A nursing diagnosis

Case Study #4
B. B. is in for a routine health examination. History elicits complaints of tinnitus and an
increase in the use of aspirin because of joint pain.

  1. What are specific subjective questions you would ask?
  2. What additional physical examinations are required to assist in making a judgment of
  3. Relate expected (normal) findings to the findings described,
  4. Identify at least one relevant nursing diagnosis for any actual or potential problem

Case study

Some of the subjective questions to be asked include the following;

  1. What was the pattern of the joint pain?
    For how long have you experienced the symptoms?
  2. Were the smaller joints affected first?
  3. Was tinnitus experienced after taking asprin?
  4. Which joints do you feel the pain most?
  5. What is your age?
  6. Is there a family history of arthritis?
  7. What other symptoms do you experience?
  8. Were the affected joints injured in the past or recently?
  9. Have the symptoms influenced daily activities such as working, driving, and living?
    So as to make the correct diagnosis, a physical examination will be necessary (Goemaere
    et al., 2012). This involves feeling, looking at, and moving every joint and evaluating it for the
    range of motion, the joints that are affected, presence of fluids in joints, tenderness, warmth,
    swelling, and bumps over the body’s pressure points. Physical findings are vital in diagnosing
    rheumatoid arthritis. In addition, they are used for evaluating the effectiveness of treatments
    (Goemaere et al., 2012).

Normally, physical examinations do not indicate any pattern of symptoms as no joints are
affected. In addition, healthy joints lack tenderness and swelling. In addition, they do not have
swollen, painful, and ‘hot’ points, which is a common feature of similar joints on the body’s both
sides in people suffering from rheumatoid arthritis.
A nursing diagnosis identifies acute pain that is related to injury agents, inflammation,
fluid accumulation, tissue distension, and joint destruction (Goemaere et al., 2012). The acute
pain is mainly evidenced through behavior distraction, focusing on the self, and complaints of
fatigue, discomfort, and pain. A nurse should also assess impaired physical mobility that is
linked to pain, skeletal deformities, activity intolerance, discomfort, and reduced muscle



Goemaere, S., Ackerman, C., Goethals, K., De Keyser, F., Van der Straeten, C., Verbruggen, G.,
& Veys, E. M. (2012). Onset of symptoms of rheumatoid arthritis in relation to age, sex
and menopausal transition. The Journal of rheumatology, 17(12), 1620-1622.