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QUESTION 1 : Your elderly aunt, an avid gardener and knitter, calls to tell you that she is awakened nearly every night with pain and numbness in both her hands. a) What other question would you ask her to determine the cause of her pain?

What rationale for obtaining this information?

c) What advice would you provide her for further investigation of this problem?


For signs and symptoms:  What are the main joint symptom pain, swelling, redness, weakness, clicking, itching, or bucking?  In which joints are the symptoms occurring?  When did your symptoms start?  Are the symptoms on & off or constant?  What activities make your joint hurt?

How intense is the pain ( maybe rate it on a scale of 1 to 10)

Personal medical / surgical history & family history:  Hare you any injuries or surgeries?  Do you have any other medical problem?  Hare any member of your family been diagnosis with Osteoarthritis?

Impact of symptoms:

 Are you symptoms limiting your activities in any way?
 

What is activities are effected? Are your symptoms affecting your life and work?


Osteoarthritis is does not effect other organ of the body. Common symptoms Osteoarthritis (OA) is pain in the affected joints causing loss of ability and often stiffness and also because of long period in activity for example gardener and knitter. Cause of OA is unknown. Risk factor include age, obesity, and activity causing joint stress also the another one reason of Osteoarthritis (OA). Treatment, OA cannot be cured. It will most likely get worse over time. However OA symptoms can be controlled and surgery but although, these treatment cannot make the arthritis go away, they can often delay surgery. The Osteoarthritis (OA) of the hands seems to have some hereditary characteristic that is, it run in families.

Observe pain before activity if possible, treat pain before activity and ensure that client is not heavily sedated.

 Work with client to set mutual goals that increase activity level.  Assess the home environment for factor that precipitate decreased activity tolerance, energy-intensive activity patterns.

Instruct the client and family in the important of maintaining proper nutrition and rest for energy conservation and rehabilitation. Help client set up an activity log to record exercise and exercise tolerance.


Advice would I provide her for further investigation of this problem is do joint x-ray to look for change in or damage to cartilage or bone not visible on x-ray and also look for damage to tissue around the joint

(example; ligaments), which are not visible on x-ray. Other investigation is Joints fluid test to rule out other disease that cause joint pain such as, gout, and also joint MRI (magnetic resonance imaging) to look for subtle change in or damage to cartilage or bone and look for damage to tissue around the joint. Blood test is to elevated blood rate and to promote infection or microorganism. Bone scan also to check the bone and identify the disease.

QUESTION 2: You are the nurse manager of an orthopedic surgery unit. This past month you have noted an increased incidence of occupation-related musculoskeletal injuries among the nursing personnel assigned to your unit. a) What type of assessments would you perform to determine the cause and severity of these injuries? b) What are some potential strategies you might implement to prevent further injuries among your nursing personnel? ANSWER 2: a) Assessing the 5 P’s of musculoskeletal injury.  PAIN Ask the patient whether he feels pain. If he does, assess the pain’s location, severity, and quality.  PARESTHESIA Assess the patient for loss of sensation by touching the injured area with the tip of an open safety pin. Abnormal sensation indicates neurovascular involvement.  PARALYSIS Assess whether the patient can move the affected area. If he cannot, he might have nerve or tendon damage.

 PALLOR Assess the injured site for paleness, which may indicate neurovascular compromise.  PULSE Check all pulse distal to the injury site. If a pulse is decreased or absent, blood supply to the area is reduced.

Causes of musculoskeletal injuries:  Varied- muscle tissue can be damaged with the wear and tear of daily activities.  Trauma to an area- jerking movement, auto accidents, falls, fractures, sprains dislocations, and direct blows to the muscle.
    

Postural strain. Repetitive movements. Overuse. Prolonged immobilization. Changes in posture or poor body mechanics- may bring about spinal alignment problems and muscle shortening.



Implement to prevent further injuries:

Make sure the floor is dry and clean. ® To avoid a fall while on duty staff nurses.

 Make sure things do not should lying on the floor. ® To avoid the duty staff nurse interrupted and fell while performing duties.  Use lifting devices and aids to move or transfer patients. ® To lessen the burden and lower back pain.

Ask nurses use their facility had adopted a “ No Lifting” policy. ® To prevent serious injury.

Ask nurses to observed, identification, risk assessment and risk danger when do their work. ® To identify the cause of the initial injury while performing the task.

 Ask the nurses encourages early reporting of incidents and here injuries. ® For early treatment.  Tell nurses use a right position or body mechanic when handle patient duty. ® To avoid injury.


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