NUR 229 Lecture Notes - Lecture 16: Erythrocyte Sedimentation Rate, Rheumatoid Arthritis, Septic Arthritis
21 May 2018
School
Department
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Professor
CVA & Parkinson’s: NUR 229 (4/17/18)
In Class Notes
Osteoarthritis: Degenerative joint disease where the cartilage wears down; occurs with
weight-bearing joints
1. Risk Factors: Increase in age, previous joint damage due to trauma, repetitive use of
joints, being overweight/obese
2. Clinical Manifestations: Pt. will complain of intermittent (constant pain but every
once in a while it will get worse) steady pain that is relieved with rest, stiffness,
asymmetrical, tenderness, enlarged joints; if you have chronic pain that interferes
with ADLs, you may need to get a partial/total replacement
a. Bouchard: proximal interphalangeal joints
b. Heberden: distal interphalangeal joints
3. Medical Management
a. Weight reduction: Want the pt. to lose weight
b. Exercise: Walking, biking, swimming, etc.
c. Medications
i. Analgesics: Used to control pain
ii. Corticosteroids: Used to reduce inflammation
4. Nursing’s Role: Assess for pain: do they have good pain control? Do they need to be
put on around the clock analgesics?
a. Goal: Keep the patient at the highest level of functioning as possible
b. Safety: Keep the environment safe because if the patient falls, they can break
their bones or worsen their joints, promote ROM, education patient on plan
of care
Rheumatoid Arthritis: Autoimmune disease that causes systemic inflammation in the joints,
the body ends up attacking its own tissues; can occur in children/young adults; at risk for
developing septic arthritis
1. Risk Factors: Autoimmune don’t know cause, does affect females more than males
because it is related to sex hormones
2. Clinical Manifestations: Joint pain, swelling, erythema, lack of function at times,
bilateral & symmetric stiffness in joints that lasts + hours and doesn’t let up
continuous stiffness that isn’t relieved with rest, fever, weight loss, may not feel
like eating
3. ***Diagnostic Tests
a. Rheumatoid Factor: Measures the amount of rheumatoid factor in the blood;
rheumatoids are proteins produced by the immune system
b. Erythrocyte Sedimentation Rate (ESR): Measures how fast RBC fall into the
bottom of the test tube; measures the degree of inflammation (how bad is the
flare occurring; if it falls fast, then the flare is worse; if it falls slow, they’re in
remission and disease is under control
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c. Arthrocentesis: Aspirate and analyze synovial fluid in the joint via needle if
they suspect septic arthritis; looks at color, clarity, bacteria, increased WBC?
(infection)
d. Septic Arthritis: Infection in bloodstream
i. S&S: )rritability, fever, can’t move affected extremity
ii. Treatment: Patient will get antibiotics and will have to rest the
affected extremity
4. Nursing’s Role:
a. Nutrition: Make sure the patient has a diet that is high in vitamins and
proteins to help with nutrition building;
b. Exercise: Low impact (swimming, biking, walking)
c. Teach patient to monitor S&S of septic arthritis to get treated early
d. Understand medications, if they’re on suppressants they will be at a higher
risk for infections
Osteoporosis: Low bone mass that increases the risk for fractures
1. Risk Factors
a. Modifiable: Low-calcium intake, disuse osteoporosis due to immobility, lack
of sun exposure/Vitamin D
b. Non-modifiable: Female; males when they’re older; thin, small frame
2. Diagnostic Tests
a. Bone Mineral Density: Measures how much bone a person has, have to be at
least 50 yrs. old
b. Calcium Levels: Blood draw checked to see if levels are low
c. X-rays: Bones will appear thinner and lighter
3. Medical Management
a. Diet: High in calcium/Vitamin D (Ex: Milk, green leafy vegetables)
b. Exercise: Weight-bearing exercises (walking)
c. ***Medications
i. Bisphosphonates: Medications taken (either once a week, monthly,
yearly), increase bone mass/loss; if the person is taking it by mouth
they need to take it on an empty stomach with a glass of water and
must sit up for minutes after taking it or else they’ll get
heartburn/ulcer
1. Ex: Boniva, Fosimax, Actinol
ii. Calcium with Vitamin D: Take calcium with Vitamin D
4. Nursing’s Role
a. Educate: The disease will not go away, something they have to live with,
medications can lead to constipation, if they have immobility issues → cause
constipation so increase fiber/fluid, HCP may want to add stool softener
b. Exercise: Make sure to walk, weight-bearing exercises
c. Safety: Want to prevent injury because if the patient falls their bones will
break
i. Wear non-skid socks, carpets instead of hardwood, declutter rooms
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Parkinson’s Disease: Neurological condition that is slow and progresses; leads to
disability; decrease in the levels of dopamine
1. Clinical Manifestations: Anxiety, depression
a. Tremor → Slow, unilateral tremor that goes away when they move
b. Bradykinesia → Active movement that becomes slow
c. Rigidity → In muscles
d. Postural Instability → Head is bent forward and the pt. walks with shuffling gait
2. Diagnostic
a. Cardinal Symptoms: Tremor at rest, Bradykinesia, muscle rigidity; if
someone presents with PD they’ll have a drug challenge prescribed
Levadopa) to see if symptoms get better → if it does, they have PD
b. On-Off Phenomenon: Sometimes the medication the patient is on will stop
working off → symptoms will get worse; then the medication dose will
become increased on; their body could be building up a tolerance so if
they start feeling symptoms, to contact HCP
3. Nursing’s Role
a. Self-Care: Encourage the patient to be as independent as possible; may use
assistive device, have PT or OT working with pt.
b. Bowel Elimination: If someone has a decreased in mobility, it decreases
peristalsis → pt. is at risk for constipation; we need to put them on stool
softener, increase fiber/fluids
c. Nutrition/Swallowing: Risk for aspiration related to dysphagia, they can be silently
aspirating → have speech evaluation, put pt. on a certain diet, thicken their liquids,
relax neck muscles before they eat so it’s easier for them to swallow
d. Psychosocial: Pt. may need to go to a support group, may have
depression/behavioral issues → may need medications, psychologist, etc.
e. Education: Disease process will progressively get worse, educate on
therapeutic regimen (plan of care/goals: keep the patient as independent as
possible), communicate with the patient (address any concerns they have)
Ischemic vs. Hemorrhagic CVA
Ischemic: Blood vessel that supplies blood to the brain is clotted
1. Clinical Manifestations: Headache, dizziness, slurred speech, numbness/tingling on one
side of the body, difficulty walking, vision problems (fuzzy vision), lesion on L side of
brain will affect other side of body; LOOK IN BOOK
2. Assessment/Diagnosis: CAT Scan to figure out if Ischemic/Hemorrhagic, carotid
ultrasound (piece of plaque breaks off carotid artery and travels to the brain); EKG:
Patient may have atrial fibrillation: blood pools, clot may form and go to the brain
3. Risk Factors
a. Non-Modifiable: Advanced age (55+ yrs.), men more than women, race (African
Americans are at more risk
b. Modifiable: Smoking, being overweight, history of HTN, medications (birth control)
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Document Summary
Ischemic: blood vessel that supplies blood to the brain is clotted. Patient may have atrial fibrillation: blood pools, clot may form and go to the brain: risk factors, non-modifiable: advanced age (55+ yrs. Hemorrhagic: bleeding into the brain tissue caused by ruptured aneurysm that occurs due to uncontrolled htn. The ischemic cascade begins when cerebral blood flow decreases to less than 25 ml per 100 g of blood/minute. Patients may present to the acute care facility with temporary neurologic symptoms. A transient ischemic attack is a neurologic deficit typically lasting 1- The initial diagnostic test for a stroke is usually a non-contrast computed tomography (ct) scan that is performed within 25 minutes: prevention: primary prevention of ischemic stroke remains the best approach. A healthy lifestyle including not smoking, engaging in physical activity, maintaining a healthy weight, and following a healthy diet can reduce the risk of having a stroke.
