Class Talk Fall 2016

1. What do you asses (priority)

-Pain, Pt’s general health, pervious and current injuries, Observe posture: standing/walking, arch of foot, look for fallen arches, high arch, overpronation/over supination. Palpation: inside of heel and arch, pain indicates plantar fasciitis. Range of motion: checking amount of dorsiflexion, decreased range can indicate tight calf muscles.

2. The pain from plantar fasciitis could limit the patient’s ability to walk, especially if it is left untreated and bone spurs develop on the heel.

3. Discharge teachingwould include stretching techniques that help relieve the pain, and use of orthotic devices and supportive shoes.

1. What do you asses (priority)

-Pain, Pt’s general health, pervious and current injuries, Observe posture: standing/walking, arch of foot, look for fallen arches, high arch, overpronation/over supination. Palpation: inside of heel and arch, pain indicates plantar fasciitis. Range of motion: checking amount of dorsiflexion, decreased range can indicate tight calf muscles.

2. The pain from plantar fasciitis could limit the patient’s ability to walk, especially if it is left untreated and bone spurs develop on the heel.

3. Discharge teachingwould include stretching techniques that help relieve the pain, and use of orthotic devices and supportive shoes.

1. What do you asses (priority)

-Pain, Pt’s general health, pervious and current injuries, Observe posture: standing/walking, arch of foot, look for fallen arches, high arch, overpronation/over supination. Palpation: inside of heel and arch, pain indicates plantar fasciitis. Range of motion: checking amount of dorsiflexion, decreased range can indicate tight calf muscles.

2. The pain from plantar fasciitis could limit the patient’s ability to walk, especially if it is left untreated and bone spurs develop on the heel.

3. Discharge teachingwould include stretching techniques that help relieve the pain, and use of orthotic devices and supportive shoes.

1. What do you asses (priority)

-Pain, Pt’s general health, pervious and current injuries, Observe posture: standing/walking, arch of foot, look for fallen arches, high arch, overpronation/over supination. Palpation: inside of heel and arch, pain indicates plantar fasciitis. Range of motion: checking amount of dorsiflexion, decreased range can indicate tight calf muscles.

2. The pain from plantar fasciitis could limit the patient’s ability to walk, especially if it is left untreated and bone spurs develop on the heel.

3. Discharge teachingwould include stretching techniques that help relieve the pain, and use of orthotic devices and supportive shoes.

Christina Caranica

Jane Han

Physical examination includes assessing for numbness and tingling in the fingers, loss of grip, pain over the ventral aspect of the wrist with possible radiation to the palm and fingers, tight or swollen feeling in the hand, and/or temperature changes. Tinel’s sign is assessed by percussing lightly over the median nerve.  A positive test reports tingling, numbness, or pain at the site. Phalen’s sign test requires that the patient holds out their hands in front of him/her and flexes the wrist followed by dropping the hands down for 60 seconds.  Report of tingling, numbness or pain indicates a positive test.

Limitations related to mobility include pain, numbness, paresthesia, and weakness along the median nerve affecting the thumb, index, and middle finger.  Commonly seen is night pain and clenching upon awakening.

Patient teaching includes: minimizing excessive wrist movements (wringing, gripping and squeezing); using a wrist splint to rest the nerves and help the wrist maintain a neutral position; taking quick breaks and performing hand exercises that rotate and stretch the palm and fingers; and asking the doctor if surgery is an option-surgery can help relieve pressure, and prevent permanent nerve and muscle damage.

 

 

Christina Caranica

Jane Han

Physical examination includes assessing for numbness and tingling in the fingers, loss of grip, pain over the ventral aspect of the wrist with possible radiation to the palm and fingers, tight or swollen feeling in the hand, and/or temperature changes. Tinel’s sign is assessed by percussing lightly over the median nerve.  A positive test reports tingling, numbness, or pain at the site. Phalen’s sign test requires that the patient holds out their hands in front of him/her and flexes the wrist followed by dropping the hands down for 60 seconds.  Report of tingling, numbness or pain indicates a positive test.

Limitations related to mobility include pain, numbness, paresthesia, and weakness along the median nerve affecting the thumb, index, and middle finger.  Commonly seen is night pain and clenching upon awakening.

Patient teaching includes: minimizing excessive wrist movements (wringing, gripping and squeezing); using a wrist splint to rest the nerves and help the wrist maintain a neutral position; taking quick breaks and performing hand exercises that rotate and stretch the palm and fingers; and asking the doctor if surgery is an option-surgery can help relieve pressure, and prevent permanent nerve and muscle damage.

 

 

Christina Caranica

Jane Han

Physical examination includes assessing for numbness and tingling in the fingers, loss of grip, pain over the ventral aspect of the wrist with possible radiation to the palm and fingers, tight or swollen feeling in the hand, and/or temperature changes. Tinel’s sign is assessed by percussing lightly over the median nerve.  A positive test reports tingling, numbness, or pain at the site. Phalen’s sign test requires that the patient holds out their hands in front of him/her and flexes the wrist followed by dropping the hands down for 60 seconds.  Report of tingling, numbness or pain indicates a positive test.

Limitations related to mobility include pain, numbness, paresthesia, and weakness along the median nerve affecting the thumb, index, and middle finger.  Commonly seen is night pain and clenching upon awakening.

Patient teaching includes: minimizing excessive wrist movements (wringing, gripping and squeezing); using a wrist splint to rest the nerves and help the wrist maintain a neutral position; taking quick breaks and performing hand exercises that rotate and stretch the palm and fingers; and asking the doctor if surgery is an option-surgery can help relieve pressure, and prevent permanent nerve and muscle damage.

 

 

Christina Caranica

Jane Han

Physical examination includes assessing for numbness and tingling in the fingers, loss of grip, pain over the ventral aspect of the wrist with possible radiation to the palm and fingers, tight or swollen feeling in the hand, and/or temperature changes. Tinel’s sign is assessed by percussing lightly over the median nerve.  A positive test reports tingling, numbness, or pain at the site. Phalen’s sign test requires that the patient holds out their hands in front of him/her and flexes the wrist followed by dropping the hands down for 60 seconds.  Report of tingling, numbness or pain indicates a positive test.

Limitations related to mobility include pain, numbness, paresthesia, and weakness along the median nerve affecting the thumb, index, and middle finger.  Commonly seen is night pain and clenching upon awakening.

Patient teaching includes: minimizing excessive wrist movements (wringing, gripping and squeezing); using a wrist splint to rest the nerves and help the wrist maintain a neutral position; taking quick breaks and performing hand exercises that rotate and stretch the palm and fingers; and asking the doctor if surgery is an option-surgery can help relieve pressure, and prevent permanent nerve and muscle damage.

 

 

Osteoporosis is a degenerative disease marked by the deterioration, weakening, and loss of bone. It is important to assess dietary and exercise habits, health history, lab values, and diagnostic tests.

In regards to dietary needs, the recommended daily intake of 1,000 mg of calcium maintains adult bone mass, and 800 IU of vitamin D maintains bone health in people over 50 years old. Physical activity stimulates bone formation, so sedentary lifestyles are a red flag.

Lab values are important, because elevated parathyroid hormone, thyroid hormone, and cortisol all cause bone resorption. Growth hormone stimulates bone growth and estrogen and  testosterone stimulate bone formation. Diagnostically speaking, X-RAY tests are the main way to determine bone density.

And finally, a thorough health history that asks about any past bone fractures, loss of height, and posture changes are important in assessing bone health.

No limitations to mobility. In fact, weight bearing activity is encouraged to promote bone mineralization

D/C teaching would include dietary recommendations to increase calcium and vitamin D intake through dairy, egg yolks, and fortified foods, and increasing weight bearing exercise as tolerated.

References

Hinkle, J.L. & Cheever, K. H. (2014). Brunner & Suddarth’s Textbook of     Medical-Surgical Nursing (13th ed.). Philadelphia, PA: Lippincott, Williams, & Wilkins.

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