What would the nurse check when assessing the patient with early to moderate rheumatoid arthritis?

Choice A reason: Compartment syndrome involves increased pressure within a muscle compartment, causing pain, swelling, and neurovascular compromise. It typically presents with localized symptoms like severe pain and paresthesia, not systemic signs like tachycardia, pallor, or confusion. These findings in a humerus fracture suggest a broader complication, making this less likely.

Choice B reason: Deep vein thrombosis (DVT) causes localized swelling, pain, and redness, primarily in the lower limbs. Systemic symptoms like tachycardia or confusion are rare unless DVT progresses to pulmonary embolism. A humerus fracture is less associated with DVT, and the patient’s symptoms point to a more acute, systemic issue.

Choice C reason: Disseminated intravascular coagulopathy (DIC) involves widespread clotting and bleeding, often triggered by sepsis or trauma. While possible in severe trauma, it typically presents with bleeding or bruising, not primarily tachycardia, pallor, and confusion. These symptoms align more closely with fat embolism in the context of a long bone fracture.

Choice D reason: Fat embolism syndrome, common in long bone fractures like the humerus, occurs when fat globules enter the bloodstream, obstructing pulmonary or cerebral vessels. This causes tachycardia, pallor (from hypoxia), and confusion (from cerebral hypoxia). These systemic symptoms match the patient’s presentation, making fat embolism the most likely complication requiring urgent intervention.

Choice A reason: Hepatomegaly is not a typical finding in early to moderate rheumatoid arthritis (RA). It may occur in advanced RA with systemic complications like Felty’s syndrome, but early RA focuses on joint inflammation. Expecting hepatomegaly misguides assessment, potentially overlooking RA’s articular signs critical for early diagnosis and DMARD therapy to prevent joint damage.

Choice B reason: Heberden’s nodes, bony growths at distal interphalangeal joints, are characteristic of osteoarthritis, not RA. RA involves synovial inflammation, causing soft tissue swelling, not bony nodes. Assuming nodes risks misdiagnosis, delaying RA-specific treatments like methotrexate, which target inflammation to prevent progressive joint erosion and deformity.

Choice C reason: Crepitus, a grating sound from joint movement, is more typical in osteoarthritis due to cartilage loss, not early RA, where synovial inflammation dominates. Expecting crepitus misaligns assessment, potentially missing RA’s soft tissue swelling and stiffness, delaying interventions like biologics critical for controlling inflammation and joint destruction.

Choice D reason: Spindle-shaped fingers, from synovial inflammation and swelling in proximal interphalangeal joints, are a classic early to moderate RA finding. This soft tissue swelling reflects autoimmune synovitis, aiding diagnosis. Recognizing this guides timely DMARD or corticosteroid use, reducing inflammation, preventing joint damage, and improving function in RA patients.