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what is RA?
an autoimmune disease characterized by alteration in the synovial membranes/tissues of the joints, as they are destroying themselves
RA - signs and symptoms
symmetric joint pain, swelling, warmth, erythema, lack of function
spongy/boggy joints on palpation
joint deviation (depending on where fluid is building up)
deformities of feet/hands
fever, weight loss, fatigue, anemia, lymph node enlargement, Raynaud’s phenomenon
nodule formation (advanced RA)
4 parameters for diagnosing RA
number of joints involved
serology (low positive or high positive rheumatoid factor; antinuclear antibody (ANA))
increased ESR and CRP
symptoms lasting longer than 6 weeks
what type of drug is used to treat RA? example of this drug?
disease modifying anti-rheumatic drugs (DMARDs)
ex = Plaquenil (hydroxychloroquine)
RA - nursing management
focus on pain/fatigue management
help fix altered moods, sleep patterns, decreased ADLs and other things
prevent any sort of falls that may occur (move objects out of the way/clear a path)
enforce non-slip socks
gout - what is it?
increased uric acid levels in the blood that exhibit themselves around the joints
gout - is it autoimmune?
YES
gout - gold standard for diagnosing
aspiration of uric acid crystals!!!!!
gout - signs and symptoms
pain
redness
inflammation
boggy feeling when palpated
acute gouty arthritis, tophi, gouty neuropathy
which joint is the most common for gout?
BIG TOE!!
gout - causes
hyperuricemia
ingestion of a high amount of sweets at ONE TIME (usually around halloween!!!)
excessive intake of alcohol, shellfish, and purine (from red meats, such as liver)
gout - nursing education
decrease intake of purines, alcohol, and shellfish
do NOT ingest too much sweets in one sitting
take your medications!!
avoid activities that could lead to potential trauma
gout - medications (HINT: short term and long term)
Colchicine (for acute gout attacks; decreases uric acid levels)
can given the patient diarrhea after a few days, after which you would discontinue this medication and replace it with allopurinol, which is suited for Longterm use
low back pain - acute vs. chronic
acute = lasting FEWER than 3 months
chronic = 3 months or longer
low back pain - prevention
weight reduction as needed
stress reduction
avoid high heels
walk daily and gradually increase the distance and pace of walking
avoid jumping or jarring activities
stretch to enhance flexibility; do strengthening exercises
low back pain - body mechanics
practice good posture
avoid twisting, lifting above waist level, and reaching up for any length of time
push objects rather than pull them
keep load close to your body when lifting
lift with the large leg muscles, not the back muscles
squat while keeping the back straight when it is necessary to pick something off the floor
bend your knees and tighten abdominal muscles when lifting
avoid overreaching or a forward flexion position
use a wide base of support
low back pain - what does self-limiting mean?
means it can resolve on its own
hiatal hernia - what is it?
the opening in the diaphragm through which the esophagus passes becomes enlarged, and part of the upper stomach moves up into the lower portion of the thorax
hiatal hernia - signs and symptoms
dysphagia
regurgitation
gastric pain/fullness
early satiety
potential hemorrhage, obstruction, volvulus, and strangulation
hiatal hernia - nursing education
advise NOT to recline for 1 hour after eating
elevate HOB on 4-8in blocks to prevent the hernia from sliding upward
enforce surgical intervention if symptomatic (laparoscopic approach)
advance diet slowly after surgery; provide small feedings
GERD - what is it?
backflow of gastric substances into the esophagus, causing injury and damage
GERD - signs and symptoms
burning
dyspepsia (indigestion)
regurgitation
dysphagia
pain
GERD - lifestyle modifications
tobacco cessation
limiting alcohol
weight loss
elevating the HOB
avoiding eating before bed (at LEAST 2 hours before)
altering the diet
decrease intake of fats, caffeine, peppermint/spearmint, carbonated beverages, and spicy foods
GERD - medications
Pepcid (Zantek)
protonix
PPIs
GERD - if medications are unsuccessful, what can you do?
SURGICAL INTERVENTION!!!!
barrett esophagus - what is it? what does it cause the increase risk for?
a condition in which the lining of the esophageal mucosa is altered, due to repeated injury from gastric acid
this has a very increased risk of turning into malignant cancer
which bacterium is very influential in the formation of gastric ulcers?
h. pylori!!!!!!
constipation - what is it?
LESS than 3 bowel movements in a week and/or bowel that is hard to pass
constipation - risk factors
pregnant women
advancing age
low fiber diet in patients
sedentary lifestyle/obesity
opioid usage
constipation - treatments
laxatives
increase fiber intake (25-30g/day)
bowel strengthening exercises (biofeedback)
use of enemas (if medications are not successful)
constipation - prevention
recognizing the physiology of defecation and the importance of responding to the urge to defecate
understand normal variations in patterns of defecation
establish BOWEL ROUTINE!!
ensure proper dietary habits (FIBER FIBER FIBER!!)
increase muscle strength (strengthen bowels; increase ambulation)
use normal bearing down position
avoid OVER USE or long-term use of stimulant laxatives
diarrhea - what is it?
greater than 3 bowel movements per day/with discomfort
3 classifications of diarrhea
acute (1-2 days)
persistent (2-4 weeks)
chronic (greater than 4 weeks)
diarrhea - risk factors
malabsorption disorders (lactose intolerance, celiac disease)
use of specific medications (antibiotics, antiarrhythmic agents, and others)
C. diff infection
any conditions that cause increased intestinal secretions, decreased mucosal absorption, or altered motility (such as IBS)
advancing age
diarrhea - treatments
medications (antibiotics, anti-inflammatory agents, antidiarrheal agents)
provision of vitamins, complex carbs, and fluids
diverticular disease - what is it?
outpouching of mucosa (saclike herniations located primarily in the large intestine that have BECOME INFLAMED)
diverticular disease - signs and symptoms
LLQ pain
fullness
constipation/diarrhea
inflammation
fever
change in bowel
bloating
nausea
rectal bleeding
diverticular disease - what is the diagnostic test most suitable?
COLONOSCOPY!!! permits visualization of the extent of the disease
diverticular disease - nursing management
DIET!!! (2L of fluid a day; foods with increased fiber (such as cereal/vegetables)
encourage exercise to promote increase in bowel/abdominal strength
avoid triggers of the disease (such as consumption of nuts/popcorn, as they can get into the herniations)
Crohn’s disease vs. Ulcerative Colitis (what are they? where do they occur?)
Crohn’s disease - acute inflammation of ALL the layers of the intestinal wall ANYWHERE in the GI tract (distal ileum in most common)
Ulcerative Colitis - ulceration/inflammation of LARGE INTESTINE in only the mucosal/submucosal layers
Crohn’s disease vs. Ulcerative Colitis (pain location)
Crohn’s = RLQ pain
UC = LLQ pain
Crohn’s disease - signs and symptoms
bleeding
F/E loss
diarrhea
emaciation
lack of absorption
RLQ pain
Ulcerative Colitis - signs and symptoms
diarrhea
LLQ pain
rectal cramping (intermittent)
bleeding (may cause pallor, anemia, and fatigue depending on how much)
anorexia/weight loss
fever
vomiting
dehydration
Ulcerative colitis - 1 complication
may need to get a colectomy (removal of part of the large intestine)
Crohn’s disease - complications
malnutrition
dehydration/ F/E imbalance
possibly may need a resection