I know I’m a little late on this post, but it was so hard for me to disconnect this past week. With the election, neuro exam, work emails and texts, SNA emails, my online class, or just needing my phone by me in case my kids needed me or something happened to them, I wasn’t able to find a time to disconnect for too long. This morning I was able to finally take a little reprieve from technology while at my daughter’s playoff soccer game. I was able to pay attention 100 percent. I also had wonderful interactions with family that was there with us. We cheered for her, my son hugged on me, and we even chatted and threw a football around after the game. It was wonderful to have that interaction and human touch. After that, we stopped by my parents’ house and I didn’t take my phone in. It was nice to visit with my nephew, sister, and parents without feeling the need to look down at my phone for any reason.
I definitely think that we miss out on so much going on around us when we looking down at our phones or typing away on our computers or watching mindless television. I want to practice disconnecting and being more present with the human beings who are there in front of me. Thank you for this assignment, it takes something like this to shake my world up a bit and take a look at something in a different way.
Assessment: Findings related to RA are rheumatoid nodules and joint inflammation detected on palpation revealing spongy tissue. Assessment focuses on bilateral and symmetrical stiffness, swelling, tenderness, and temperature changes in the joints. The patient should also be assessed for sensory changes, weight loss, fatigue, and lymph node enlargement. Labs show the presence of rheumatoid factor, an elevated ESR and C-reactive protein, and decrease in RBCs.
Mobility limitations: Physical mobility will be impaired related to decreased range of motion, pain, and weakness. Joint motion will be affected due to the loss of articular surfaces, muscle fibers undergo degenerative changes, and the tendons will lose its elasticity and contractile power. As RA progresses, it can affect mobility in the knees, shoulders, hips, elbows, ankles, cervical spine, and temporomandibular joints. Long periods of immobility can lead to contractures.
D/C Teaching: This will include educating the patient about the pathophysiology of the disease and how to manage it. Educate the patient about self-care needs, joint protection, and energy conservation. Provide and educate on the use of assistive devices. Emphasize the need for activity and safe exercises. Also educate the patient about pain management techniques, relaxation techniques, medication adherence, and medication side effect
Lithium (Lithobid) is a mood stabilizer that is the drug of choice for patients with bipolar disorder. Its mechanism of action is altering cation transport in nerve and muscle, and influencing the reuptake of neurotransmitters. renal excretion of lithium is highly dependent on serum sodium levels and this is because the kidneys process lithium and sodium in the same way.
Lithium can cause many adverse effects on the kidneys including polyuria, glycosuria, renal toxicity, chronic interstitial nephritis, and glomerulonephritis. Long-term lithium therapy should be avoided if possible, and the dosage should be kept as low as possible to reduce renal damage. Kidney function (BUN, serum creatinine, creatinine clearance, urinalysis) should be assessed before starting treatment and at least once a year after. Lithium is contraindicated in patients with severe renal disease.
Other nursing considerations for this drug is to be aware of lithium levels if the patient is taking a diuretic concurrently. The nurse must monitor intake and output, and report any significant changes. Weight must be monitored every 3 months, and unless contraindicated, fluid intake should be about 2000 to 3000 mL a day. Important labs to monitor during therapy are renal and thyroid function, WBCs, serum electrolytes, adn glucose. It’s also really important to monitor lithium levels, making sure they stay in the therapeutic range, every 2 to 3 days during initial therapy and every 3 to 6 months during maintenance therapy.
Picking a picture that represented me was pretty hard. I’m a family girl… I love my kids, I love my two dogs, and I love my fiance more than I could ever put into words. I love to be silly with my family, and although I have thousands of fantastic pictures with my family, this one from Mother’s Day is one of my faves. Our pictures together always end up something like this. It captures a moment where we weren’t taking ourselves too seriously and we were just enjoying life. In all the seriousness of nursing school and studying and taking care of very sick people, I have to make sure I have more moments like this with my family.
Now, regarding the “dreaded” lab values, it was a challenge to choose my favorite because they can all be a little confusing. I’d have to say my favorite value is potassium (K+)! It was pretty much the first lab value I ever memorized in nursing school. Go ahead ask me, I’ll scream “3.5 to 5.0 mEq/L” before you even finish the question. It is such an important value to watch in our patients, and there were a few instances last semester when I had to take it into consideration during med passes, etc. My least favorite would probably be phosphorus….and maybe magnesium. I can’t seem to get those values to stick in my brain, ugh!
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