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 Hypertension  Cigarette smoking  Record baseline blood g.

Importance of routine follow-

According to World Health  Hypercholesteremia pressure in three position up
Organization, hypertension  Increased sodium intake ( lying, sitting, standing) and
is persistent elevation of the in both arms.
systolic blood pressure above  Continuously assess blood Cardiac Arrest
140 mmHg and a diastolic pressure and report any  Sudden, unexpected
above 90 mmHg. Medical Management variables that relate to cessation of breathing and
 Diet and weight management changes in blood pressure adequate circulation of blood
Types reduction. (restricted, kcal, ( positioning, restlessness) by the heart.
 Essential( primary,idiopat cholesterol)  Administer antihypertensive
hic): marked by loss of  Life style changes: alcohol agents as ordered: monitor Medical Management
elastic changes in the aorta moderation, exercise closely and assess for side  Cardiopulmonary
and larger vessels coupled regimen, cessation of effects. resuscitation (CPR)
with decreased caliber of the smoking  Monitor intake and hourly  Defibrillation (electrical
artrioles.  Antihypertensive drug outputs. countershock)
 Benign: a moderate rise in therapy  Provide client teaching and  Drug therapy
blood pressure marked by a discharge planning a. Lidocaine,
gradual onset and prolonged Assessments concerning procainamide,verapamil
course.  Pain similar to anginal pain: 1. Risk factor identification b. Dopamine, isoproterenol,
 Malignant: characterized by pain in calves after and norepinephrine
a rapid onset and short ambulation or exercise development/implementation c. Epinephrine to enhance
dramatic course with a ( intermittent claudication) : of methods to modify them. myomardial automaticity,
diastolic blood pressure of severe occipital 2. Restrict sodium, kcal, excitability, conductivity and
more than 150mmHg. headaches, particularly in cholesterol diet; include contractility.
the morning; polyuria, family in teaching. d. Atropine sulfate to reduce
 Secondary: Elevation of the 3. Antihypertensive drug
blood pressure as a result of nocturia, fatigue, dizziness; vagus nerve’s control over
epistaxis; dyspnea on regimen: the heart, thus increasing the
another disease as such renal a. Names, actions, dosages, and
parenchymal ds, Cushing’s exertion. heart rate
 Blood pressure consistently side effects of prescribed e. Sodium Bicarbonate:
ds, pheochromocytoma, medications,.
primary aldosteronism, above 140mmHg/90mmHg, administered during first few
retinal hemorrhages and b. Take drugs at regular times moments of a cardiac arrest
coarctation of the aorta. and avoid omission of any
exudates, edema of to correct respiratory and
extremities (indicative of doses. metabolic acidosis.
 Essential hypertension usually c. Never abruptly discontinue
occurs between ages and right-sided heart failure). f. Calcium Chloride: calcium
the drug therapy
50: more common in men  Rise in systolic blood pressure ions help the heart beat more
d. Supplement diet with
over 35, women over 45; from supine to standing effectively by enhancing the
potassium-rich food if taking
African-American men position ( indicative of myocardium’s contractile
potassium-wasting diuretics.
affected twice as often as essential hypertension) force.
e. Avoids hot baths, alcohol, or
white men/women. strenuous exercise within 3
Diagnostic Test Assessments
hours of taking medications
Risk factors  Elevated serum uric acid  Unresponsiveness
that cause vasodilation
 Positive family history  Sodium f. Development of a graduated  Cessation of respiration
 Obesity  Cholesterol levels exercise programs  Pallor
 Stress  Cyanosis
Nursing Interventions
 Absence of hear beat sounds/  4. Post-menopausal  Provide adequate dietary
blood pressure/ palpable  5. Genetics- caucasian and supplement of calcium and
pulses asian vitamin D  DEGENERATIVE JOINT
 Dilation of pupils  6. Immobility  Instruct to employ a regular DISEASE
program of moderate
Nursing Interventions exercises and physical
ASSESSMENT FINDINGS  The most common form of
 Perform CPR  1. Low stature activity
degenerative joint disorder
 2. Fracture  Manage the constipating side-
effect of calcium supplements  Chronic, NON-systemic
 Common  Femur disorder of joints
Musculoskeletal  Take calcium supplements
 3. Bone pain
with meals
conditions  Take alendronate with an
 Nursing management LABORATORY FINDINGS Pathophysiology
EMPTY stomach with water
 METABOLIC BONE DISORDERS  1. DEXA-scan  Injury, genetic, Previous
 Instruct on intake of
Osteoporosis  Provides information joint damage, Obesity,
Hormonal replacement
 A disease of the bone about bone mineral Advanced age à Stimulate
characterized by a decrease density the chondrocytes to
2. Relieve the pain
in the bone mass and density  T-score is at least 2.5 release chemicalsà
 Instruct the patient to rest
with a change in bone SD below the young chemicals will cause
on a firm mattress
structure adult mean value cartilage degeneration,
 Suggest that knee flexion will
 2. X-ray studies reactive inflammation of
cause relaxation of back
Osteoporosis: Pathophysiology the synovial lining and
 Normal homeostatic bone Medical management of bone stiffening
Osteoporosis  Heat application may provide
turnover is alteredà rate of comfort
bone RESORPTION is greater  1. Diet therapy with calcium OSTEOARTHRITIS: Risk factors
and Vitamin D  Encourage good posture and
than bone FORMATIONà body mechanics
 1. Increased age
reduction in total bone  2. Hormone replacement  2. Obesity
therapy  Instruct to avoid twisting and
massà reduction in bone heavy lifting  3. Repetitive use of joints with
mineral densityà prone to  3. Biphosphonates- previous joint damage
FRACTURE Alendronate, risedronate  4. Anatomical deformity
3. Improve bowel elimination
produce increased bone mass
 Constipation is a problem of  5. genetic susceptibility
by inhibiting the OSTEOCLAST
calcium supplements and
Osteoporosis: TYPES  4. Moderate weight bearing OSTEOARTHRITIS: Assessment
 1. Primary Osteoporosis- exercises findings
 Advise intake of HIGH fiber
advanced age, post-  5. Management of fractures  1. Joint pain
diet and increased fluids
menopausal  2. Joint stiffness
 2. Secondary osteoporosis- 4. Prevent injury  3. Functional joint
Steroid overuse, Renal failure  Instruct to use isometric impairment limitation
Osteoporosis Nursing Interventions exercise to strengthen the  The joint involvement is
RISK factors for the development of trunk muscles ASYMMETRICAL
Osteoporosis 1. Promote understanding of
osteoporosis and the treatment  AVOID sudden jarring,  This is not systemic, there is
 1. Sedentary lifestyle bending and strenuous lifting
regimen no FEVER, no severe
 2. Age  Provide a safe environment swelling
 3. Diet- caffeine, alcohol, low
Ca and Vit D
 Atrophy of unused  Use of Fatigue, emotional stress, cold,  Rheumatoid nodules may
muscles PARACETAMOL, infection be found in the
 Usual joint are the WEIGHT NSAIDS  Rheumatoid arthritis subcutaneous tissues
bearing joints  Use of Glucosamine Pathophysiology
and chondroitin  Immune reaction in the Diagnostic test
OSTEOARTHRITIS: Assessment  Topical analgesics synovium à attracts  1. X-ray
findings  Intra-articular steroids neutrophils à releases  Shows bony erosion
1. Joint pain to decrease inflam enzymes à breakdown of  2. Blood studies reveal (+)
 Caused by collagen à irritates the rheumatoid factor,
 Inflamed synovium OSTEOARTHRITIS: Nursing synovial liningàcausing elevated ESR and CRP and
 Stretching of the joint Interventions synovial inflammation ANTI-nuclear antibody
capsule  1. Provide relief of PAIN edema and pannus formation  3. Arthrocentesis shows
 Irritation of nerve  Administer prescribed and joint erosions and synovial fluid that is cloudy,
endings analgesics swelling milky or dark yellow
 Application of heat containing numerous WBC
2. Stiffness modalities. ICE ASSESSMENT FINDINGS and inflammatory proteins
 commonly occurs in the PACKS may be used  1. PAIN
morning after awakening in the early acute MEDICAL MANAGEMENT
 2. Joint swelling and stiffness-
 Lasts only for less than 30 stage!!! SYMMETRICAL, Bilateral  1. Therapeutic dose of
minutes  Plan daily activities NSAIDS and Aspirin to
 3. Warmth, erythema and
 DECREASES with movement when pain is less reduce inflammation
lack of function
 Crepitation may be elicited severe  2. Chemotherapy with
 4. Fever, weight loss,
 Pain meds before methotrexate, antimalarials,
anemia, fatigue
OSTEOARTHRITIS: Diagnostic exercising gold therapy and steroid
 5. Palpation of join reveals
findings  2. Advise patient to reduce  3. For advanced cases-
spongy tissue
1. X-ray weight arthroplasty, synovectomy
 6. Hesitancy in joint
 Narrowing of joint space  Aerobic exercise  4. Nutritional therapy
 Loss of cartilage  Walking GOLD THERAPY:
 Osteophytes  3. Administer prescribed ASSESSMENT FINDINGS  IM or Oral preparation
2. Blood tests will show no evidence medications  Takes several months (3-6)
 Joint involvement is
of systemic inflammation and are not  NSAIDS before effects can be seen
useful  Can damage the kidney and
 Characteristically beginning in
causes bone marrow
the hands, wrist and feet
OSTEOARTHRITIS: Medical Rheumatoid arthritis  Joint STIFFNESS occurs early
management  A type of chronic systemic morning, lasts MORE than 30 Nursing MANAGEMENT
 1. Weight reduction inflammatory arthritis and minutes, not relieved by 1. Relieve pain and discomfort
 2. Use of splinting devices to connective tissue disorder movement, diminishes as the
support joints affecting more women  USE splints to immobilize
day progresses
 3. Occupational and physical (ages 35-45) than men the affected extremity
 Joints are swollen and warm during acute stage of the
therapy  Rheumatoid arthritis  Painful when moved disease and inflammation
 4. Pharmacologic FACTORS:
 Deformities are common in to REDUCE DEFORMITY
management Genetic
the hands and feet causing  Administer prescribed
Auto-immune connective tissue
misalignment medications
 Suggest application of COLD crystals in the joint and 2. Encourage an increased fluid
packs during the acute body tissues intake (2-3L/day) to prevent
phase of pain, then HEAT  CAUSES: stone formation
application as the  1. Primary gout- disorder 3. Instruct the patient to avoid
inflammation subsides of Purine metabolism alcohol
2. Decrease patient fatigue  2. Secondary gout- 4. Provide alkaline ash diet to
 Schedule activity when pain is excessive uric acid in the increase urinary pH
less severe blood like leukemia 5. Provide bed rest during early
 Provide adequate periods of attack of gout
rests Nursing Intervention
3. Promote restorative sleep 6. Position the affected extremity in
 1. Severe pain in the involved mild flexion
4. Increase patient mobility joints, initially the big toe 7. Administer anti-gout medication
 Advise proper posture and  2. Swelling and inflammation and analgesics
body mechanics of the joint
 Support joint in functional  3. TOPHI- yellowish-
position whitish, irregular deposits
 Advise ACTIVE ROME in the skin that break
 Rheumatoid arthritis open and reveal a gritty
5. Provide Diet therapy appearance
 Patients experience anorexia,  5. Fever, malaise
nausea and weight loss  6. Body weakness and
 Regular diet with caloric headache
restrictions because  7. Renal stones
steroids may increase
 Supplements of vitamins,  Elevated levels of uric acid in
iron and PROTEIN the blood
6. Increase Mobility and prevent  Uric acid stones in the kidney
 Gouty arthritis
 Lie FLAT on a firm
 Medical management
 1. Allupurinol- take it WITH
 Lie PRONE several times
to prevent HIP FLEXION
- Rash signifies
 Use one pillow under the reaction
head because of risk of
 2. Colchicine
dorsal kyphosis
For acute attack
 NO Pillow under the joints
because this promotes Nursing Intervention
flexion contractures 1. Provide a diet with LOW purine
 Avoid Organ meats, aged and
Gouty arthritis processed foods
 A systemic disease caused  STRICT dietary restriction
by deposition of uric acid is NOT necessary