A male client with type 1 diabetes mellitus (DM) develops a gangrenous toe and is admitted for possible amputation. Which pathophysiological consequence of DM has contributed to this client's complication?

Chronic osteoarthritis (OA) is a degenerative joint disease characterized by the breakdown of joint cartilage and underlying bone changes. The pathophysiological process of OA involves various factors contributing to joint pain and inflammation. Here's why option C is the correct choice:

A) Inflammation results from deposition of crystals in the synovial space of joints producing irritation:

This statement is more characteristic of crystal-induced arthritis, such as gout or pseudogout, where crystals (e.g., urate or calcium pyrophosphate crystals) deposit in the joints and cause acute inflammation and irritation. While inflammation may occur in OA, it is primarily a result of mechanical stress and cartilage degradation rather than crystal deposition.

B) Inflammation is caused by immune complex and autoantibody deposition in connective tissue:

This statement is more characteristic of autoimmune diseases such as rheumatoid arthritis (RA), where immune complex deposition and autoantibody production lead to chronic inflammation and joint damage. In OA, inflammation is not primarily mediated by immune complex deposition or autoantibodies.

C) Joint inflammation occurs when chondrocyte injury destroys joint cartilage, producing osteophytes:

Correct. In osteoarthritis, joint inflammation occurs as a result of chondrocyte injury and cartilage breakdown. Over time, the degenerative changes in the joint lead to the formation of osteophytes (bone spurs) at the joint margins. These changes can irritate surrounding tissues, including the synovium, ligaments, and tendons, contributing to joint pain and inflammation.

D) Joint destruction happens due to an autoimmune inflammation involving IgG response to an antigen:

This statement is more characteristic of autoimmune arthritis, such as rheumatoid arthritis (RA), where autoantibodies (e.g., rheumatoid factor, anti-citrullinated protein antibodies) target joint tissues, leading to chronic inflammation and joint destruction. In OA, joint destruction primarily results from mechanical stress and wear-and-tear on the joint structures rather than autoimmune mechanisms.

A) Fatigue and weakness:

Correct. The client's hemoglobin and hematocrit levels are below the reference ranges, indicating mild anemia. Anemia, characterized by low red blood cell count or hemoglobin levels, can lead to symptoms such as fatigue, weakness, and shortness of breath, as the body's oxygen-carrying capacity is reduced. Fatigue and weakness are common manifestations of anemia and are indicative of tissue hypoxia due to decreased oxygen delivery.

B) Cardiac dysrhythmias:

While severe anemia can lead to cardiac complications, such as dysrhythmias, the client's hemoglobin and hematocrit levels are only slightly below the reference ranges, indicating mild anemia. Cardiac dysrhythmias are more commonly associated with severe anemia or acute changes in hemoglobin levels rather than the mild anemia indicated in this scenario.

C) Fever and infection:

Anemia is not typically associated with fever and infection. While anemia may occur secondary to chronic inflammatory conditions or certain infections, the client's symptoms of fatigue and weakness are more directly related to the decreased oxygen-carrying capacity of the blood due to mild anemia.

D) Decreased clotting time:

Anemia is not directly associated with changes in clotting time. While severe anemia can lead to alterations in platelet function and clotting factors, the client's hemoglobin and hematocrit levels are only slightly below the reference ranges, indicating mild anemia. Decreased clotting time is not a typical manifestation of mild anemia.