what is the focus of Singh
- musculo
- resp
- circulatory
what is rheumatoid arthritis
- chronic progressive condition where the bodies immune system attacks the lining of the joints
- it causes stiffness, pain and swelling of the joints
what are the s/s of RA
- morning stiffness
- edema
- bilateral pain and tenderness to the joints
- trouble doing ADL’s
what are the risk factors for rheumatoid arthritis
- gender: women are more likely to develop RA
- age: anyone can get RA develops around 30-50 y/o
- life style like smoking, obesity and inactivity increases risks but also worsens symptoms of RA
what are the diagnosis for rheumatoid arthritis
- blood tests: elevated c-reactive proteins (CRP) and ESR indicate inflammation within the body
- physical examination to check for joint swelling and overall reflexes
- imaging like x-ray or MRI to assess the progression of RA
what are the tx options for rheumatoid arthritis
- knee replacement to replace the worn out joint
- cold or hot compresses
- rest
- NSAID’s or steroids to reduce pain and inflammation
- physical therapy to keep mobility in joints
what are some safety considerations for someone with rheumatoid arthritis
- encourage rest and avoid overworking the joints
- use assistive devices like walkers and canes to support yourself and joints
- clutter free environment
- educate patient on calling for help when getting out of bed especially after getting medications as they can cause sedation and falls risk
- proper foot wear grip socks
what is TKA
total knee arthroplasty/ replacement a surgery done to relieve pain and restore functions with artificial implants like metal or plastic in the knee joint
what are post-op risks for TKA
- infection: risk for infection at the surgical site
NI: aseptic technique, ax for s/s of infection at site, ensure dry and intact dressing - poor mobility and stiffness: due to RA and pain from TKA
NI: ROM exercises, ambulate early, administer pain meds to encourage patient to mobilize - poor wound healing: due to CHF causing poor oxygenated blood going to the surgical site delaying wound healing
NI: proper nutrition and fluids, encourage early ambulation and ROM
what are s/s of infection at surgical site
- warmth / redness
- purulent drainage
- swelling
- fever
what do you assess before ambulating a TKA patient
- QMA (strength and mobility)
- assistive devices patient may need (2WW)
what is CHF
heart is unable to pump the blood effectively causing poor blood flow though the body
what is left and right sided CHF
left = lungs
(left ventricle can’t pump blood effectively out) fluid buildup in the lungs like
- dyspnea
- crackles
- SOB
- orthopnea
right = rest of the body
(right ventricle can’t pump blood effectively out) fluid builds up in the rest of the body like abdomen and legs
- JVD
- weight gain
- edema
what are the risk factors for CHF
- congenital heart disease: birth defect that makes heart work harder to pump blood
- smoking: increases risk for heart disease
- hypertension: makes the heart work harder weakening the heart muscles
- diabetes: damaged blood vessels making them stiff and narrow making heart work harder to pump blood
what are the diagnostic tests CHF
echocardiogram: ultrasound that uses soundwaves to create a detailed images of the heart
chest x-ray to assess the condition of the heart
blood tests like BUN to assess the kidney function which can be damaged with CHF
what are the treatment options for CHF
- heart healthy diet low sodium, fat, and cholesterol
- surgery’s like pacemakers to help the heart beat at a normal and steady pace
- medications like diuretics (furosemide) to remove excess fluid within the tissues
- avoid smoking and alcohol
what are signs of fluid overload
- JVD
- bounding pulse
- edema
- crackles
- SOB
how do you prevent DVT after TKA?
- TED stockings
- early ambulation
- SCD (squeezes the legs to promote blood flow)
- ROM exercises
why does Singh have a foley catheter
urinary retention could be from
- pain meds
- anesthesia
- immobility
what are discharge teachings for TKA?
- report s/s of infection
- keep wound dry and intact
- use walker and canes for safety, but don’t over work or stain yourself
- home environment to lower falls risk
- DB+C or incentive spirometer to strengthen lung muscles
what is the importance of incentive spirometry post-op?
prevents atelectasis or pneumonia by encouraging deep breathing and lung expansion
While listening to her chest, you hear coarse crackles to the bases bilaterally. What do you think could be causing this?
- left sided CHF and fluid overload could also be bc of mucus buildup in the lungs due to immobility
You notice a large amount of drainage to her knee dressing on POD 0. What would you do? Is this okay?
- patient is hemorrhaging
- apply direct pressure to site to stop bleeding
- call for help
- ax vitals and notify physician
what is Peripheral Neurovascular Assessment?
used to assess sensation and circulation in extremities in casts or tight dressings
5 p’s
- pallor
- pain
- paresthesia
- paralysis
- pulselessness
