"this is jane mazloum, i'm a patient of dr. olgivy. i just listened to a phone message from your office about coming in for a checkup. my husband and i were talking about this. since this is my first pregnancy and i am working, we really don't want anyone else to know about it yet. has this information been given to anybody outside the clinic? " how do you recommend that she respond?

Mrs. h, age 42 years, is experiencing severe rheumatoid arthritis in her wrists, fingers, and knees. the joints are quite inflamed, red, and swollen. she is sitting rigidly in a chair and refuses to put on a sweater, even though she is shivering, or let anyone touch her arms. she has been prescribed an analgesic and an anti-inflammatory drug, but her dose is not due for another hour. she is feeling nauseated, so she has not eaten for the past 8 hours. based on patient history and the signs and symptoms, discuss how the effects of pain are exacerbating her condition.