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under upervised miss Islam AL-shami
Transcript of under upervised miss Islam AL-shami
trigger is viral or bacterial infection .
has articular manifestation that involve chronic chronic inflammation that begin in the synovial membrane and progresses to subsequent damage in the joint cartilage .
some studies suggest tea cause RA
another say it protective from RA .
Drug therapy :
chronic , inflammatory ,autoimmune disease
cause is unknown ,certain gene play role in
our case today
**present case study
saja A. madremah
occur more frequently in woman than in men ,
commonly occur between 20-45 years of age .
choice of drug class and type is based on pt`s response to Med. ,incidence ,severity of illness.
salicylates and NSAIDs commonly used .
DMARDs to slow or prevent joint damage .
, folat antagonism)
gold salt and D-penicillamine therapy
surgery considered if pharmacological and non-pharmacological can not adequately control the pain and acceptable level of function .
joint replacement .
Around the joints
limitations in joint motion
Glucocorticoids ,e.g: prednisone
-Richard jacobs , male, caucasian , 39 yo
-occupation : employment counselor
(M-F 9-6 PM)
- live alone
chief complaint :
-morning stiffness is considerably worse and actually last almost noon .
-weak up during night with pain.
onset disease 5 year ago Dx with RA
type of Tx Motrin 1000mg , prednisone 10mg/day
PMH no significant illness .
family Hx yes
HTN who ? richard`s father
Nutrition Tx :
evaluate his intake by computerized dietary analysis.
abnormal lab value
blood glucose(70-100) 119
uric acid 9.2
(4-9) 9.2 H
ESR 33 (0-15) 33
intake-related nutrition problem.:
* BMI= 21.8 (healthy weight)
*%IBW=current wt/IBW *100%
= 70/78*100% = 90%
*%UBW= current wt/UBW*100%
= 70/75*100%= 93%
>> sever wt loss
** we can use AMA to assess lean body mass.
>> S.f (1.14-1.35)>> suppose it 1.2
>> Activity factor >> 1.1
>> So energy req. =1661*1.3= 2159 kcal
Focus on omega-3 fats & vegetable oil (which is have anti-inflamatory effect).
folic acid supplementation
Vit B12, B6, D & Ca supplementation
appetite fair(hungrier when pain is controlled.
inadequate intake generally and high coffee consumption.
what is kosher Diet
indicate and why loss
all of them WNL ,but
neurological: alter and oriented
mild limitation in motion ,bony enlargement of distal inter phalanges.
-elbow, shoulder ,wrists ,small joint of feet are swelling.
problem and goal ::
difficult in motion
sedentary life style .
muscle loss function .
difficult in shopping and preparing food.
dryness of mouth; xerostomy
total separation of meat and dairy products. Meat and dairy may not be cooked or eaten together.
these diet made meal lack from one basic nutrient .
is more strict and difficult in applied it .
ensure adequate intake by food record
participant in group ,..
case study "for practicing "
The patient is a 34-year-old Caucasian woman her wt is 100 kg , and ht is 170cm who initially presented to her primary care physician with a chief complaint of pain and swelling in multiple joints that made it difficult to carry out her duties as executive assistant to the vice president of a trucking company. She has been experiencing increased morning stiffness and difficulty with simple tasks such as tying shoelaces, buttoning clothes, and typing. The patient's primary care physician discussed the possibility of rheumatoid arthritis (RA) and prescribed 1 month of treatment with a nonsteroidal anti-inflammatory drug (NSAID). This treatment did not reduce the severity of the patient's symptoms and her primary care provider referred her to a rheumatologist.
Her lab test result :
Uric acid 7mg/dl
As RD check this case ?