage crops up early, hence the family advised for aggressive treatment with disease-modifying drugs to prevent joint damage. R. T. also said that her mum made good use of fish oil, notably omega-3 fatty acids to reduce the symptoms of the disease. However, the quantity of omega-3 fatty acids ought to be carefully monitored because fish oil supplements can increase the risk of heart failure in patients already receiving NSAIDs.
It was an incisive interaction with R. T. and I learnt a great deal. I was diligent in the way I was asking her questions and it was helpful in obtaining the information I needed from my patient. When the patient arrived, I introduced myself and made her feel comfortable and relaxed. The interview was conducted in a conducive environment and she was complaint, she listened attentively to my questions and gave me every detail of her medical information she could remember. There were no hindrances in terms of communication. I had some concerns before the interview, especially the divulging of personal and family information, but she felt at ease and told me everything I needed to know.
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