rheumatoid arthritis involves inflammation of the joints. A membrane called the synovium lines each of your movable joints. When you have rheumatoid arthritis, white blood cells — whose usual job is to attack unwanted invaders, such as bacteria and viruses — move from your bloodstream into your synovium. Here, these blood cells appear to play an important role in causing the synovial membrane to become inflamed (synovitis).
This inflammation results in the release of proteins that, over months or years, cause thickening of the synovium. These proteins can also damage cartilage, bone, tendons and ligaments. Gradually, the joint loses its shape and alignment. Eventually, it may be destroyed.
Some researchers suspect that rheumatoid arthritis is triggered by an infection — possibly a virus or bacterium — in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that create an increased susceptibility are. People who have inherited these genes won't necessarily develop rheumatoid arthritis. But they may have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited. Some researchers also believe that hormones may be involved in the development of rheumatoid arthritis.
Risk factors
The exact causes of rheumatoid arthritis are unclear, but these factors may increase your risk:
§ Getting older, because incidence of rheumatoid arthritis increases with age. However, incidence begins to decline in women over the age of 80.
§ Being female.
§ Being exposed to an infection, possibly a virus or bacterium, that may trigger rheumatoid arthritis in those with an inherited susceptibility.
§ Inheriting specific genes that may make you more susceptible to rheumatoid arthritis.
§ Smoking cigarettes over a long period of time.
Signs and symptoms
The signs and symptoms of rheumatoid arthritis may come and go over time. They include:
§ Pain and swelling in your joints, especially in the smaller joints of your hands and feet
§ Generalized aching or stiffness of the joints and muscles, especially after sleep or after periods of rest
§ Loss of motion of the affected joints
§ Loss of strength in muscles attached to the affected joints
§ Fatigue, which can be severe during a flare-up
§ Low-grade fever
§ Deformity of your joints over time
§ General sense of not feeling well (malaise)
Rheumatoid arthritis usually causes problems in several joints at the same time. Early in rheumatoid arthritis, the joints in your wrists, hands, feet and knees are the ones most often affected. As the disease progresses, your shoulders, elbows, hips, jaw and neck can become involved. It generally affects both sides of your body at the same time. The knuckles of both hands are one example.
Small lumps, called rheumatoid nodules, may form under your skin at pressure points and can occur at your elbows, hands, feet and Achilles tendons. Rheumatoid nodules may also occur elsewhere, including the back of your scalp, over your knee or even in your lungs. These nodules can range in size — from as small as a pea to as large as a walnut. Usually these lumps aren't painful.
In contrast to osteoarthritis, which affects only your bones and joints, rheumatoid arthritis can cause inflammation of tear glands, salivary glands, the linings of your heart and lungs, your lungs themselves and, in rare cases, your blood vessels.
Although rheumatoid arthritis is often a chronic disease, it tends to vary in severity and may even come and go. Periods of increased disease activity — called flare-ups or flares — alternate with periods of relative remission, during which the swelling, pain, difficulty sleeping, and weakness fade or disappear.
Swelling or deformity may limit the flexibility of your joints. But even if you have a severe form of rheumatoid arthritis, you'll probably retain flexibility in many joints.
RHEUMATOID ARTHRITIS NURSING INTERVENTIONS
Assess joints carefully.
Look for deformities, contractures, inability to perform ADL, and immobility.
Monitor vital signs.
Monitor changes of weight.
Assess sensory disturbances.
Assess level of pain.
Monitor duration of stiffness and not the intensity to determine when to perform ROM.
Observe for pressure ulcers – with traction and wearing splints.
Encourage patient to perform ADL at the level of activity.
Provide emotional support.
Teach patient how to stand, walk, or sit correctly upright and erect.
collaborative:
a) Bed rest during acute pain
b) Passive ROM exercises of joints
c) Splint painful joints
d) Heat and cold application – cold application during acute pain; 20 minutes at a time.
e) Warm bath in the morning. To relieve morning sickness.
f) Protect from infection
g) Well-balanced diet
h) Physical therapy
i) Surgery:
· Osteotomy –surgical removal of a wedge from the joint
· Synovectomy – removal of synovia
· Arthroplasty – replacement of joints with prostheses.
· Pharmacotherapy
v Aspirin – mainstay of treatment, has both analgesic and anti inflammatory effects.
v NSAIDS:
§ Indomethacin (Indocin)
§ Phenylbutazone (Butazolidin)
§ Ibuprofen (Motrin)
§ Fonoprofen (Nalfon)
§ Naproxen (Naprosyn)
§ Sulindac (Clinoril)
v Gold compounds (chrysotherapy)
§ Injectable form: sodium thiomalate (Myochrysine)
Aurothioglucose (Sulganal); given IM once a week; takes 3-6 months to become effective.
§ Oral form: auranofin (Ridaura); smaller doses are effective; diarrhea is a common side effect.
v Corticosteroids (intra-articular injections)
Friday, March 6, 2009
GOUT NURSING INTERVENTIONS
Gout is an inflammation in your joint resulting from an accumulation of urate crystals. Uric acid is a waste product formed from the breakdown of purines. These are substances found naturally in your body as well as in certain foods, especially organ meats — such as liver, brains, kidney and sweetbreads — and anchovies, herring, asparagus and mushrooms.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much or excretes too little of this acid. In that case, uric acid can build up, forming sharp, needle-like crystals (urate) in a joint or surrounding tissue that cause pain, inflammation and swelling.
Crystal deposits also cause another condition, known as false gout (pseudogout). But rather than being composed of uric acid, pseudogout crystals are made of calcium pyrophosphate dihydrate. And while pseudogout can affect the big toe, it's more likely to attack large joints such as your knees, wrists and ankles.
Risk factors
The following conditions or circumstances can increase the chances you'll develop high levels of uric acid that may lead to gout:
§ Lifestyle factors. Excess consumption of alcohol is a common lifestyle factor that increases the risk of gout. Excess alcohol generally means more than two drinks a day for men and more than one for women. Gaining 30 pounds or more than your ideal weight during adulthood also increases your risk.
§ Medical conditions. Certain diseases make it more likely that you'll develop gout. These include untreated high blood pressure (hypertension) and chronic conditions, such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
§ Certain medications. The use of thiazide diuretics — used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone a transplant.
§ Genetics. About one out of five people with gout has a family history of the condition.
§ Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop symptoms after menopause.
Signs and symptoms
The signs and symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:
§ Intense joint pain. Gout usually affects the large joint of your big toe but can occur in your feet, ankles, knees, hands and wrists. The pain typically lasts five to 10 days and then stops. The discomfort subsides gradually over one to two weeks, leaving the joint apparently normal and pain-free.
§ Inflammation and redness. The affected joint or joints become swollen, tender and red.
GOUT NURSING INTERVENTIONS
Advise change of lifestyle.
Encourage bed rest.
Encourage and facilitate drinking of plenty of fluids.
Record intake and output accurately.
Advise patient to avoid foods rich in purine
organ meats
shellfish
legumes
sardines
salted anchovies
mushrooms
herring
sweetbreads
consomme
beer / wine
Encourage weight loss after initial attack of gout.
Collaborative:
a) Acute attack – colchicines (discontinue if diarrhea or nausea and vomiting occur)
NSAIDS – indocin, butazolidin
b) Prevention – uricosuric agents
· Probenecid (Benemid), Sulfinpyrazone (Anturane), increase renal excretion
of uric acid.
· Allopurinol (Zyloprim) inhibits uric acid formation.
· Encourage fluids to 2,000 to 3,000 cc/day when giving antigout drugs to
Prevent formation of kidney stones.
Normally, uric acid dissolves in your blood and passes through your kidneys into your urine. But sometimes your body either produces too much or excretes too little of this acid. In that case, uric acid can build up, forming sharp, needle-like crystals (urate) in a joint or surrounding tissue that cause pain, inflammation and swelling.
Crystal deposits also cause another condition, known as false gout (pseudogout). But rather than being composed of uric acid, pseudogout crystals are made of calcium pyrophosphate dihydrate. And while pseudogout can affect the big toe, it's more likely to attack large joints such as your knees, wrists and ankles.
Risk factors
The following conditions or circumstances can increase the chances you'll develop high levels of uric acid that may lead to gout:
§ Lifestyle factors. Excess consumption of alcohol is a common lifestyle factor that increases the risk of gout. Excess alcohol generally means more than two drinks a day for men and more than one for women. Gaining 30 pounds or more than your ideal weight during adulthood also increases your risk.
§ Medical conditions. Certain diseases make it more likely that you'll develop gout. These include untreated high blood pressure (hypertension) and chronic conditions, such as diabetes, high levels of fat and cholesterol in the blood (hyperlipidemia), and narrowing of the arteries (arteriosclerosis).
§ Certain medications. The use of thiazide diuretics — used to treat hypertension — and low-dose aspirin also can increase uric acid levels. So can the use of anti-rejection drugs prescribed for people who have undergone a transplant.
§ Genetics. About one out of five people with gout has a family history of the condition.
§ Age and sex. Gout occurs more often in men than it does in women, primarily because women tend to have lower uric acid levels than men do. After menopause, however, women's uric acid levels approach those of men. Men also are more likely to develop gout earlier — usually between the ages of 40 and 50 — whereas women generally develop symptoms after menopause.
Signs and symptoms
The signs and symptoms of gout are almost always acute, occurring suddenly — often at night — and without warning. They include:
§ Intense joint pain. Gout usually affects the large joint of your big toe but can occur in your feet, ankles, knees, hands and wrists. The pain typically lasts five to 10 days and then stops. The discomfort subsides gradually over one to two weeks, leaving the joint apparently normal and pain-free.
§ Inflammation and redness. The affected joint or joints become swollen, tender and red.
GOUT NURSING INTERVENTIONS
Advise change of lifestyle.
Encourage bed rest.
Encourage and facilitate drinking of plenty of fluids.
Record intake and output accurately.
Advise patient to avoid foods rich in purine
organ meats
shellfish
legumes
sardines
salted anchovies
mushrooms
herring
sweetbreads
consomme
beer / wine
Encourage weight loss after initial attack of gout.
Collaborative:
a) Acute attack – colchicines (discontinue if diarrhea or nausea and vomiting occur)
NSAIDS – indocin, butazolidin
b) Prevention – uricosuric agents
· Probenecid (Benemid), Sulfinpyrazone (Anturane), increase renal excretion
of uric acid.
· Allopurinol (Zyloprim) inhibits uric acid formation.
· Encourage fluids to 2,000 to 3,000 cc/day when giving antigout drugs to
Prevent formation of kidney stones.
MENINGITIS
Meningitis is an infectious process of the central nervous of the central nervous system caused by bacteria and viruses that may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections.
Diagnosis is made by testing CSF obtained by lumbar puncture, which shows increased pressure, cloudy CSF, high protein, and low glucose.
Meingococcal meningitis occurs in epidemic form and is the only readily transmitted by droplet infection from nasopharyngeal secretions.
Viral meningitis is associated with viruses such as mumps, paramyxovirus, and enterovirus.
Transmission
Transmission is by direct contact, including droplet spread.
Transmission occurs in areas of high population density, crowded living areas, and prisons.
Assessment
Mild lethargy
Memory changes
Short attention span
Personality and behavior changes
Severe headache
Generalized muscle aches and pains
Nausea and vomiting
Fever an chills
Tachycardia
Deterioration in the level of consciousness
Photophobia
Signs of meningeal irritation such as nuchial rigidity and positive Kernig’s sign and Brudzinski’s sign
Red, muscular rash with meningococcal meningitis
Abdominal and chest pain with viral meningitis
Interventions
Monitor vital signs and neurological signs
Assess for signs of increasing ICP
Initiate seizure precautions.
Monitor for seizure activity
Monitor for signs of meningeal irritation
Perform cranial nerve assessment
Assess peripheral vascular status
Maintain isolation precautions as necessary with bacterial meningitis.
Maintain urine and stool precautions with viral meningitis.
Maintain respiratory isolation for the client with pneumococcal meningitis
Elevate the head of the bed 30 degrees, and avoid neck flexion and extreme hip flexion
Prevent stimulation and restrict visitors
Administer analgesics as prescribed
Administer antibiotics as prescribed
Meningitis is an infectious process of the central nervous of the central nervous system caused by bacteria and viruses that may be acquired as a primary disease or as a result of complications of neurosurgery, trauma, infection of the sinus or ears, or systemic infections.
Diagnosis is made by testing CSF obtained by lumbar puncture, which shows increased pressure, cloudy CSF, high protein, and low glucose.
Meingococcal meningitis occurs in epidemic form and is the only readily transmitted by droplet infection from nasopharyngeal secretions.
Viral meningitis is associated with viruses such as mumps, paramyxovirus, and enterovirus.
Transmission
Transmission is by direct contact, including droplet spread.
Transmission occurs in areas of high population density, crowded living areas, and prisons.
Assessment
Mild lethargy
Memory changes
Short attention span
Personality and behavior changes
Severe headache
Generalized muscle aches and pains
Nausea and vomiting
Fever an chills
Tachycardia
Deterioration in the level of consciousness
Photophobia
Signs of meningeal irritation such as nuchial rigidity and positive Kernig’s sign and Brudzinski’s sign
Red, muscular rash with meningococcal meningitis
Abdominal and chest pain with viral meningitis
Interventions
Monitor vital signs and neurological signs
Assess for signs of increasing ICP
Initiate seizure precautions.
Monitor for seizure activity
Monitor for signs of meningeal irritation
Perform cranial nerve assessment
Assess peripheral vascular status
Maintain isolation precautions as necessary with bacterial meningitis.
Maintain urine and stool precautions with viral meningitis.
Maintain respiratory isolation for the client with pneumococcal meningitis
Elevate the head of the bed 30 degrees, and avoid neck flexion and extreme hip flexion
Prevent stimulation and restrict visitors
Administer analgesics as prescribed
Administer antibiotics as prescribed
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