RA with Joint Arthroplasty HESI case study
Increasing fluid intake after a bone scan will help with elimination of the injected radioisotope. Terry should also be instructed that because the dose of radioisotope is minimal, no special precautions are necessary.
Because the incidence of RA in persons with a positive family history is significantly greater than for the general population, genetic predisposition is probably a significant etiologic factor. In addition, increased stress has been linked to RA, and viral infections are believed to be a trigger for the onset of this autoimmune disease.
Joint deformities and subcutaneous nodules are common in advanced RA. A persistent low-grade fever is a common early manifestation of this inflammatory disease. Remember, RA is both a local and systemic inflammatory disease with many generalized symptoms such as fever, fatigue, and weakness, along with multiple lung, cardiac, and renal manifestations.
Symptoms of aspirin toxicity include tinnitus, confusion, weakness, GI bleeding, and diarrhea.
Decreased levels of neutrophils place the client at high risk for infection. The client with neutropenia should be instructed to institute measures to avoid infections.
Need essay sample on "RA with Joint Arthroplasty HESI case study" ? We will write a custom essay sample specifically for you for only $12.90/page
Heat applications will increase blood supply to the joints, decrease pain, and increase mobility. Cold applications may also be used, primarily for acute pain flare-ups.
Joint splints provide rest and support for the joints while maintaining good anatomical alignment.
This is an important nursing intervention. Clients experiencing a high level of stress may need guidance to solve even simple problems. In addition, support groups are often beneficial for clients coping with chronic disease.
Clarification of Terry’s feelings is a therapeutic technique which will encourage further communication.
Making a client-focused suggestion offers Terry an alternative without being confrontational or belittling.
Arthroplasty is the term used for total joint replacement. Hip replacement is the most common joint arthroplasty, followed by knee replacement. Clients with rheumatoid arthritis may also benefit from elbow, wrist, or finger arthroplasty.
A drainage device, such as a Hemovac or Jackson-Pratt suction device, is put in place during surgery. The nurse should monitor the amount and nature of the drainage, and report excessive or abnormal drainage to the surgeon. In addition, the nurse should assess the surgical compression dressing, and mark any areas of drainage on the dressing.
Paresthesia is an abnormal sensation such as numbness or tingling that may indicate neurovascular compromise. Following any trauma or invasive procedure of a lower extremity, adequacy of neurovascular function distal to the site must be assessed regularly. This includes assessment for the six Ps: Pulselessness, Pain, Pallor, Paresthesia, and Paralysis, as well as Prolonged (> 3 seconds) capillary refill.
Terry needs to know that the lockout feature prevents an overdose of the analgesic, since this is often a fear that prevents adequate analgesia. However, the nurse will still need to monitor Terry for indications that the prescribed dose is not excessive.
The nurse should always assess the client first because pain may indicate a complication that requires medical intervention.
This is an activity that can be delegate to a UAP. Activities delegated to a UAP should fall within the intervention component of the nursing process, and should not require the expertise of a licensed nurse.
A physician’s assistant (PA), working in collaboration with a physician, may legally prescribe medications.
This prescription is incomplete and requires clarification from the prescriber. Remember the five rights: right client, drug, dose, rout, and time. The PRN frequency (right time) is missing from this prescription. A correct medication prescription includes not only the five rights, but also the prescriber’s signature and the date and time written.
Further assessment of Terry’s condition is the highest priority. The nurse should first assess Terry’s vital signs and the appearance of the surgical dressing.
Terry is exhibiting symptoms of sepsis. Infection is a significant postoperative problem following joint replacement. Wound and blood cultures should be obtained, antipyretics administered, and cooling packs applied to reduce the fever.
Early signs of shock include agitation and restlessness resulting from cerebral hypoxia. The nurse should assess carefully for these early symptoms. Other manifestations may include pallor, diaphoresis, hypotension, tachypnea, and tachycardia.
50 mL/30 minutes = X mL/60 minutes
300 = 30X
X = 100 mL/hr
The best method to evaluate that a skill has been learned is by the performance of a return demonstration by the client.
Correct positioning includes the arms flexed at no more than 30 degrees, with the tops of the crutches 2-3 finger-widths from the axilla when the crutch tips are at least 6 inches in front of the foot.