Gout (Gouty Arthritis)

A form of arthritis characterized by severe burning pain, redness, tenderness and stiffness in joints. Gout is a kind of arthritis caused by uric acid crystals forming in one or more joints.

Symptoms

  • Usually start at night
  • Very common in the big toe joint but can also occur in other joints
  • Affected joint becomes red, feels hot, and painful.
  • Pain increases when the joint is touched.

Causes & Risk Factors

  • Foods that are rich in purines increase the risk for gout – Salmon, sardines, organ meats, asparagus, mushrooms and herring are examples of foods rich in purines.
  • Gout is hereditary.
  • Overweight, Alcohol, High cholesterol, Diabetes, high blood pressure
  • Men develop gout more often than women.

Treatment

  • Rest
  • Pain relievers & anti-inflammatory medications – Motrin, Advil and Naproxen

Patient teaching – Teach patient to

  • Take all medication as prescribed.
  • Inform the MD before taking any aspirin product because aspirin can interfere with other medications
  • Lose weight if patient is overweight.
  • Seek treatment promptly for high blood pressure, high cholesterol or diabetes
  • Follow diet prescribed – low-salt, & low-fat diet.
  • To avoid alcohol and foods that are high in purines.
  • To drink lots of water to help flush uric acid from the body.

Complications

  • When gout is not treated, a gout attack can last for days or even weeks.
  • Prolong attacks for many years may lead to TOPHI – uric acid crystals that form lumps under the skin.
    • Tophi usually form on the toes, fingers, hands and elbows.
  • Gout may also lead to kidney disease or kidney stones from uric acid crystals that collect in the urinary tract.

Reference: Lewis & Heitkemper, Med-Surg Nursing 2007

Rophem Nursing 🙂

Systemic Lupus Erythematosus (SLE)

What is SLE?

  • SLE is an autoimmune disease that can affect many parts of the body, like the kidneys, skin, the heart, joints, and lungs.
  • Systemic lupus erythematosus (SLE) is the most common and most serious type of lupus.
  • Discoid lupus erythematosus (DLE) also called cutaneous lupus erythematosus. DLE affects the skin. It does not affect other organs.
  • DLE shows up like a red rash or scaly patch, commonly found on the face or scalp, butterfly rash.
  • Leading cause of death in clients with Lupus – Kidney and Cardiac involvement.
  • Another type of lupus is the Drug-induced lupus, this type is caused by reaction to some prescription drugs.

Triggers of Lupus

  • Sunlight – very specific with Lupus
  • Stress
  • Pregnancy
  • Drugs

Assessment Findings – SLE

  • Joint pain and decreased mobility, Photosensitivity, HTN,
  • Fever, Pericarditis, Nephritis, Pleural effusion

Instructions for the client with SLE

  • Instruct client to avoid prolonged exposure to sunlight.
  • Avoid stress and illness
  • Provide instruction about medications – steroids.

Nursing Care

  • Monitor for Pain, mobility, and fatigue,
  • Vital signs
  • UOP, BUN, & serum creatinine.

Medications

  • Corticosteroids
  • NSAIDs (not for clients who have renal compromise)
  • Immunosuppressant agents
  • Antimalarial

Complications – Lupus nephritis, Pericarditis and myocarditis

References:
Medical-Surgical Nursing, 9th Edition by Lewis, Heitkemper, et all.
Understanding Medical Surgical Nursing by Paula D Hopper

Rophem Nursing. 

 

When you have a difficult Patient

Hello Nurses,

Every day is different, there will be days or times when, no matter what you do or how caring you try to be, you will still have people who are not satisfied with your services. There will always be ungrateful people.

So, what do you do as a nurse when this happen to you?

First, know that it is not personal. Do not think it is because of who you are or how you look, etc. It is important to understand that no one chooses to be sick or be in the hospital or in the healthcare facility where you may be working. Many people who happen to be receiving care may be frustrated for other reasons – not because of the you.

Nursing is a calling, and since you have accepted this calling, you have all that it takes to take great care of every client and every situation you may come across.

  • Remain calm. Remember it is not about you. They may be going through pain or anxiety about their health and they may want to discuss their feelings with you. Whatever the case may be, find the good in each day and appreciate it.
  • Listen and have a conversation with the client, this may not work the first time you try it. Try again. This is how you demonstrate the patience of being a nurse. I am sure you can do it!
  • Greet your patients and introduce yourself with a very big smile. Make it a part of your uniform as a great nurse. You may have received in report that the client is the most difficult on the unit; but your approach with this client will make a big difference. With a big smile and a warm greeting as you introduce yourself, you can successfully gain the trust of the client, and just earn yourself a great shift.
  • Do not get in an argument with the client, this will only make the situation worse. Know when to leave for a moment, then try again when they may have calmed down.

Much love to all of you great Nurses out there, you are doing an awesome job!
Happy Nurses’ Week 🙂

Rophem 🙂

Pharm: Carbidopa-Levodopa (Sinemet)

Sinemet is used to treat Parkinson’s disease.

  • Classifications: Autonomic Nervous System Agent; Anticholinergic; Antiparkinsonism Agent
  • Available in Capsule & Tablet forms

Geriatric

  • Elderly patients may have increase chance of side effects during treatment due to high sensitivity.

Contraindications

  • Narrow-angle glaucoma
  • Pregnancy (category C)

Caution in

  • Kidney disease
  • Diabetes mellitus
  • Chronic lung disease

Side effects

  • Urine, saliva, and sweat become darker in color than usual.
  • May cause a bitter taste, or a burning sensation of the tongue

Interactions – MAOI, Tricyclic antidepressants, Haloperidol

Nursing Implications

  • Observe for therapeutic effects and report adverse reactions promptly.
  • Monitor vital signs & rhythm, particularly during period of dosage adjustment.

Patient teaching

  • Teach to make position changes slowly, particularly from sitting to upright position.

Reference: Roach’s Introductory Clinical Pharmacology. 

To Your Success!

Rophem 🙂