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signs and symptoms of R.A.
fever, malaise, stiffness, swelling, nodules
Sjögren’s Syndrome
associated with R.A.
Rheumatoid Factor
An antibody found in ~80% of RA patients An antibody which can bind to other antibodies
Sed Rate (ESR)
Confirms inflammation or infection anywhere in body
NSAIDs used in R.A
use with caution
Plaquenil
common s/e is retinal damage
Methotrexate
Cytoxan
Imuran
Azulfidine
Prednisone
How can we teach a client with R.A to manage fatigue?
–  Anemia –  Pace activities –  Depression –  Sleep hygiene
What is uric acid?
Uric acid is a waste product formed from the breakdown of purines
Foods high in purines
organ meats (liver, brains, kidney), anchovies, herring, mackerel.
Primary Gout
Results from elevated serum uric acid Inborn error in purine metabolism OR Decrease in renal uric acid excretion
Secondary Gout
Results from another disorder such as malignancy OR Treatment with certain medications such as diuretics, TB drugs, low-dose ASA.
Phase 1 (p. 415) Asymptomatic Hyperuricemia
No symptoms Client may not progress to symptomatic disease Uric acid levels elevated to 9-10 range
Normal uric acid levels
3-6
What is uric acid?
Uric acid is a waste product formed from the breakdown of purines
What foods have high levels of purine?
organ meats (liver, brains, kidney), anchovies, herring, mackerel
How does primary gout result?
elevated serum uric acid
How does secondary gout develop?
Results from another disorder such as malignancy OR Treatment with certain medications such as diuretics, TB drugs, low-dose ASA
Normal Uric acid levels
3-6
Phase 1 of Gout Asymptomatic Hyperuricemia
Uric acid levels elevated to 9-10 range...no symptoms
Phase 2Acute Gouty Arthritis
Sudden onset, acute pain, redness, swelling Usually hits the big toe, may affect another joint Fever, chills Elevated WBC, sed rate “Attack” lasts hours to weeks 60% have recurrent attack in 1 yr
Phase 3 “Intercritical”
Period of time between first attack and subsequent attacks Asymptomatic
Phase 4 Chronic Tophaceous Gout
Hyperuricemia untreated Tophi (urate crystals deposits) develop in cartilage, synovial membranes, tendons, soft tissues Pain, ulceration, nerve damage Uric acid crystals—>kidney stones
Diagnosis of Gout
Serum uric acid WBC, Sed Rate Renal studies Analysis of joint aspirate
Allopurinol
used for prevention of future gout attacks
Indocin
Herniated Nucleus Pulposis
Lumbar HNP
back pain and sciatica
Herniated Intervertebral Disk Symptoms
Leg pain   Parasthesias   Muscle weakness   Bowel, bladder problems
Osteomyelitis (p. 1172) Pathophysiology
Bone inflammation secondary to infection   Ischemia  bone necrosis and/or abscess   Many infections   are caused by Staphylococcus
Causes of Osteomyelitis
Exogenous Endogenous (hematogenous) Contiguous
Risks for osteomyelitis
Trauma (penetrating) Malnutrition, alcoholism Renal, liver, immune diseases Compromised vascular supply
Chronic Osteomyelitis Trauma (penetrating) Malnutrition, alcoholism Renal, liver, immune diseases Compromised vascular supply
skin ulceration Drainage Low grade fever Localized pain
Treatment for Osteomyelitis
Difficult to treat! Long-term IV antibiotics Hyperbaric Oxygen Surgical procedures Nursing Interventions Administer pain meds Administer antibiotics Maintain affected limb in functional position       Provide high calorie, high protein diet Prevent contractures Maintain wound precautions Immobilize affected extremity
Signs/Symptoms of fractures
Pain Loss of function Deformity Visible contraction of attached muscle Crepitus Swelling and discoloration
Factors Which Promote Bone Healing --- Local
Good emergency care and fracture setting Immobilization of broken bone Ice to reduce swelling
Factors Which Promote Bone Healing --- Systemic
Ca++, Vitamin D, Growth Hormone Adequate Blood Supply Young and Active No Infection
Manifestations of Fractures
Pain Swelling Deformity Numbness Hematoma Formation Muscle spasm
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