CARE PLAN

ON

HYPONATREMIA
1.INTRODUCTION:

For my clinical experience I was posted in Medical ward in Muthu kumaran Medical College
and Hospital as part of Advanced Nursing Practice requirements. Mrs Suganthi, 79 years old
brought to the hospital by her daughter with increased confusion .

She was cooperative throughout my study. So, I selected Mrs. Suganthi who was suffering from
headache, loss of appetite and muscle cramps care plan .

2.PATIENT PROFILE:

Name of the patient : Mrs. Suganthi

Age : 79Yrs

Sex : Female

Marital Status : Married

Education : 2 nd standard

Occupation : Nil

Monthly Income : Nil

MRD.No :

IP. No :

Ward : Medical ward

Date of Admission :

Final Diagnosis : Hyponatremia

2.1. Chief Complaints:

Patient brought to hospital with increased confusion .Two weeks before she was normal. Two
days before she had a complaints of loss of appetide , headache, Muscle cramps and also cold
hands and feet. She is known hypertensive patient.

3. HISTORY

3.1 Past Medical Illness:

Mrs. Suganthi is known case of hypertensive past 5 years. The client has also had a history of
severe head ache and giddiness 2 months back got admitted in the hospital her BP was 150/100
mm/hg. She was on tab. Atenanol . after admission they changed in to Tab. Bendroflumethazide
2.5 mg OD

3.1.1 Present medical illness:

Mrs. Suganthi brought to hospital with increased confusion .Two weeks before she was normal.
Two days before she had a complaints of loss of appetide , headache, Muscle cramps and also
cold hands and feet. She is known hypertensive patient

3.2 Past surgical history:

There is no history of past surgical history.

3.2.1 Present surgical history:

There is no history of present surgical history.

3.3 Family History:

There is no history of consanguineous marriage.

There is no history of hypertension and diabetes mellitus.

There is no history of communicable disease like Tuberculosis and leprosy.

3.3.1 Family Composition:

S. Name of Age Sex Relationship Marital Education Occupation Health

No the family Status Status
members

1 Mr. Kannan 82 M Husband Married 4 th std Nil Healthy

yrs
2 Mrs. 79 F Client Married 2nd std House wife Healthy
Suganthi yrs
3 Mr. 48 M Son in law Married B.com Supervisor Healthy
Sugumaran yrs
4. Ms. Kavitha 45 F Daughter Married 12th std Nil Healthy
yrs
5. Mr. Praveen 18 M Grand son Un Joined in Nil Healthy
yrs married college
6. Ms. Preethi 15 F Grand Un Studying Nil Healthy
yrs daughter married 11 th
standard
3.3.2 Pedigree Chart :

Mr. Kannan 82 yrs Mrs. Suganthi 79 yrs

Mrs. Kavitha 45 yrs Mr. Sugumaran 48 yrs

Mr. Praveen 18 yrs Ms. Preethi 15 yrs

INDEX :

MALE

FEMALE

CLIENT
3.4. Personal History:

Mrs . Suganthi is non vegetarian, but she likes to eat vegetarian food. She takes adequate rest
and sleep daily. She is not allergic to any kind of food or drugs. She speaks Tamil .

3.5 .Socioeconomic background:

Mr. Sugumaran is the breadwinner of her family. Mrs Suganthi lives in a own house and in a
nuclear family. Her house is well ventilated and lighted. The water and electricity facility are
adequate. Good sewage disposal facility was available. There is no pet animals or garden in her
home.

3.6. Elimination Pattern:

Elimination pattern is good only.

3.7. Sleep Pattern

Mrs. Suganthi sleeping pattern is little bit poor during night. She use to take a nap in the noon
time.

3.8. Martial History

She got married 42 years back

3.9. Menstrual history

Attained puberty at the age of 14.

3.10. Diet History

Mrs. Suganthi is non vegetarian, but she likes to eat vegetarian food. She takes adequate rest
and sleep daily. There is no allergic to food.
 Diet chart for 24 hrs
Time Food Amount Protein Calcium Iron Calories

6.30am Tea 200ml 0.93 33 0.03 30

8am Idly 3 nos 7.7 3.6 5.7 231

200ml 7.31 192 5.91 301

Sambar
11am Veg soup 200ml 0.2 140 0.26 96

1pm Rice 1 cup 4.30 2.00 11.0 205

Drumstick 200ml 7.31 192 5.91 301

Sambar
Rasam 200ml 0.0 0.0 0.0 50

Egg 2 12 56 0.16 144

Cabbage 1 small 1.1 - - 102
porriyal bowl
4pm Tea 200ml 0.93 33 0.03 30

Marie 4 3.0 0.0 0.4 150

biscuit

8.30pm Dosa 2 7.3 0.03 0.10 319

Chutney 1 bowl 1 0.08 0.08 25

10pm Milk 200ml 8.03 307 0.04 122

Total 61.11 958.71 29.62 2106

4. PHYSICAL ASSESSMENT:
4.1 HEAD TO FOOT ASSESSMENT:

4.1.1 GENERAL APPEARANCE:

Nourishment : Moderately nourished

Body built : Moderate body built

Health : Unhealthy

Activity : Dull

4.1.2 VITAL SIGNS:

Temperature : 98.4’F

Pulse : 72 beats per minute

Respiration : 22 breaths per minute

Blood pressure : 150 /100 mm Hg

Oxygen saturation : 97%

Pain : Severe pain

4.1.3 ANTHROPOMETRIC MEASUREMENT:

Height : 157 cm

Weight : 38 kg

4.1.4 MENTAL STATUS:

Consciousness : increased in confusion,partially oriented

Look : Dull and drowsy

4.1.5 POSTURE:
Movement : Drowsy, not able to walk properly

4.1.6 SKIN CONDITIONS:

Color : White in complexion

Texture : Dry

Temperature : Normal

Hydration : Moderate

4.1.7 HEAD AND FACE:

Scalp : No dandruff and pediculosis is present

Facial : Puffiness

4.1.8 EYES:

Eye brows : Equally distributed

Eye muscles : Normal

Lens : Transparent

Vision : Normal vision

Pupils : Reacting to light

Sclera : Normal

4.1.9 EARS:

External ears : No discharges, normal in alignment

Hearing acuity : Normal

4.1.10 NOSE:

External nose : No discharges

Nostrils : No septal deviation

Nasal septum : Midline

4.1.11 MOUTH:

Tongue : Pale, dry

Lips : Dry and cracks

Odour : No bad smell

Teeth : White in color, No dental caries

Gums : Normal

Mucus membrane : No discharges

4.1.12 NECK:

Range of motion : Normal

Lymph nodes : No enlargement

Thyroid gland : No enlargement

4.1.13 THORAX:

Chest : Symmetrical chest wall movements present

4.1.14 ABDOMEN:

Umbilicus : Clean

Appetite : loss of appetite

Bowel sounds heard in all four quadrants.

4.1.15 EXTREMITIES:

 Range of motion is restricted due Knee pain age related factor

 Both the extremities are symmetrical

4.1.16 BACK AND SPINE:

 Normal curvature
 No abnormality found.

4.1.17 GENITALIA : Normal

4.1.18 ELIMINATIONS:

Voiding : Normal

Discharges : No discharges

Colour of urine : yellow present.

4.1.19 RECTUM AND ANUS:

Bowel elimination : passes stool one time a day

INFERENCE:

Through this physical examination the following findings were identified.

 Bowel sounds heard in all four quadrants.

 Muscle cramps present.
 Severe head ache also present

4.2 SYSTEMIC ASSESSMENT:

4.2.1 CENTRAL NERVOUS SYSTEM:

  Confused and disoriented
 Normal reflexes

4.2.2 CARDIO-VASCULAR SYSTEM:

Inspection : symmetrical chest wall movements present.

Auscultation : S1 S2 heart sounds heard.

No murmur.

Heart rate: 72 beats per minute.

Rhythm: Regular

Palpation : Pulse rate: 84 beats per minute.

Blood pressure: 150/100 mm Hg.

4.2.3 RESPIRATORY SYSTEM:

Inspection : Respiratory rate: 22 breaths per minute.

Symmetrical chest wall movements present.

Auscultation : Bilateral air entry present and NVBS heard.

Percussion : No excessive air collection is present.

4.2.4 GASTRO-INTESTINAL SYSTEM:

Inspection : No scar and abdominal distension

Auscultation : Bowel sounds heard in all four quadrants.

Palpation : Pain over right lumbar region present.

Percussion : Dullness over right lower abdomen present.

4.2.5 GENITO-URINARY SYSTEM:

Inspection : There is no insertion of Foleys catheter

Auscultation : No murmurs on right and left side of the upper abdomen

Palpation : There is no pain in the lumbar region.

Percussion : Dullness over supra pubic region present.

4.2.6 MUSCULO-SKELETAL SYSTEM:

 Edema present in the legs.

 Range of motion is restricted due to Acute mono arthritis . Both extremities are
symmetrical.
 Capillary refilling time is less than 4 seconds

4.2.7 INTEGUMENTARY SYSTEM:

Inspection : Dry, pallor, no cyanosis and no lesions.

Palpation : Warm.

4.2.8 LYMPHATIC SYSTEM:

 No lymph nodes enlargement

4.2.9 ENDOCRINE SYSTEM:

 No thyroid gland enlargement

INFERENCE:

 Severe head ache is present. Not fully oriented.

 Dullness over supra pubic region present
 5. INVESTIGATION:

S.NO. INVESTIGATIONS BOOK’S PICTURE CLIENT’S REMARKS

REPORT
1. Complete blood count:
TC 4500 – 11000 18,000 Elevated
cells/minute cells/minute
DC P50 – 70% E2 – 4% P67% L 21% E6% Normal
HB L20 – 30% 9 g/dl Decreased
ESR 13.5 – 16.5 g/dl 26mm/hr Elevated
Platelets 0 – 15 mm/hr 2.2lakhs/minute Normal
Renal function test: 2 – 4 lakhs/minute Normal
Blood sugar 80 – 120 mg/dl 117 mg/dl Normal
2. Urea 17 – 40 mg/dl 19.62 mg/dl Normal
Creatinine 0.5 – 1.5 mg/dl 1.6 7 mg/dl Increased
Sodium 135 – 145 mEq/L 98 mEq/L Decreased
Potassium 4.5 – 5 mEq/L 3.1 mEq/L
Liver function test: 0.90mg/dl Normal
Bilirubin 0.3– 1mg/dl 41.94U/L Elevated
SGOT 10– 40 U/L 17.73U/L Normal
3. SGPT 5– 40 U/L 6.78 g/dl Normal
T. Protein 5 - 8 g/dl 3.93 g/dl Normal
Albumine 3.5 – 5 g/dl 2.3g/dl Decreased

4. Coagulation profile:
PT (INR) 1-18 seconds 14.1(1.14) sec Normal
aPTT 28-38 seconds 28.4 seconds Normal
6. MEDICATION CHART:

Drug name Dosage / Action Contra indication Side effect Nurses

Frequency responsi
route bility
Inj. 1g / bd / IV Cefoperazone is an  Diarrhoea Diarrhea, Monitor
Cefaperazone antibiotic. It works from an infection Abnormal for
+Sulbactum by preventing the with Clostridium liver diarrhea,
formation of the difficile bacteria. function Inform
bacterial protective  Low tests, the
covering which is vitamin K levels. Allergic patient
essential for the reaction, regarding
 A decrease
survival of bacteria. Anemia any skin
in the blood
Sulbactum is a beta- (low rashes,
clotting protein
lactamase inhibitor number of fever.
prothrombin.
which reduces red blood
 Increased
resistance and cells).
risk of bleeding
enhances the
due to clotting
activity of
disorder.
Cefoperazone
against bacteria.  alcohol
intoxication.

 inflammatio
n of the large
intestine.

 liver
problems.
Inj. 1g / BD/ IV Paracetamol has a Severe hepatic Nausea, Monitor
Paracetamol central impairment, or Acute renal liver
analgesic effect that severe active Tubular function
is mediated through hepatic disease. necrosis, test,
activation of Liver Watch
 descending damage for any
serotonergic rashes
pathways. Debate over the
exists about its body
primary site
of action, which
may be inhibition of
prostaglandin (PG)
synthesis or through
an active metabolite
influencing
cannabinoid
receptors.
Inj. 40mg / bd / IV Pantoprazole is Pantoprazole is co Diar Monitor
Pantaprozole used to treat certain ntraindicated in rhea from vital
stomach and patients with a an infection signs,
esophagus problems history of with Monitor
(such as acid hypersensitivity to Clostridium electrolyt
reflux). It works by the drug itself, to difficile e
decreasing the components of the bacteria. imbalanc
amount of acid your formulation, and/or inad e
stomach makes. other equate
This medication reli benzimidazole . vitamin
eves symptoms such B12.
as heartburn,
 Low
difficulty
amount of
swallowing, and
magnesium
persistent cough.
in the
blood.

 a
type of
 kidney
inflammatio
n called
interstitial
nephritis.

 suba
cute
cutaneous
lupus
erythematos
us.

 syste
mic lupus
erythematos
us, an
autoimmune
disease.
Tab. 2.5 mg oral Bendroflumethiazid  sympathect Feeli Advised
ng thirsty,
Bendroflumet e, a thiazide omy. the
with a dry
hizide diuretic, removes  diabetes. mouth. patient to
excess water from  increased  take lot
 Feeli
the body by activity of of water
ng or being
increasing how the sick (nausea to
or
often you urinate parathyroid prevent
vomiting)
(pass water) and gland.  Sto dehydrati
also widens the mach pain. on.
 high

blood vessels which cholesterol. Advised
 Diar
helps to reduce  a type of rhoea. to take
blood pressure. It joint  high
inhibits  Loss fiber
disorder of appetite.
Na+/Cl- reabsorption due to diet.
from the distal excess uric Advised
convoluted tubules acid in the  Con to take
stipation
in theKidney blood called adequate

gout.  Seve rest
 low amount re joint
pain.
of

magnesium Feeli
in the ng dizzy
and faint.
blood.

 high
amount of
calcium in
the blood.
 low amount
of sodium
in the
blood.
9. NURSING PROCESS APPLICATION

9.1 Nursing Diagnosis:

1. Acute pain related to inflammation of joint as evidenced by reports of pain.

2. Impaired physical mobility related to neuromuscular skeletal impairment evidenced by

inability to move purposefully within the physical environment.

3. Risk for infection related to septic arthritis as evidenced by client says having temperature.

4. Impaired skin integrity related to surgical repair as evidenced by client says that itching and
numbness present near to surgical site.

5. Activity intolerance related to joint pain.

6. Self care deficit related to musculoskeletal impairment as evidenced by inability to carry out
proper personal hygiene.

7. Deficient knowledge related to lack of exposure as evidenced by frequently asking questions.

8. Fear and anxiety related to disease progress as evidenced by patient’s verbalization.

9. Imbalanced nutrition less than body requirements related to loss of appetite.

10. Severe pain associated with distention of tissue by the inflammatory process.

11.  Impaired Physical Mobility associated with skeletal deformities, pain, discomfort, and
decreased muscle strength.
 9.2 Nursing care plan

Assess Nursing Goal Intervention Implementation Rationale Evaluatio

ment diagnosis n

Subject Monitor Monitored Increased

ive temperature temperature hourly body
data: every hour for and it maintains temperature
Patient increase in 99’f to 100’f. will destroy
says temperature. the cells.
that she Risk for Keep the Windows kept
is infection To reduce the windows opened and fan Helps to cool
having related to temperature open, and use also switched on. the
increas traumatized the fan. atmosphere.
ed body tissue as Tepid sponging
tempera evidenced by Sponge the given. It helps to
ture client says patient with bring down Patient’s
having running tap the body
temperature water (tepid Removed excess temperature. temperatur
sponging). clothing’s. Exposing skin e returned
Eliminate to room air to normal
excess decreases temperatur
clothing and Oxygen kept ready warmth and e 98.8’f.
covers. with mask increases
evaporative
Objecti Ready oxygen cooling
ve therapy. Hyperthermia
data: Tab. Dolo 650 increases the
Vitals given per orally metabolic
checke demand for
d oxygen.
tempera Antipyretic
ture is medications
99’f lower body
temperature.

. Discuss Discussed to the It helps in

Subject patient’s patient. planning the
ive fatigue and care.
data: identity
Patient activities that
express Impaired produce
that shephysical fatigue. Monitored vital Provide
is not mobility signs, checked for baseline for
able to related to Monitor pallor. increasing
do his neuromuscular To improve limitations, activities and Improved
daily skeletal activity provisions for fatigue could the daily
activitie
impairment within her activity, signs be due to living
s. evidenced by capability. and symptoms circulatory activities.
inability to of fatigue Assisted the collapse.
move while doing patient in her daily
purposefully activities. living activities. It helps to
within the improve her
Objecti physical Assist patient Teaches the activities.
ve environment. with self-care patient passive
data: activities of exercise and
Patient daily living. encouraged to do Helps to
looks it own. conserve
dull Encourage Advised to take energy.
and adequate rest nutritious diet.
weak. and passive Helps to meet
exercises. the metabolic
needs
Encouraged
adequate
dietary
improvement.
 Assess for Assessed the The
Subject recent physiological consequences
ive changes in status of nutrition of
data: physiological by obtaining the malnutrition
Patient status that eating pattern. can lead to a
express may interfere further
ed that with nutrition. decline in the
she is Imbalanced Instructed the patient's
not nutrition less To improve Discourage patient not to take condition. Patient
feeling than body the fluid intake fluid in between consumes
to take requirements nutritional during meals the meals. In-between sufficient
food. related to loss status and and allow fluid intake amount
of appetite . improve the after the meal reduces food food.
appetite. is completed. Encouraged to intake.
take her take rich
Encourage to protein diet
take protein
Objecti rich diet Advised to split It helps to
ve the meals into six promote
data: Split the small units. eating habit.
Patient meals into six
looks small units The small
dull instead of units taken in
three large regular
ones. Patient is on intervals
vitamin tablets. reduce the
fullness
feeling and
Provide the risk of
energy vomiting.
supplements These
as per Dr’s supplements
advise have been
proven to
increase
weight
Subject
ive Assess for Massage that area To increase blood
data: any skin slightly to improve circulation
Patient discoloration the blood circulation
express near to the
ed that Impaired skin surgical site. Improve
she is integrity To improve Bed sheet is tucked To prevent d the
having related to the skin Assess for properly without pressure sore circulati
numbne surgical repair integrity any wrinkles wrinkles. on
ss. as evidenced in the bed
by client says cover. Patient Position is To improve the
that itching changed often circulation
Objecti and numbness Assess for
ve present near to the position
data: surgical site. which is
She is suitable for
scratchi the patient. Early ambulation is
ng near preferred
to
surgery Assess for
site early
ambulation

Subject Future Internal fixation Explained about

ive expectation devices can the surgery as
data: about ultimately well as when the
Patient ambulation compromise the implant can be Patient
express bone’s strength it removed. kept
ed that Fear and To reduce the Encourage can be removed Improve the comfort
she is anxiety related anxiety and the patient to later stage mobility able
having to disease fear about the continue position
so progress as disease active Prevents joint
much evidenced by exercise for stiffness,
of patient’s the joints contractures, and Discoloration of
questio verbalization muscle wasting, skin watched to
ns promoting earlier prevent
about Identify the return to complications
disease signs and independence in
 symptoms activities of daily Grooming is
for patient living encouraged to
for further kept comfortable
treatment. Prompt intervention
Recommend may reduce the To improve
for proper severity of muscle strength
clothing complications such
Objecti as infection or
ve impaired circulation
data: Discuss the
She dietary needs Facilitates dressing
looks and grooming
dull activities.

A low-fat diet with

adequate quality
protein and rich in
calcium promotes
healing and general
well-being.
Subject Assess Return of color Assessed for the
ive capillary should be rapid (3–5 Capillary return
data: return, skin sec). White, cool
Patient color, and skin indicates
express warmth arterial impairment.
ed that Risk for To improve distal to the Cyanosis suggests Early ambulation
not able neurovascular neurovascular fracture. venous impairment.  is encouraged
to dysfunction function
move related to Investigate There is an
the legs tissue trauma. tenderness, increased potential
its swelling, for thrombo Assessed for the
heavy pain on phlebitis and extremity is for
dorsiflexion pulmonary emboli the edema
of the foot in patients immobile
for several days. 
Assess the
entire length An increasing
of injured circumference of the Checked the
extremity for injured extremity peripheral pulse
swelling or may suggest general for circulatory
edema tissue swelling or status
Objecti formation. edema but may
ve reflect hemorrhage. 
data: Evaluate the
Edema presence and A decreased or Vitals checked
is quality of absent pulse may and recorded
present peripheral reflect vascular
pulse distal injury and
to injury via necessitates
palpation or immediate medical
Doppler. evaluation of
circulatory status.
Monitor vital
signs. Note
signs of Inadequate
general circulating volume
pallor, compromises
cyanosis, systemic tissue
cool skin, perfusion.
changes in
mentation.
Subject Self care Encourage To improve the self Encouraged them
ive deficit related them to do confidence to do their daily
data: to their daily activities
Patient musculoskelet activity
says al impairment Encourage Encouraged the
that she as evidenced the patient To improve the patient to take
is not by inability to take a good elimination pattern rich in fibre diet
able to carry out fibre and
do proper protein rich To prevent
work. personal diet dehydration Encouraged the
hygiene. Encourage patient to take
the patient to plenty of water to
take prevent hydration
adequate
water to Divert her mind to
prevent over come out of Provided musical
hydration disease therapy to divert
Encourage her mind .
Objecti the patient to
ve divert her
data: mind from
thinking
Very about disease
difficult
to
move
one
place to
another
10. NURSING THEORY APPLICATION:

LYDIA E. HALL NURSING THEORY:

As Hall (1965) says; “To look at and listen to self is often too difficult without the help of a
significant figure (nurturer) who has learned how to hold up a mirror and sounding board to
invite the behaver to look and listen to himself. If he accepts the invitation, he will explore the
concerns in his acts and as he listens to his exploration through the reflection of the nurse, he
may uncover in sequence his difficulties, the problem area, his problem, and eventually the threat
which is dictating his out-of-control behavior”.

MAJOR CONCEPTS:

The individual human who is 16 years of age or older and past the acute stage of a long-term
illness is the focus of nursing care in Hall’s work. The source of energy and motivation for
healing is the individual care recipient, not the health care provider. Hall emphasizes the
importance of the individual as unique, capable of growth and learning, and approach.
Health can be inferred to be a state of self-awareness with conscious selection of behaviors that
are optimal for that individual. Hall stresses the need to help the person explore the meaning of
his or her behavior to identify and overcome problems through developing self-identity.
The concept of society/environment is dealt with in relation to the individual. Hall is credited
with developing the concept of Loeb Center because she assumed that the hospital environment
during treatment of acute illness creates a difficult psychological experience for the ill individual
(Bowar-Ferres, 1975). Loeb Center focuses on providing an environment that is conducive to
self-development. In such a setting, the focus of the action of the nurses is the individual, so that
any actions taken in relation to society or environment are for the purpose of assisting the
individual in attaining a personal goal.

Nursing is identified as consisting of participation in the care, core, and cure aspects of patient
care.
METEPARADIGM:
Sl. No Four major concepts Explanation by Lydia H. Hall

1 Individual or person The individual human who is admitted in hospital

for treatment of “Acute glomerular Nephritis” focuses on
nursing care in Hall’s work. The source of energy and
motivation for healing is the individual care recipient, not
the health care provider. Hall emphasizes the individual’s
importance as unique, capable of growth and learning, and
requiring a total person approach.

 Maintain ABC of the patient.

 Provide supplemental oxygen therapy to the patient.

 Do not deliver more than 2 lt. of oxygen per minute

if person has history of chronic pulmonary diseases.

 Monitor for ABG value to assess the patient

response to oxygen therapy.

 Continuous monitoring of vital signs should be

done.

 Check for urine output of the client.

 Maintain nutritional status of the patient.

Administer prescribed medication to the patient.

Give psychological support to the patient and the relatives

2 Health Health can be inferred as a state of self-awareness with a

conscious selection of optimal behaviours for that
individual. Hall stresses the need to help the person explore
the meaning of his or her behaviour to identify and
overcome problems through developing self-identity and
 maturity.

 Give comfortable position.

 Keep the patient warm and monitor temperature

hourly.

 Administer intravenous fluids as ordered.

 Monitor urine output.

 Administer oxygen as ordered.

3 Society or The concept of society or environment is dealt with

environment concerning the individual. Hall is credited with developing
Loeb Centre’s concept because she assumed that the
hospital environment during treatment of acute illness
creates a difficult psychological experience for the ill
individual. Loeb Centre focuses on providing an
environment that is conducive to self-development. In such
a setting, the focus of the nurses’ action is the individual.
Any actions taken concerning society or the environment
are to assist the individual in attaining a personal goal.

 Consult nutritionist for recommendations about

diet.

 Provide psychological support

 Assist for daily living activities

4 Nursing Nursing is identified as participating in the care, core,

and cure aspects of patient care.

 Take precautions to prevent nosocomial infections.

 Wash hands frequently.

  Use aseptic techniques.

 Monitor the extent of fluid retention.

 Monitor daily weight of the patient.

 Determine the severity of oedema

 Watch for elevation in central venous pressure

10.1CONCEPTUAL FRAME WORK:

11. JOURNAL PRESENTATION:

Name of the topic : Occurrence and relative risk of stroke in incident and prevalent
contemporary rheumatoid arthritis

Name of the Author : Holmqvist M, Gränsmark E, Mantel A, Alfredsson L, Jacobsson LT,

Wallberg-Jonsson S, Askling J

DOI: 10.1136/annrheumdis-2012-201387

Abstract

Objective: In contrast with the wealth of data on ischaemic heart disease in rheumatoid arthritis
(RA), data on stroke are scarce and contradictory. Despite the high clinical and aetiological
relevance, there is no data regarding when (if ever) after RA diagnosis there is an increased risk.
Our objective was to assess the risk of stroke (by subtype) in contemporary patients with RA,
particularly in relation to time since RA diagnosis.

Methods: One incident RA cohort diagnosed between 1997 and 2009 (n=8077) and one
nationwide prevalent RA cohort followed at Swedish rheumatology clinics between 2005 and
2009 ((n=39 065) were assembled). Each cohort member was matched to a general population
comparator. Information on first-time hospitalisations for stroke up to 2009 was retrieved from
the Swedish Patient Register. HR and 95% CI were estimated using Cox models.

Results: In prevalent unselected RA, the HR of ischaemic stroke was 1.29 (95% CI 1.18 to
1.41). In the incident RA cohort, the overall risk increase was small and non-significant (overall
HR 1.11, 95% CI 0.95 to 1.30). When stratified by RA disease duration, an increased risk of
ischaemic stroke was indeed detectable but only after 10 or more years since RA diagnosis
(HR>10 years: 2.33, 95% CI 1.25 to 4.34). Risk of haemorrhagic stroke was increased in
prevalent but not in incident RA.

Conclusion: The magnitude of stroke risk is lower than for ischaemic heart disease in RA, and
the evolvement of this risk from RA diagnosis may be slower. This suggests different driving
forces behind these two RA co-morbidities and has implications for the clinical follow-up of
patients with RA.

CONCLUSION:

By doing this nursing case study I have learnt more about “ACUTE MONO ARTHRITIS” and I
am able to give comprehensive nursing care to the client. The client also gained more knowledge
about the disease and ways to get out of the discomfort. I can provide proper care and
psychological support for this type of patients in future.

12. BIBLIOGRAPHY:

12.1 Book Refference:

 Bare G. Brenda and Suzzane C. Smeltzer (2012), “Brunner and Suddarth’s Textbook of
Medical and Surgical Nursing”, 12th edition, Philadelphia Lippincott Williams and
Nilkins, 1314 – 1316.
 Joyce Black, Jannatekanson Hawks (2005), “Textbook of Medical and Surgical Nursing”,
7th edition, Missouri Elsevier Inc., 1112 - 1114.
 Lewis (2015), “A Textbook of Medical and Surgical Nursing”,7th edition, westline
industries, New York, 781- 783.
 Brunner and Siddharth’s (2009). Textbook of medical surgical nursing, edition 13th
published by Lippincott publishers, Pg.no (216 – 234)
 Joyee M Black and Hawks J.H. (2009). Medical and Surgical nursing clinical
management for positive outcomes, edition 7th, Pg.no (2443 – 2477)
 Lewis (2013). Medical – Surgical Nursing, edition 3rd, Elsevier publications, New Delhi,
Pg.no (248 – 286)
 Saunders (1977). Manual of nursing practice, 1st edition, published by W.B. Saunders,
Pg.no (364 – 380)
 American academy of orthopaedic surgeons, emergency, care and transportation of the
sick and injured published by Jones and Barlett, 7th edition printed in1998, Pg.no (541 –
550)
  Smeltzer C. Suzanna, Bare G Brenda, Brunner and Suddath, (2004). Text book medical
surgical nursing,10th edition, Philadelphia, Pg.no (84 – 90)
 Lgnatavicius D Donna, Workman Linda M. Misher Marry A, Medical Surgical Nursing –
nursing approach. Vol – 1, edition 2nd, USA, Saunders company, 1995, Pg, no 102 – 103
 Bourgeois, M. S., & Hickey, E. (2011). Dementia: From Diagnosis to Management – A
Functional Approach. New York: Taylor & Francis.
 Grifka, J., & Ogilvie-Harris, D. (2012). Osteoarthritis: Fundamentals and Strategies for
Joint-Preserving Treatment. New York: Springer Science & Business Media.
 Izzo, J. L., & Black, H. R. (2003). Hypertension Primer: The Essentials of High Blood
Pressure. New York: Lippincott Williams & Wilkins.
 Kilmartin, A. (2002). The Patient’s Encyclopaedia of Urinary Tract Infection, Sexual
Cystitis and Interstitial Cystitis. Boston: Angela Kilmartin.
 Moskowitz, R. W. (2007). Osteoarthritis: Diagnosis and Medical/Surgical
Management. New York: Lippincott Williams & Wilkins.

12.2 Journal Refference:

 Maetzel, A., Mäkelä, M., Hawker, G., & Bombardier, C. (1997). Osteoarthritis of the hip
and knee and mechanical occupational exposure--a systematic overview of the
evidence. The Journal of rheumatology, 24(8), 1599-1607.
 Hart, D. J., & Spector, T. D. (1993). The relationship of obesity, fat distribution and
osteoarthritis in women in the general population: the Chingford Study. The Journal of
rheumatology, 20(2), 331-335.
 Wolfe, F., Altman, R., Hochberg, M., Lane, N., Luggan, M., & Sharp, J. (1994). Post
menopausal estrogen therapy is associated with improved radiographic scores in OA &
RA. Arthritis Rheum, 37(Suppl 9), S231.
 Hellgren, K., Smedby, K. E., Feltelius, N., Baecklund, E., & Askling, J. (2010). Do
rheumatoid arthritis and lymphoma share risk factors?: a comparison of lymphoma and
cancer risks before and after diagnosis of rheumatoid arthritis. Arthritis and
rheumatism, 62(5), 1252–1258. https://doi.org/10.1002/art.27402
12.3 Net Refference :

http://www.aafp.org

http://www.ncbi.nlm.nih.gov

http://www.uptodate.com