Exam 3 - Hinkle Ch. 34, 36, 39, 41

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

1. number of joints involved
2. serology (low positive or high positive rheumatoid factor; antinuclear antibody (ANA))
3. increased ESR and CRP
4. 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