Concept of Immunity, Metabolism, and Mobility SP.pptx - Nursing Lecture Notes PDF

Concept of Immunity: Rheumatoid Arthritis NURS 1250/1610 Victoria Leonetti, MSN, RN Rheumatoid Arthritis Autoimmune disease Chronic, progressive, and systemic Recurrent inflammation of diarthrodial joints Articulating surfaces Marked by periods of remission and exacerbation...

Concept of Immunity: Rheumatoid Arthritis NURS 1250/1610 Victoria Leonetti, MSN, RN Rheumatoid Arthritis Autoimmune disease Chronic, progressive, and systemic Recurrent inflammation of diarthrodial joints Articulating surfaces Marked by periods of remission and exacerbation Pathophysiology Autoimmune disease Targets the synovium Inflammation Overtime= joint deformities & loss of function Recognizing Cues Joint Manifestations: Boutonniere, Ulnar deviation, Swan neck, Nodules Recognizing Cues Early Stage: Generalized weakness; warm, tender, swollen, and painful joints; mild to moderate pain Late Stage: Joint stiffness, chronic pain, muscular atrophy  Recognizing Cue- Exacerbation FEVER LOSS OF FATIGUE SYMMETRICAL APPETITE JOINT (ANOREXIA) DEFORMITY  Diagnostic Studies Laboratory Imaging C-reactive protein X-ray Rheumatoid factor MRI CBC Erythrocyte sedimentation rate Anti-CCP antibodies—anti- cyclic citrullinated peptide test is positive Pharmacotherapy Corticost DMARDs NSAIDs eroids Methotre Etanerce Hydroxychloro xate pt quine Generate Solutions Promote Use assistive exercise Maintain proper devices as balanced with body alignment necessary rest Apply moist Complementary HEAT before / Balanced activity. COLD nonpharmacolo nutrition after activity. gic therapies Surgical Management Arthrodesis- fusion of two or more bones in a joint Synovectomy- removal of the synovial lining in a joint Goals of Patient Care The The patient patient maintain has s joint decreas The mobility The ed pain disease patient process can is participa controlle te d with indepen appropri dently in ate ADL’s interven tions The Concept of Mobility: Osteoarthritis NURS 1250/1610 Victoria Leonetti, MSN, RN Pathophysiology Erosion of joint articular cartilage leads to overgrowth of bone Chronic, painful, and mild swelling Affecting hands and weight bearing joints Recognizing Cues Initial symptom – pain with joint movement Stiffness Crepitus Decreased range of motion (ROM) Recognizing Cues Deformities: Heberden’s node Distal Interphalangeal joints (DIP) Bouchard’s node Proximal Interphalangeal joints (PIP  Analyzing Cues Age – Repetiti Gender 55 and BMI ve – above stress women Work- Weight Genetic related – influenc – poor obesity es posture Analyzing Cues History & physical exam Laboratory 1. CRP (C-reactive protein) 2. ESR (erythrocyte sedimentation rate) 3. Rheumatoid factor- negative 4. Synovial Fluid Imaging 5. X-ray 6. MRI Pharmacotherapy Meditation to control pain/inflammation 1. NSAIDs, acetaminophen 2. Local injections 3. Topical analgesics Take Action: Collaborative Interventions Lifestyle Promote rest Physical Heat and cold Therapy/Exercise Assistive device Improve balance Increase ROM Build muscle Decrease fall risk Surgical Management Arthroplasty: knee (TKA) or hip (THA) Goal: Remove damage, relieve pain, and restore function of the joint  Joint Surgery: Complications Hip Joint Bleedi DVT disloc infecti ng ation on Joint Surgery: Take Action Joint Surgery: Take Action Early Mobilization Assistive devices Continuous passive motion (CPM) Hip precautions Wound care, drain care Take Action: Hip Precautions Avoid adduction and hyperflexion Take Action Use abduction pillow to Continuous passive prevent legs moving motion machine to inward, as well as promote joint mobility keeping them straight. and increase knee Immediately after flexion! surgery we must limit mobility!  Generate Solutions 1 2 3 The patient The patient has The patient does maintains joint satisfactory pain not develop mobility and management complications muscle strength The Concept of Mobility: Gout NURS 1250/1610 Victoria Leonetti, MSN, RN Gout Inflammatory joint disorder resulting from deposition of uric acid crystals in joints Cause: ↑ in uric acid production and under excretion of uric acid by the kidneys Four stages: 1. Hyperuricemia 2. Acute gouty arthritis 3. Intercritical gout Pathophysiology 1 2 3 4 Uric Acid Uric Acid Inflammatio Repeated Builds Crystals n Attacks Can Form Damage Joints Hyperuricemia What happens: What you feel: Risk: Acute Gout Arthritis What happens: What you feel: Risk: Intercritical Gout What happens: What you feel: Risk: Chronic Tophaceous Gout What happens: What you feel: Risk: Analyzing Cues Family history Excessive alcohol consumption Diet Medicines Medical conditions Analyzing Cues Serum uric acid History and Physical levels Synovial fluid 24-hour urine aspiration Pharmacotherapy Take Action: Collaborative Take Action General Solutions TREATMENT PREVENTION PREVENTION OF ACUTE OF FUTURE OF ATTACKS ATTACKS COMPLICATION S The Concept of Metabolism: Osteoporosis NURS 1250/1610 Victoria Leonetti, MSN, RN  Provide safe, patient-centered Provid evidence-based nursing care to adults experiencing stable and e unstable acute and chronic illness guided by the Caritas philosophy Course Learning Demo nstrat Demonstrate intermediate levels of critical thinking and clinical reasoning strategies to provide quality patient Outcome e care s Relate the impact of quality improvement measures to improved Relate patient care in health care microsystems  Use the nursing process as a framework of care for patients with Use alterations in musculoskeletal function Unit List List nursing strategies for the prevention and reduction of risk factors associated with alterations Learning in musculoskeletal function Outcome Discus Discuss medications for patients s with musculoskeletal alterations s Descri Describe the goals for health teaching of patients with be musculoskeletal system alterations Osteoporosis: Overview Chronic, progressive bone disease characterized by low bone mass and deterioration of bone tissue Bone resorption (osteoclast) exceeds bone deposition (osteoblast) “Silent disease” – occurs without signs or symptoms Affects an estimated 54 million Americans Results in about 2 million bone fractures each year Pathophysiology What is normal? Bone remodeling is a continuous process where old bone is removed (resorption) by osteoclasts, and new bone is formed (formation) by osteoblasts. This maintains bone strength and calcium balance.  Pathophysiology What is abnormal? After age 30, pace of osteoclasts outpaces osteoblasts (rate of bone resorption exceeds rate of bone formation)  C – Calcium & Vitamin D A – Age L – Lifestyle Risk C – Caucasian or Asian Factors female I – Inherited (family history) U – Underweight M – Medications Recognizing Cues (signs & symptoms) Loss of height Kyphosis (Dowager’s hump) Low back pain Fragility-related fractures Diagnostic Studies 1. Dual-energy X-ray absorptiometry (DEXA) scan A quick, painless, and noninvasive test that uses low levels of X-rays to measure BMD at various sites in the body, including the hip and spine. DEXA is considered the gold standard for diagnosing osteoporosis and predicting fracture risk. 2. Ultrasound and X-ray 3. Calcium 4. Vitamin D 5. Alkaline phosphate  PHARMACOTHERAPY Bisphosphon Hormonal Calcium & ates Agents Vit D Alendronate Calcitonin Calcium RDA (Fosamax) Produces 1000 – 1200 Inhibits modest mg bone increases in Vit D RDA reabsorptio bone mass 600 – 700 iu n by because it suppressing slows the Surgical Intervention- Vertebroplasty Surgical Intervention- Kyphoplasty Take Action: Collaboration Take Action: Collaboration Assess for risk Educate on ways Teach about factors Smoking to prevent Encourage weight- preventing Enable fall osteoporosis bearing exercises Injury prevention Lifestyle changes Consume foods rich Teach adequate in calcium & vitamin calcium and vitamin D D Smoking cessation  The Concept of Mobility: Fractures NURS 1250/1610 Victoria Leonetti, MSN, RN Fractures SAME pathophysiology as osteoporosis The integrity of the bone or joint has been altered Most common in trauma and older adults Etiology and Risk Factors Pathologic Direct Injury Causes Trauma Neoplasms Abuse Malnutrition Medication Osteoporosis  Fractures are classified based on their characteristics, location, and severity. BONE FRACTURE SEVERITY LOCATION ALIGNMENT LINE PATTERN AND BONE CONDITION Based on Bone Alignment Closed (Simple) Fracture: The bone breaks but does not penetrate the skin. Open (Compound) Fracture: The broken bone pierces through the skin, increasing the risk of infection. Based on Fracture Line Pattern Transverse Fracture: A straight horizontal break across the bone. Oblique Fracture: A diagonal break across the bone. Spiral Fracture: The bone is twisted, causing a spiral-shaped break. Comminuted Fracture: The bone shatters into three or more fragments. Greenstick Fracture: An incomplete fracture where one side Based on Severity and Bone Condition Complete Fracture: The bone is completely broken into two or more parts. Incomplete Fracture: The bone cracks but does not break all the way through. Stress Fracture: A small crack in the bone caused by repetitive force or overuse, common in athletes. Pathological Fracture: Occurs in a bone weakened by disease (e.g., osteoporosis, cancer). Based on Location (examples) Skull Fracture: Involves the bones of the skull. Spinal Fracture: Occurs in the vertebrae and may affect spinal cord function. Hip Fracture: A break in the femur near the hip joint, common in older adults. Long Bone Fracture: Includes fractures of the femur, tibia, humerus, and radius/ulna. Recognizing Cues Pain Edema Deformity FRA CTU Muscle spasm RES Bruising ↓ ROM Crepitus  Hemorrhage Hematoma formation Decreased H&H Deep Venous Thrombosis Analyze Edema Cues: Warmth Pain/cramping Complication Neurovascular s Compromise/Compartment Syndrome Pain Pressure Paralysis Pallor Paresthesia Compartment syndrome Compartment syndrome happens when too much pressure builds up inside a muscle compartment. A compartment is a group of muscles, blood vessels, and nerves surrounded by a tough layer of tissue called fascia, which doesn’t stretch. When there’s swelling (from an injury, like a fracture, or a tight cast), the fascia traps the swelling inside. This pressure can: 1.Cut off blood flow to the muscles and tissues. 2.Damage the nerves and muscles if the pressure isn’t How It Feels or Looks: Severe pain that doesn’t go away, even with medication A tight or swollen limb Numbness or tingling The limb might look pale or feel cool because blood isn’t circulating properly  Pain Pressure Recognizing Cues: Compartment Paralysis Syndrome Pallor Paresthesia Why It’s Serious: Without treatment (like a surgery called a fasciotomy to release the pressure), it can lead to permanent damage, loss of function, or even amputation. Collaborative management: Fasciotomy – fascia is cut to relieve pressure Rest Pain reliever Ice/cold pack  Infection/osteomyelitis Increased temperature Increased WBC Analyze Cues: Fat embolism Complications (syndrome) Neurologic deterioration Respiratory distress Petechiae Tachypnea Fat Embolism: Take Action Collaborative management: Careful immobilization of patient Encourage deep breathing exercises O2 therapy Volume expander Fractures: Diagnostics History and physical exam X-ray, CT, MRI CBC If surgery indicated, additional testing: Complete metabolic panel Coags Urinalysis (UA) EKG  Rest Keep limb stationary Ice Take Action: reduces the pain of inflammation Immediate Intermittent application for 24-48 Nursing hours Compression Management Reduces swelling and assists with immobilization Elevation Reduces swelling Take Action: Treatments Fractures Treatment Goal: Restore Function Fixation- Reduction immobilizat Prevent - anatomic ion of bone secondary bone until complicatio realignmen healing ns t occurs Fractures: Collaborative Treatment Closed reduction (Non-surgical, manual realignment of bone) Cast or Splint Traction Open reduction (Surgery) Internal fixation External fixation Cast or Splint Cast Rigid device used to immobilize, support, and protect fractured bones & surrounding tissue Applied to a stable fracture after it has been reduced Splint Less support Easily adjusted to accommodate swelling & prevent compartment syndrome Often used to stabilize fresh injuries before the swelling has subsided After the reparative phase of healing to allow some movement of the joint Take Action: Cast Care  Perform neurovascular assessment  Expose a newly applied cast to air circulation.  Never permit the wet cast to rest directly on a flat or firm surface  Elevate the casted extremity  May use blow dryer on low, COOL setting for itching  Observe all edges and check for integrity of the cast  Apply ice for first 24-36 hours Traction Straighten bones & maintains alignment with pressure Slowly/ gently pulls fracture or dislocated body part Do not change tenson without order Open Reduction and Internal Fixation During reduction the bone is correctly aligned Hardware is inserted into the bone to hold the bone in place Plates are attached on the outer surface External Fixation Used to set bone fractures in which a cast would not allow proper alignment of the fracture. Metal pins and screws are placed into the bone above and below the fracture Pins and screws are then attached to a metal bar outside of the skin This is often performed if damage to soft tissue prevent internal fixation Take Action: Collaborative Treatment Pain Infection Physical Therapy Management/Ph Prevention armacotherapy Encourage safe Sterile dressing NSAIDs mobility! changes Opioid Antibiotics Analgesics Pin care Muscle Relaxants Steroids Non- Treatment Evaluation Healing occurs Pain Neurovascu (bones adequately lar status realignment controlled intact and remodeling) Function No signs of restored infection