GROUP 6

CABANTOC, MARY JOY S. CABIGAO, ANDRONICO CADO, ROMA AMOR CAMACHO, HANNAH CEPE, NIGEL DE SAGON, DORIS DINGLASAN, JENNILOU ENCELA, JULIE ANN

REITER’S SYNDROME

I. INTRODUCTION
A 20y/o student worker was diagnosed of having Reiter’s syndrome, before admission the client manifest a sign and symptoms of joint pain and fever for a week with convulsion. Before admission the patient had done several laboratory examinations and found out that she was treated from Chlamydia Trachomatis. STD is a continuously increasing case here in Philippines one of these sexually transmitted disease could be Reiter’s syndrome as a result of unprotected or unsafe sexual intercourse. Even though Reiter’s syndrome had its underlying causes also, STD is the largest percentage of the reason why this syndrome occurs.

000 in the United States.806 cases were reported after a Chlamydia trachomatis infection.000 5 versus 3. . as of 2009 in Finland. German statistics reported an estimate of 10/10.5/100. there is a statistic review. There is no statistics available on the prevalence or incidence of Reiter’s syndrome in the Philippines. Frequency of Reiter’s has been increasing since 1998. 8. Although there is no clear regional prevalence in the Philippines.At this age the patient suffers from this Reactive Arthritis which could be detrimental to ones health.

Know the nursing management that will aid for the treatment of the disease. nursing students will be able to. OBJECTIVES At the end of the presentation. And understand why all of these occurs.  Become familiarize or be knowledgeable about the Reiter’s syndrome.II. Use the knowledge for nursing practice in the near future.   .  Know what are the clinical manifestations associated with the disease process.

III.NURSING HISTORY .

2011 .BIOGRAPHICAL DATA Name: Joan Adorna Sex:Female Address: Tondo Manila Age: 20 y/o Occupation: Accounting Staff Educational level: College level Support person: Angelita Adorna.A.mother Admission Date: July 17.

B. REASONS FOR SEEKING HEALTH CARE The patient complains of severe joint pain causing immobility and high fever with convulsion. .

And presence of lesions with edema on her left leg and left arm.C. . Aside from that the patient wasn’t able to walk due to severe joint pain having a pain scale of 9 out of 10 being the most painful PTA. HISTORY OF PRESENT ILLNESS During midnight 2 days PTA the patient had a fever ranges from 39-40 continuously increasing for 2 days with convulsion and chills.

PAST HEALTH HISTORY The patient has a history of Chlamydia infection having a whitish discharge in vagina and was treated with antibiotic by her physician 3 weeks PTA. .D. The patient also suffers from burning sensation while voiding at that time and she was diagnosed of having UTI when she was young.

She occasionally drinks without abusing it. For her it relieves her stress and anxiety at work and she stated also that she was influenced by her friends. She also has multiple sex partners from 18 years old until now when she was 20 years old. .F. SOCIAL HISTORY The patient used to cigarette 2 packs every day at work and even in school.

diabetes and UTI.E. . FAMILY HEALTH HISTORY On paternal and maternal side her family had a history of high blood and heart disease.

(-) Contraceptives . OBSTETRICAL HISTORY SEX: Female LMP: 7/14/11 > No history of birth loss COITUS: 18y/o G-0 T-0 P-0 A-0 L-0 M-0 STATUS: single MENARCH: 16y/o (-) Dysmenorrhea 8pads/wk.G.

toileting. dressing.  No supplements  Has normal appetite  No difficulty in swallowing During Hospitalization The patient now consider  health as a significant factor due to her hospitalization Analysis Pt. was waek that she can’t do those things. Health Perception Pattern  Activity-Exercise Pattern Pt needs assistance in bed mobility. shopping. bathing. cooking.IV. Pt is independent. stair climbing. bathing. In a soft diet( eats champorado) (+) stomatitis @ tongue Presence of some chicken pox in her arms and feet  Pt. quit smoking because she obey her mother. dressing. toileting and other activities she need to do. and in bed mobility. was Nutrition Metabolic Pattern .     Pt. GORDON’S FUNCTIONAL PATTERN Pattern Before Hospitalization The patient views health not a significant factor to consider as she frequently drinks and smoke and didn’t even go to the clinic for check up if she feels something bad in her body  No need of assistance in eating.

was disturbed because she’s not at ease.  Pt. experienced difficulty in vision maybe because she was always “puyat”  Coping Stress Tolerance Pattern  Studies and financial are her major concern Lost of her 4 mos. survive to this illness and go back to work Optimistic  Pt. niece 1 year ago   Pt. Sleep Rest Pattern  Sleeps in almost 13 hrs      Cognitive Perceptual Pattern    Alert No difficulty in speaking speaks TAGALOG Both eyes are blurred but she don’t use any eyeglasses No anxiety Hearing is within normal limits      Nap only Feels rested after sleep No problem in sleeping Alert No difficulty in speaking speaks TAGALOG Both eyes are blurred but she don’t use any eyeglasses No anxiety Hearing is within normal limits Outlook in the future: studies.  . Elimination   Bowel habit of 1 time per day Bladder habit of 3-4 times a day No pain in urinating   Same bowel movement Same bladder habit  No complications experienced by the pt. was optimistic.

2011 Menarche 1st year high school 1st coitus 18 yrs old Has no problem in menstruating.Sexuality Reproductive Pattern        Role Relationship Pattern  LMP: July 14. believes that she will be cured through the help of the doctor and herself. Uses 2 pad a day Not performing selfbreast exam Single Working student as a staff in a private agency Support system was her boyfriend and family Roman catholic There is no religious restrictions  Presence of vaginal discharge  Pt.   Support system was her boyfriend and family Concern about her health    Not requesting for chaplain visitation at this time  Value Belief Pt. has anxiety. .

V. PHYSICAL ASSESSMENT .

7 degree Celcius PTA the patient verbalizes the pain she felt on her left leg and arm with edema was 9 out of 10 being the most painful.  pink and moist without discharge. Blue white in color. With watery eye.  bluish hue.  Mouth: Lips .  In white skin. 100/60 mmHg 69 cpm 23 bpm 37. Pale in color.   VS: BP PP RR Temp  Moderate to severe anxiety due to concern about health. Dry cracked with lesions on the side. Conjunctiva lighter pink in color. Cool with tense VS: 120/80 mmHg 60-100 cpm 12-20 bpm 37 body temp. PAIN ASSESSMENT using PAIN SCALE ranges from 1-10  0 1 No pain 2 3 4 5 6 7 8 9 10 worst pain EENT  Eyes: Conjunctiva Sclera    Palpebral conjunctiva is smooth. pink in dark skin. Light yellowish in color. Moist. smooth with no lesions.NORMAL FINDINGS GENERAL PHYSICAL SURVEY • Behavior   CLIENT FINDINGS   Mood  Cooperative attitude and behavior Cooperative attitude with irritable behavior due to pain she felt.

9/10 pain. Yellowish in color Edema on left arm and legs. Immobile .      SKIN     With lesions and discharges on lesion. DOB when asleep.  No lesions Fair in color Without edema Without pain felt.LUNGS  Breathing Pattern  Regular in breathing pattern without hardness to breath.  Irregular breathing pattern at night. Ambulatory   MUSCULOSKELETAL Unable to move because of pain in edema. Without discharges Scanty white color discharges GENITOURINARY   Able to move when instructed.

VI. LABORATORY EXAMINATIONS .

2 Unit g/L Reference 120-180 WBC Platelet count 31. HEMATOLOGIC EXAM Test Hemoglobin Results 75. .A.32 430 X10^q/L X10^q/L 5-10 150-450 ANALYSIS: An increase in white blood cell denotes an infection in a patient. With low Hgb resulting to decrease oxygenation to blood.

.60 3. CHEMISTRY Test Creatinine Sodium Potassium Results 107.6-5.89 131.B. causing uric acid retention.104 135-145 3.78 Unit mmol/L mmol/L mmol/L Reference Ranged Adult 45 .5 ANALYSIS: Abnormal creatinine level indicates renal failure.

( ) GRAM STATE ON DIRECT SMEAR • PUS CELLS : FEW • EPITHELIAL CELLS : FEW • GRAM (-) BACILLI : +2 • GRAM(+) COCCI : +2 • GRAM(+) BACILLI : FEW ANALYSIS: Indicates the presence bacteria causing infection. .

PAP’S SMEAR RESULT Patient noted from smelling (Fish like Odor) Vaginal discharge prompting consult with private O.  Patient with Pap’s smear w/c revealed the following results:  Bevish cellular change  Micro organism consisted w/ cocobacilli. .B.

VII. MEDICAL DIAGNOSIS REITER’S DISEASE OR REACTIVE ARTHRITIS .

VIII. ANATOMY AND PHYSIOLOGY .

HUMAN ANATOMY: URINARY SYSTEM .

HUMAN ANATOMY: KNEE JOINT .

PATHOPHYSIOLOGY .IX.

ankles) arthritis .UUTI kidney failure uric acid secretion crystal stones unprotected sexual intercourse blood stream 2-3wks C.Trachomatis conjunctivitis access to urethra urethritis mucupurulent discharge “milk-like” burning sensation/ unable to void joints( knees.

Pharmacological Management  NSAID’s and corticosteroids often produce marked improvement in back.  Sulfasalazine and Methotrexate may help in pheripheral disease.  Maintaining range of motion with a regular exercise and muscle-strengthening program is essentially important.  . MEDICAL/ SURGICAL MANAGEMENT Medical management focuses on treating pain and maintaining mobility by suppressing inflammation.X. skin and joint symptoms.

Surgical management  Surgical management may include total joint replacement. . anti-TNF therapy is under investigation for treatment of the spondyloarthropathies. More recently.

DRUG STUDY .XI.

tenderness at injection site . Adverse effect CNS: Fever. Skin: pain. Mechanism of Action Third – generation cephalospori n that inhibits cell wall synthesis.candi diasis. 3rd generation Cephalospori n 5.Uncompli cated gonococcal vulvovaginit s.Contraindicate d in patients hypersensitivity to drug or other cephalosporins.pruritus. dizziness. 2. 2. 4. inject deep into a large muscle. diarrhea. Therapy may begin while awaiting results. Perioperativ e prevention.Obtain specimen for culture and sensitivity test before giving first dose. 3.M.Before administration.rash . carditis and arthtitis from penicillin 1. induration. vomiting. such as the gluteus maximus or the lateral aspect of the thigh. Diarrheal. 3. 3. 2. chills.sensitivity with other betalactam antibiotics. 1.Drug Classificatio n Side effect CNS: Seizures GI: Nausea. Use cautiously in patients hypersensitive to penicillin because of possibility of cross. Neurogical complicatio ns. CV: phlebitis GI: pseudomem branous colitis. For I. headache. administration. Dyscrasias. Use cautiously in breast-feeding women and in patient with history of colitis and renal insufficiency. . Contraindicati on Nursing Implication Generic name: CEFTRIAXONE sodium Brand name: ROCEPHIN Anti infective. DERM: rashes HEMAT: Blood. haemolytic anemia. serum sickness. usually bactericidal.Acute bacterial otitis media. GU: genital pruritus.ana phlyaxis. Meningits. promoting osmotic instability. Other: hypersensitiv ity reaction.a sk patient if he is allergic to penicillins or cephalosporins. Hematologic : eosinophilia. Indication 1.

.ALERT: Don’t confuse drug with other cephalospori ns that sound a like.

CV: vasodilation EENT: visual disturbance. vertigo. CNS stimulation.anxi ety . synthetic analgesic compound not chemically related to opiods. usually after the first dose. Mechanism of Action Indication Contraindica tion 1. somnolence. Asthenia. CV: vasodilation.Reassess patient’s level of pain at least 30 min.In the case of an overdose. A centrally. 3. hypnotics. nervousness. malaise. euphoria. centrally acting analgesic. DERM: pruritus GU: urinary retention/ frequency. Thought to bind to opiod receptors and inhibit reuptake of Norepinephri ne and serotonin. acting. opiods or psychotropic drugs.Contraindic ated in patient hypersensitiv e to drug or other opiods.coordination disturbance. serous hypersensitivit y reactions can occur. 2. Moderate to moderately severe pain.heada che .heada che. sleep disorder. Unknown.seizu res. . and in those with acute intoxication from alcohol. naloxone may also increase risk of seizure. 1.confusion .Monitor CV and respiratory status. . constipation. Nursing Implication Generic name: TRAMADOL hydrochloride Brand name: Ultram CNS: dizziness/ vertigo.Drug Classificatio n Analgesic Side effect Adverse effect CNS: dizziness. GI: nausea. in breast feeding women. After administration . With hold dose and notify prescriber if respirations decrease or rate is below 12 breaths/minut e. somnolence.

dry mouth.GI: nausea. . Musculoskel etal: Hypertonia.Monitor bowel and bladder functions ALERT: Don’t confuse tramadol with trazodone or trandolapril. GU: urine retension. constipation. 2. 4.flat ulence. Anorexia. menopausal symptoms. vomiting. urinary frequency. Use cautiously in patient at risk for seizures or respiratory depression. dyspepsia. diaphoresis. in patients with increased intracranial pressure.rash. abdominal pain. proteinuria Skin: pruritus. diarrhea.

pancytopenia.Adverse effect Drug Classification Side effect Mechanism of Action Indication Contraindica tion Nursing Implication Generic name: Paracetamo l Brand name: Acetaminop h en. ALERT: Many OTC and prescription products contain acetaminophe n. .Use liquid form for the children and patients who have difficulty swallowing. Skin: Rash. neuropenia. Contraindi cated in patient hypersens itive to drug. be ware of this when calculating total daily dose.urticaria. leukopenia. In children don’t exceed 5 dose in 24 hours. Mild pain or Fever 1. Hepatic: jaundice Metabolic: Hypoglycemia. antipyretic GI: hepatic necrosis (overdose) DERM: rash. Thought to produce analgesia by blocking pain impulse by inhibiting synthesis of prostaglandi n in the CNS or of other substance that sensitize pain receptors to stimulation. 2. 2. Unknown. urticaria Hematologic: haemolytic anemia. Non-opiod analgesic. Use cautiously in patient with long term alcohol use because therapeutic doses cause hepatotoxicity in these patients 1. Actamin.

XII. NURSING CARE PLAN .

Instruct patient with proper positioning. These measure to help to reduce anxiety and help client to regain sense of control altered by the painful experience. the client will be able to reduce pain from 9 to 6.  To served as a baseline data.Assessment Subjective: “Masakit at namamaga ang kanang paa ko lalo na pag ginagalaw ko grabe” as verbalized by the patient. heat and cold techniques and relaxation techniques. deep breathing exercises. To promote non – pharmacolo gical pain manageme nt.   . Intervention Independent:  Monitor v/s Rationale Evaluation Goal met  The client able to decrease the pain scale from 9 to 6  Facial grimace less evidence. Objective: VS.69 RR.7 PA: •Watery yellowish eye •Light pink conjunctiva •Dry with lesion lips •Mucocutaneous lesion •Left arm and left leg edema • Circle lesions on arm and leg •Unable to move Diagnosis Inference:  Acute pain is an unpleasant sensory and emotional experience arising from actual or potential tissue damage. To prevent fatigue.     Provide comfort measures quiet environmen t and calm activities. BP. The client will able to go back to her Activity of daily living without due pain and discomfort.23 Temp37. Encourage adequate rest periods.100/60 PP. sudden or slow onset of any intensity from mild to severe with an anticipated or predictable end and a duration of less than 6 months. Planning STG:  After 1 hr of effective nursing intervention. LTG:  24 to 48 hours upon discharge.

As prescribed by the Physician. . Collaborative: • Collaborate • with kidney specialist and endocrinolog ist.  Monitor  surgical for dehiscence and eviscerations . For the treatmen of the causes that distribute to pain. Dependent:  Administer  analgesis as indicated to maximum dosage as needed. Assist in coping with after pain. Careful monitoring enables early detections of complication s To maintain acceptable level of pain.

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