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Grand Case Presentation
Group 1 and 2
This case presentation aims to impart knowledge to the readers about the disease process, anatomy and physiology and to implement a comprehensive nursing care management for Gouty Arthritis.
•To be able to determine the effects of the disease in the human body.Specific Objectives: •To be able to determine the signs and symptoms of gouty arthritis •To be able to determine the precipitating. predisposing and aggravating factors of gouty arthritis. and •To provide a well-formulated discharge plan necessary for the patient’s well being. side effects and adverse effects • To identify the nursing problem of the patient to provide a well-suited nursing care plan for the patient. . •To be able to determine the treatment necessary to cure a person afflicted with this kind of disease • To identify the pharmacologic treatment given to the patient including its therapeutic effect.
GOUTY ARTHRITIS Also known as: the disease of kings It refers to a form of arthritis caused by deposits of needle-like crystals of uric acid. It is one of the most painful rheumatic diseases. It accounts for approximately 5% of all cases of arthritis. .
SIGNS AND SYMPTOMS .
ETIOLOGY Certain conditions related to diet and body weight Medicines that may increase uric acid concentration .
FOUR STAGES OF GOUTY ARTHRITIS •Asymptomatic Hyperurecemia •Acute Gout/Acute Gouty Arthritis •Interval/Intercritical •Chronic Tophaneous Gout .
RISK FACTORS Overweight or Obesity Eating Purine-Rich Foods Excessive Alcohol Intake High Blood Pressure Lead Poisoning Abnormal Kidney Function Family History .Gender – Age Certain Medications Certain Medical Conditions .
CASE ABSTRACT .
. The doctor ordered Colchicine. Arcoxia as some of his curative medications. Operation started at 10:00 AM. and the collection of fluid that was aspirated was 94mL on his right leg and 80mL on his left leg. Following day. Patient was then advised for admission. Medical and nursing management was continuously given after. December 4.Patient X is a 55-year-old male rushed to the emergency room of Los Baños Doctors’ Hospital last December 3. and Uric Acid were conducted in order to determine the disease condition of the patient. Urinalysis. Blood Chemistry. The results showed that he has Gouty Arthritis. The operation ended at 11:00AM and patient was brought back to his room. Hematology. He was then transferred to the Pay Ward with an IVF of PNSS 1L x 31-32gtts/min to run for 8hrs. he has undergone Arthrocentesis for the aspiration of uric acid that has accumulated in his knees. Laboratory tests. 2011. 2011 around 1:54 PM because he couldn’t move his legs due to severe pain in his both knees.
PATIENT ASSESSMENT DATA BASE .
4:00 pm •Attending Physician: Dr. both •Vital Signs: Temp: 36.R: 76cpm BP: 140/90 mmHg .HEALTH HISTORY •Patient: X •Birthday: 09-11-56 • Age: 55 years old •Address: Bambang. 1:54 pm •Date of Discharge and Time: 12-07-2011. T •Initial Diagnosis: Acute Gouty Arthritis •Final Diagnosis: Gouty Arthritis •Source of History: Patient • Reliability of Historian: Reliable • Chief Complaint: Painful Knee.5 °C R. Los Banos. Laguna •Religion: Catholic •Sex: Male •Nationality: Filipino •Civil status: Married •Rank in the Family: Father •Admission Date and Time: 12-03-2011.R: 25bpm C.
The doctor order to have a laboratory tests of blood chemistry and urinalysis. 2011 at 1:54pm. He was advised for an admission and was immediately hooked with an IVF of PNSS 1Lx31-32gtts/min to run for 8 hours. He was given a standing order medication of arcoxia. He became weak. As the pain progresses it became severe that he can no longer bear it. 120mg OD and colchicine. Parecoxib was also ordered as PRN for pain. patient was experiencing joint pain on both knees. and can hardly sleep. He was then brought to the ER of Los Banos Doctors Hospital and Medical Center on December 3. loses his appetite.HISTORY OF PRESENT ILLNESS Four days prior to admission. He was advised for arthrocentesis the following day. 1 tab OD. Result of arthrocentesis was 94ml on right knee and 80ml on left knee .
His tophi on both of his elbows were then removed through excision. 200mg TID for maintenance and Arcoxia for pain reliever. 2011. He has no known allergies for any drugs and foods.PAST HEALTH HISTORY August 2008 when patient was diagnosed with gouty arthritis. . he was hospitalized due to recurrence of joint pain. He was given an allopurinol. On March 19. When the patient is relieved with pain after 3 or 4 days. A year after. he suddenly stops his medication. he was confined and treated at Healthserv Medical Center for the same medical diagnosis of gouty arthritis.
FAMILY HISTORY OF ILLNESS Patient X has three siblings and he is the eldest. His father has arthritis and his mother has a heart disease. His sister is hypertensive but the youngest brother has no known illness. . They have a history of arthritis. His grandmother on his father side died of a kidney disease and has also a history of arthritis. He has two children but no known illnesses.
Developmental Task .
He has his work in IRRI. stagnation. While stagnation is when the relationships or goal change. In the period of Generativity strength comes through care of others. Patient X got the moral support and strength from his family and loving children. and if we don’t get through this stage successfully. we can become stagnant. .His developmental task according to Erik Erickson is generativity vs. maybe forced with major life changes.the mid-life crisis and struggles with finding new meanings and purposes. where he has good friends around him and hang out with him.
FUNCTIONAL HEALTH PATTERN .
he drinks alcohol often especially during Friday night out to unwind himself from his work together with his officemates. he usually follows the doctor’s order but when he feels better after a few days.Health Perception and Health Management Pattern According to the patient. He does not usually finish his medication regimen. . He then realized how important it is to finish the course of treatment. When given a medication. he stops the medications. He also smoked 5 sticks of cigars a day or can be increased if he is under stress.
Nutritional and Metabolic Pattern
According to the patient, his typical foods to eat are monggo and string beans. He sometimes make the monggo bean as his rice and rice as his viand. He also loves to eat dinuguan, boiled camote, tuna, grilled liempo, and innards. He is a drinker, he drinks four times weekly.He loses weight after he experiences the recurrence of joint pain. He has a diet restriction of low purine, low salt, and low fat.
According to the patient, he defecates at least once a day and urinates several times. He has no difficulty in urination and defecation. His stool color is dark brown and soft formed.
The patient works as a research technician at IRRI. He has a sedentary lifestyle; he does not have any routine exercise. On weekends, he usually spend his time with his family, sometimes they go to the mall. During confinement, the patient has no physical activity. He can’t do whatever he wants, and has seen very limited range of motion especially in his lower extremities.
Feeding Bathing Toileting Bed Mobility Dressing = = = = = 0 2 2 2 2 Grooming General Mobility Cooking Home Maintenance Shopping = = = = = 2 3 4 1 4
Legend: Level 0 Level 1 Level 2 Level 3 Level 4
- Full self care - Requires use of equipment or device - Requires assistance or supervision from another person - Requires assistance or supervision from another person or device - is dependent and does not participate
sometimes around 8:30pm or 11:00pm and wakes up at 5:30 am. But whenever the pain attacks him. . he can hardly sleep at night.Sleep-Rest Pattern The patient sleeps randomize.
Cognitive-Perceptual Pattern The patient has no hearing difficulty. Joint pain is the only factors that affect his activities of daily living. . He wears reading eyeglasses and he is a near-sighted. He has a good memory and can recall past events clearly.
Self-Perception and Self-Concept Pattern The patient states that he is very anxious and irritable whenever pain attacks him. . He believed that his condition is a part of aging process.
He doesn’t have any problems regarding his family affairs since his two children are all educated and stable. . He has a good relationship with his co-workers but he often misses to work lately because of his hospitalization. They have their own house and his wife is usually in-charge of the household chores.Role-Relationship Pattern The patient’s family structure is nuclear. His eldest son is working abroad and his youngest son is living with them and is currently working.
2011. . he gradually decreases his alcohol drinking habit but not smoking.Coping-Stress Tolerance Pattern The patient took his medications whenever he feels pain. He also knows of his diet restrictions but still he continues to eat it. After the excision of his tophi on March 19.
their belief in God becomes even stronger.Value-Belief Pattern The first time when patient learned of his condition. They rely everything to Him and believe in miracles He do. .
PHYSICAL ASSESSMENT .
2011 (12pm) 36. 2011 Time assessed: 8:00 a.04.m. A. General Survey Received patient lying in bed with IVF of PLR 1L for 24 hours.Date assessed: Dec.2011 Temperature: 36. 04.4 C 24 cpm Dec. he is in pain (10/10) and irritable and upon observation patient X looks pale and weak with rapid shallow breathing. Vital Signs Dates: Dec 03.5 C 25 cpm Respiratory Rate: Pulse Rate: 76 bpm 140/90 mmHg Blood Pressure: Dec 04.9 C 19 cpm Dec 05. (+) swelling on his both knees.6 C 19 cpm 81 bpm 130/80 mmHg 80 bpm 89 bpm 140/100 mmHg 130/80 mmHg .2011 36.2011 (8am) 36.
there’s no presence of dandruff and lice. His skin is rough and dry as noted.) •Hair: Upon inspection. Blanche test was performed and capillary refill was 4-5 seconds (1-2 sec. . He has scar in both elbow with the length of 2. Patient X has a pale light brown complexion. intact nailbed and pale in color. uniform in color except those areas exposed to the sun. •Nails: His fingernails and toenails are concave and short. Patient’s X hair is evenly distributed with smooth. INTEGUMENT •Skin: Upon inspection. short. no presence of infestations and no lesions. and thick black hair with minimal white hair.B.5 inches.
He can able to read but most likely to wear reading eyeglasses. he can recognize to any sound. • Mouth/Throat/Pharynx/Teeth/Tongue: Upon assessment. masses and tenderness. symmetry and contour. • Ears: Smooth and soft to touch. and auricle aligned with outer canthus of eye. Ears also recoil. Tongue is positioned in the center.HEENT • Head: Upon inspection. Facial features are symmetrical. No nodules. Symmetrical upon inspection. • Nose: Smooth to touch. No presence of any discharge. its color is the same as his color of the skin. Air moves freely as the client breathes through nares. He is nearsighted. . he has a round with smooth skull contour. no noted sores and gums. • Eyes: Patient X’s eyebrow is fairly distributed. eyelashes are slightly short and curl. Nasal septum is intact and in midline. no presence of any discharge and deformities. patient’s lips are pale in color. no noted discharge. He can recognize good and bad smell. His eyes are black in color and pale conjunctiva.
No evidence of enlargement of the spleen or liver. has intact skin. • Musculo-Skeletal/ Extremities: Upper: Upon inspection. Thorax: Spine is vertically align. he has a normal heart sound and normal heart rate and regular rhythm. • Abdomen: Abdomen circumference is 120 cm. no noted lesion. • Cardiovascular: Upon auscultation. Upon performing the range of motion. There’s a rapid and shallow breathing. Neurological: Upon assessment. Chest circumference is about 95cm. Chest excursion was done and noted equal expansion of chest on both sides. Patient X was very irritable and just focusing on his pain being . there’s metacarpophalengeal joints. Abdomen is symmetric in contour. the score was 2/5 • felt. No nodes palpable. no palpable lymph nodes. Has an audible bowel sound. a presence of tophi in patient’s both Lower: The patient has a (+) swelling on both knees.• • Neck/Lymph Nodes: No noted lesions.
ANATOMY AND PHYSIOLOGY .
uric acid could not be able to excrete in the body.Predisposing Factors: Age: 55years old Gender: Male (9:1)unction Hereditary Precipitating Factors: Diet (monggo.5mg/dL) . alcohol drinker) Excessive amount of protein is ingested Proteins are converted into purine The end product of purine is Uric Acid But because of decrease functional level of the kidney. tuna) Lifestyle (smoking. Therefore. stringbeans. there would be an increase amount of Uric Acid HYPERURECEMIA (Uric Acid = 10.
bradykinin – causes swelling of the joints Mediators cause capillaries to dilate Dilation causes the skin to become red REDNESS Causes pain to knee PAIN and SWELLING on both knees GOUTY ARTHRITIS . prostaglandin. leukotrienes.Monosodium urate crystals in tendons. joints (metacarpophalangeal joint) ACCUMULATION OF TOPHI Triggers Local Inflammatory Response Release of Chemical Mediators Histamine.
5 – 5.3 NORMAL VALUES M – 14-16 mg/dl F – 12.30 12..14 mg/dl M ..52 cv/L F . HEMATOLOGY HEMOGLOBIN HEMATOCRIT WBC RBC RESULT 9..I.42 ..6 .900 3.5 x 10 12/L DIFFERENTIAL COUNT SEGMENTERS LYMPHOCYTES MONOCYTES 80 20 3 55-65 % 20-40 % 2-8 % .47 cv /L 5 – 10 x 10 9/L M – 5.5 – 6.5 x 10 12/L F – 4.37 .
002-1.30 Negative Negative 0-2 / hpf RBC EPITHELIAL CELLS AMURATES 6-8 / hpf Some Negative 0-2 / hpf Negative Negative .URINALYSIS COLOR TRANSPARENCY REACTION SPECIFIC GRAVITY SUGAR ALBUMIN PUS/WBC RESULT Light yellow Slightly hazy 6.5 1.010 Negative Trace 3-5 NORMAL VALUES 5-7 1.
5 mg/dl NORMAL VALUES 0. COMPLETE BLOOD COUNT (CBC) RESULT CREATININE BLOOD URIC ACID 2mg/dL 10.7 mg/dl M : 3.5 – 6.0 mg/dl F: 2.0 mg/dl INTERPRETATION Slightly increased Elevated purine deposits in the blood or hyperurecimia .III.4 – 7.5 – 1.
DRUG STUDY .
* Stop the medication immediately if gastrointestinal lesions occur. who has heart dse. * Monitor blood pressure regularly while taking this medication. 6 prostaglandin pm synthesis by decreasing enzyme needed for biosynthesis. ankles or feet high blood pressure dizziness insomnia drowsiness mouth ulcers . . * Drink adequate fluid to avoid dehydration. Caution for those pt. Congestive heart failure Patients with hypertensio n Pregnancy feeling sick (nausea).DRUG/CLASSI DOSAGE/RO FICATION UTE OF ADMINISTRA TION/FREQU ENCY Generic Name: Etoricoxib Brand Name: Arcoxia ACTION CONTRAINDI CATION SIDE EFFECTS NURSING CONSIDERATION Inhibits 120 mg. OD.analg esic and antiinflammatory INDICATION Relief of chronic musculoskele tal pain Relief of acute pain To treat acute gouty arthritis Patients with hypersensiti vity to any component of Arcoxia. vomiting heartburn diarrhea swelling of the legs.
diarrhea.DRUG/CLASSI DOSAGE/RO FICATION UTE OF ADMINISTRA TION/FREQU ENCY Generic Name: Goutnil Brand Name: Colchicine ACTION CONTRAINDIC SIDE ATION EFFECTS NURSING CONSIDERATION Inhibits 1 tab. vomiting anorexia malaise peptic ulcer hematuria oliguria. before and during therapy. chills. OD. Contraindic ated in pregnancy. hepatic Cardiac disorders. . PO. diarrhea. abdominal pain. INDICATION For the treatment of acute flares of gout. vomiting. renal. Monitor I&O ratio observe for decrease in urine output. which decreases phagocytosis and inflammation in joints. dermatitis Assess pain and mobility of joints. nausea. CBC. microtubule 6 pm formation of lactic acid in leukocytes. hypersensiti vity serious GI. weakness. may cause Assess for toxicity.
. magnesium and phosphate. TID. Amino Acids 8-1-6 Brand Name: Ketosteril ACTION CONTRAINDIC ATION SIDE EFFECTS NURSING CONSIDERATION Normalizes metabolic process.DRUG/CLASSI DOSAGE/RO FICATION UTE OF ADMINISTRA TION/FREQU ENCY Generic Name: Essential 1 tab. promotes recycling product exchange. PO. INDICATION Protein energy malnutrition. Reduces ion concentration of potassium. vity to any content of this drug Hypercalce mia Evaluate for any contraindications Warn the patient about possible side effects and how to recognize them Give with food if GI upset occurs Frequently assess for hypercalcemia. Allergy and Hypercalcemia hypersensiti may develop.
which are involved in the synthesis of prostaglandins and thereby reduce pain and inflammation. and DOB >Misc: back pain. heart failure. >Drink adequate fluid to avoid dehydration.O For moderate Non-steroidal pain. disturbed sleeping. rash. severe liver impairment. Generic name: Parecoxib Brand name: Dynastat Dosage: 40mg.PRN Route: P. itching. antiinflammatory drug(NSAIDs) Action: NSAIDs inhibit cyclooxygenas e enzynes . and hypersensitivity. high /low blood pressure. decrease urine output . >Contraindicated in patients with inflammatory bowel disease. >GI: Ulcer and gastrointestin al bleeding. >Skin: swelling. peptic ulcer. >Monitor blood pressure regularly while taking this medication. agitation. >Heart: slow heart rate.Drug Classification Indication Contraindications Side effects Nursing Considerations >Caution for those patient with heart disease.
TID Route: P. >Be alert for adverse reaction and drug interaction. >Give drug with or immediately after meals to minimize adverse GI reactions. >Skin: Rash. Diarrhea. >Have patients drink plenty of fluid while taking drug.O . Contraindicatio ns >Contraindicated in patients hypersensitivity to drug and in those with idiopathic hemochromatosis . and pain before and during therapy. unless contraindicated Generic name: Allopurinol Brand name: Aloprim Dosage: 200mg.Home Medications Drug Classification Anti-gout Action: Alleviates gout symptoms Indication >To prevent gouty attack.vomiting. >Monitor fluid intake and output. abdominal pain. Nursing Considerations >Assess patient’s uric acid level. joint stiffness. Side effects >CNS: drowsiness and headache >GI: Nausea .
abdominal pain >Musculoskele tal: Hypertonia >Skin: sweating. anticipate need for laxative therapy. >Give drug before the onset of intense pain. >If respiratory rate decreases or falls below 12bpm. constipation. dry mouth. centrally acting analgesic. >Monitor CV and respiratory status.Drug Classification Indication Contraindications Analgesic Moderate Action: to severe Unknown.O Nursing Considerations >Assess patients pain before starting therapy and regularly thereafter to monitor the drug effectiveness. >Use cautiously in patients at risk for seizures or respiratory depression. vertigo. >Contraindicated in patients hypersensitive to the drug or any of its component and in those with a cute intoxication from alcohol. Generic name: Tramadol Brand name: Ultram Dosage: 500mg. sleep disorders and seizure.tab Route: P. opioids. >GI: Nausea. Confusion. nervousness. rash. diarrhea. >Because constipation is a common adverse effect. or psychotropic drugs. >EENT: visual disturbances. malaise. dyspepsia. pain. >Tell ambulatory patient to be careful when getting out of bed. . with hold dose and notify physician. headache. hypnotics. anxiety. centrally acting synthetic analgesic compound not chemically related to opioIds that is though to bind to opioids receptors and inhibit re uptake of norephineprine and serotonin. Side effects >CNS: Dizziness. >Be alert for adverse reactions and drug interactions. vomiting. >Monitor patient for drug dependence.
Extravas Before giving the ation loading dose. emia order regarding Electrolyt the type of IVF to e be used and also imbalanc its volume and e rate. q8 CLASSIFICATION INDICATION CONTRAINDICATION Administered to prevent dehydration for patient who cannot consume liquids and nutrients by mouth and sue as a solvent for drugs that are to be administered parenterally Isotonic ACTION: Replace body fluids and is the safest fluid to give quickly in large volumes SIDE NURSING EFFECTS PRECAUTIONS Not known Fever Check and verify contraindication Hypervol the Doctor’s . B..P. and electrolytes Maintain sterility when preparing and administering the medication Document the procedure and note the patient’s reaction . Infection obtain the at the baseline data injection (heart rate and site rhythm.IV FLUIDS PNSS Plain Normal Saline Solution iL x 3132gtts/min .
USP is indicated as a source of water and electrolytes or as an alkalinizing agent.5 (alkalotic). Do not administer simultaneously with blood through same administration set because of the likelihood of coagulation. Not known contraindicatio n . laryngeal edema coughing.IV FLUIDS Plain Lactated Ringer’s Solution iL x 24 hr CLASSIFICATI INDICATION CONTRAINDICATI ON ON Isotonic ACTION: Isotonic hydration. don’t give lactated ringer’s soloution. SIDE EFFECTS urticaria pruritis. replace electrolytes and extra-cellular fluid losses. If patient’s serum is above 7. mild to moderate acidosis (the lactate is metabolized into bicarbonate which counteracts the acidosis Lactated Ringer’s Injection. sneezing difficulty of breathing NURSING PRECAUTIONS Observe for fluid overload.
patient’s subjective perception of pain will decreases. frequency and aggravating factors. Objective: o Pain scale of 10/10 o Pale looking o Facial Grimace o Guarding Behavior o Redness and Swelling of the affected area. quiet environment and calm activities. repositioning. . Patient will feel more comfortable. absence of irritability. onset/duration.Assessment Subjective: “Sobrang sakit ng tuhod ko. as documented by a pain scale from 10 to 7. >Distracts attention and reduce tension. >Promotes nonpharmacological pain management. Patient’s descriptive assessment of pain decreases from 10 to 7.“ as verbalized by the patient. Rationale >Rule out worsening of underlying condition/development of complications. Evaluation Goal met. There is absence of facial grimace and patient can interact with others without irritability seen. facial grimace and guarding behavior. Reassess each time pain occurs/is reported. o Irritability o Aspirated 94mL in the R leg and 80mL in the L leg after arthrocentesi s o Changes in vital signs BP: 140/90 RR: 25 PR: 76 Diagnosis Acute pain related to deposition of urate crystals as evidenced by aspirated uric acid in the joint of both knee Planning After series of nursing intervention. >Provide comfort measures such as therapeutic touch. >Instruct in use of relaxation techniques such as focused breathing. Intervention INDEPENDENT: >Obtain client’s assessment of pain to include characteristics.
Assessment Diagnosis Planning Intervention >Encourage diversional activities such as watching TV or listening to radio and socialization to others. >Instruct patient to report pain as soon as it begins. >Relaxation decreases oxygen demand and could decrease level of pain. >Analgesic drugs lessen the pain. DEPENDENT: >Administer Arcoxia (120 mg OD) as prescribed by the physician. Evaluation . > To control the amount of protein digested in the body. Rationale >Divert attention from pain. Collaborative: > Collaborate with the dietician regarding the Low Purine Diet >Discuss with the health team concerning the Blood Chemistry. >It permits the health team to see if there is deviation in normal values. >Timely intervention is more likely to be successful in alleviating pain. >Facilitate coordination across healthcare providers to provide rest periods between care activities.
RATIONALE EVALUATION Goal Met. As verbalize by the patient. excessive noise in life.”.ASSESSMENT SUBJECTIVE: “ Hindi ako makatulog sa gabi sa sakit. disorientation) Distinguish client’s beneficial bedtime habits. restlessness. Determine client usual sleep pattern Observe physical signs of fatigue (frequent yawning. Suggest abstaining from day time naps. NURSING INTERVENTION INDEPENDENT: Note environmental factors affecting sleep. . Patient was able to report improvement in sleep and rest patter with a pain scale of 7/10. including sleep environment. irritability. Provide comparative baseline in sleeping patterns They impair ability to sleep at night. OBJECTIVE: Severe pain in the joints of the knee with a pain scale of 10/10 Body weakness Restlessness Irritability DIAGNOSIS Sleep disturbance related to joint pains PLANNING After 1 day nursing interventio n the patient will report improvem ent in sleep and rest pattern.
Instruct in relaxation technique music therapy Limit evening fluid intake RATIONALE EVALUATION To reduce stimulation so client can relax To decrease tension and prepare patient for rest and sleep To reduce need for night time elimination Provide calm and quite environment and manage controllable sleepdisturbing factors. DEPENDENT: Administer (Arcoxia 120 mg OD) pain reliever To reduce pain . and listening to soothing in the evening.ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTION Recommend quite activities such as reading.
maintain optimal function mobility and increase strength of affected body part. OBJECTIVE: Severe pain in the joints of the knee with a pain scale of 10/10 Limited range of motion Difficulty turning SUGGESTED FUNCTIONAL LEVEL CLASSIFICATION : 2.”. with the degree of independence. roller pads Support affected body parts/joints using pillows/rolls.ASSESSMENT SUBJECTIVE: “ Hindi ko maigalaw ang paa ko. . NURSING INTERVENTION After 2 INDEPENDENT: days of Encourage nursing verbalization intervention regarding . Goal Partially Mobility is not met. patient will limitations in attain and mobility.“ as verbalized by the patient. move his stiffness and both feet. To maintain position of function and reduce risk of pressure ulcers. supervision or teaching. The strength of degree of mobility affected body is not synonymous part. Decreased mobility may influence a person’s selfconcept and lead to social isolation.Requires help from another person for assistance. Pain. RATIONALE EVALUATION Instruct in use of side rails. fatigue may and gradually temporarily limit increases mobility. Patient necessarily related can slightly to deformity. For position changes/transfers. DIAGNOSIS PLANNING Impaired Physical Mobility related to joint pain. As verbalize by the patient.
DIAGNOSIS PLANNING NURSING INTERVENTION Encourage participation in self-care. Position the joint in mild flexion during acute attack DEPENDENT: Administer Arcoxia as ordered by the physician RATIONALE EVALUATION Enhances selfconcept and sense of independence To permit lement in maximal effort/involvemen t in activity. .ASSESSMENT . Provide bed rest during the acute attacks with the affected extremity elevated Monitor joint range-ofmotion ability and appearance of joints. gradually. occupational/diversional/ recreational activities such as sitting with less support by others. And dangling activity while sitting on the side of the bed.
DIAGNOSIS Activity in tolerance related to joint pains NURSING INTERVENTION After 2 days INDEPENDENT: of nursing Note client intervention. able to fatigue. supervision or teaching.36. Patient can slightly move his both feet. and gradually increases strength of affected body part but still needs assistance.ASSESSMENT SUBJECTIVE: “ Nahihirapan ako tumayo kaya kailangan ko ng katulong.76 BP. pain. reports of patient will be weakness. A certain ability to stand and move about and degree of assistance PLANNING RATIONALE EVALUATION Goal Partially met.25 PR. Symptoms maybe result or contribute intolerance of activity To determine current status and needs associated with participation in needed or desired activities .” As verbalize by the patient OBJECTIVE: Vital signs: T. intolerance.5 RR.140/90 Limited range of motion Body weakness Pain scale of 10/10 SUGGESTED FUNCTIONAL LEVEL CLASSIFICATION: 2.Requires help from another person for assistance. identify difficulty in techniques to accomplishing enhance task and activity insomnia.
ASSESSMENT DIAGNOSIS PLANNING NURSING INTERVENTION RATIONALE EVALUATION Adjust patient’s activities. Reduce intensity level or discontinue activities that may cause undesired physiologic changes Balance rest period Provide positive atmosphere while acknowledging difficulty of the situation of the client Assist client in learning demonstrating appropriate safety measures To prevent over exertion To reduce fatigue Helps minimize frustration and rechannel energy To prevent injury .
DISCHARGE PLANNING .
500mg tab for 7 days qid Allopurinol. especially the medications as ordered by the doctor.Medication 1. Encourage the patient to continue taking his medications. 200mg tab for 7 days tid Encourage the patient to exercise and when he exercise include range of motion to reduce stiffness of the joints and improved mobility of the joints Encourage the patient to follow faithfully the regimen for gouty arthritis. Encourage the patient to exercise every morning Encourage the patient to eat low purine and low fats Encourage the patient to stop drinking alcohol drinks Encourage the patient to increase his fluid intake Encourage the patient about the follow up on: December 14 2011 at OPD of Los Baños Doctors Hospital a The diet as ordered should be low in purine and low in fats Always pray for the guidance of the lord in spiritual health affects the wellness of an individual greatly. 2. Had undergone arthrocentesis to relieve the pain in both knees. Encourage the patient to take his medication on right time as prescribe for faster recovery. Take home meds: Tramadol. Straighten relationship with lord by showing love and respect to the other people around you and your family Exercise Treatment Health Teaching Out Patient Follow Up Diet Spiritual .
Thank you!! .