Management / Treatment of Rheumatoid Arthritis

Management / Treatment of Rheumatoid Arthritis

Therefore, the exact cause of rheumatoid arthritis is unknown, there is no causative treatment that can cure this disease. This should really be explained to patients so that it knows that the treatment is given aimed at reducing complaints / symptoms slow the progression of disease.

The main objective of the program management / treatment of Rheumatoid Arthritis, as follows:

• To relieve pain and inflammation
• To maintain joint function and the maximum capability of the patient
• To prevent and or correct deformity that occurs in the joints
• Maintain independence so it does not depend on others.

There are a number of ways that management deliberately designed to achieve the objectives mentioned above, namely:

1. Education

The first step of this management program is to provide adequate education about the disease to the patient, family and anyone associated with the patient. Education will include understanding the pathophysiology (disease course), the cause and the estimated trip (prognosis) of this disease, all components of program management including complex drug regimens, sources of help to overcome this disease and effective method of management provided by health team . This education process should be carried out continuously.

2. Rest

Is important because of rheumatism, usually accompanied by severe fatigue. Although fatigue may arise every day, but there are times where patients feel better or heavier. Patients should be split into several times a day time activity time, followed by a period of rest.

3. Physical exercise and Thermoterapy

Specific exercises can be helpful in maintaining joint function. This exercise includes active and passive movements in all joints are sore, at least two times a day. Medication for pain relief should be given before starting the exercise. Hot compresses on the sore and swollen joints may reduce pain. Exercise and Thermoterapy is best regulated by the health workers who have received special training, such as a physical therapist or occupational therapist. Excessive exercise can damage the structure supporting the joints that are already weakened by the disease.

4. Diet / Nutrition

Rheumatic Patients do not require a special diet. There are a number of ways giving a diet with a variety of variations, but all of which has not been proven true. The general principle for obtaining a balanced diet is important.

5. Drugs

Drug delivery is an important part of the program management of rheumatic diseases. Drugs used to reduce pain, relieve inflammation and to try to change the course of the disease.

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Pathophysiology of Hypertension

Pathophysiology of Hypertension

Mechanisms that control the constriction and relaxation of blood vessels located in the vasomotor center, the medulla in the brain. Of the vasomotor center, the sympathetic nerve pathway begins, which continues down the spinal cord and the spinal cord out of the column to the sympathetic ganglia in the thorax and abdomen. Central vasomotor stimulation delivered in the form of impulse which moves downward through the sympathetic nervous system to the sympathetic ganglia. At this point, preganglionic neurons, releasing acetylcholine, which will stimulate post-ganglion nerve fibers to blood vessels, where the release of norepinephrine resulting in constriction of blood vessels. Various factors such as anxiety and fear can affect the response to stimuli vasoconstriction of blood vessels.

Individuals with hypertension is very sensitive to norepinephrine, although it is not clear why this could occur.

At the same time in which the sympathetic nervous system stimulates the blood vessels in response to emotional stimuli, the adrenal glands are also stimulated, resulting in additional vasoconstriction activity. Adrenal medulla secretes epinephrine, which causes vasoconstriction. Adrenal cortex to secrete cortisol and other steroids, which can strengthen the vasoconstrictor response of blood vessels. Vasoconstriction resulting in decreased flow to the kidneys, causing the release of renin. Renin stimulates the formation of angiotensin I is then converted into angiotensin II, a powerful vasoconstrictor, which in turn stimulates the secretion of aldosterone by the adrenal cortex. This hormone causes retention of sodium and water by kidney tubules, causing increased intra-vascular volume. All these factors tend to trigger a state of hypertension.

For consideration of Gerontology. Structural and functional changes in the peripheral vascular system are responsible for changes in blood pressure that occurs in the elderly. These changes include atherosclerosis, loss of elasticity of the connective tissue and a decrease in vascular smooth muscle relaxation, which in turn lowers the ability of distention and tensile strength of blood vessels. Consequently, the aorta and large arteries decreases its ability to accommodate the volume of blood pumped by the heart, resulting in decreased cardiac cheating and increased peripheral resistance. Pathophysiology of Hypertension (Brunner & Suddarth, 2002).

Hypertension Nursing Care Plan : Assessment, Diagnosis and Interventions

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Acute Pain Nursing Care Plan for Pyelonephritis

Pyelonephritis or a kidney infection usually caused by Escherichia Coli, a bacteria type that is found in the large intestine. This infection makes its way from the genital area through the urethra to the bladder, up the ureters and then it reaches the kidneys. Being more common in women than in men.

Pyelonephritis known that if a person has any physical obstruction to the flow of urine, like a kidney stone, an enlarged prostate, or the backflow of urine from the bladder into the ureters, it is very likely the risk of pyelonephritis to rise.

Persons with pyelonephritis might experience painful urination, tightly contraction of the abdomen muscles, one or both kidneys may be enlarged and tender, and cystitis symptoms can appear also. Usually, pyelonephritis starts suddenly, with pain in the lower part of the back on either side, fever, chills, nausea and vomiting, but very often, in children these symptoms are slight and difficult to recognize.

Nursing Care Plan for Pyelonephritis

Nursing Diagnosis for Pyelonephritis : Acute Pain related to inflammation and infection of the urethra, bladder and other urinary tract structures.

Evaluation criteria: no pain when urinating, no pain on percussion of the pelvis.

Nursing Interventions and Rational for Pyelonephritis

Independent

1. Monitor urine output to changes in color, odor and voiding pattern, input and output every 8 hours and monitor the results of repeated urinalysis.

Rational: To identify indications of progress or deviations from expected results.

2. Record the location, duration, intensity scale (1-10) the spread of pain.

Rational: To help evaluate the obstroksi and cause pain.

3. Provide comfort measures, such as back massage, environment, rest, sleep.

Rational: Increase relaxation, reduce muscle tension.

4. Help or encourage the use of focused relaxation breathing.

Rational: Helps to redirect attention and for muscle relaxation.

5. Give perianal care.

Rational: To prevent contamination of the urethra.

6. If mounted catheter, catheter care provided 2 times per day.

Rational: The catheter provides a way for bacteria to enter the bladder and up into the urinary tract.

Collaboration

1. Consul doctor if: previous urine yellow, ivory, yellow urine, dark orange, hazy or cloudy. Micturition pattern changes, frequent urination in small amounts, feeling the urge to urinate. Persistent pain or increasing pain.

Rational: These findings could signal further tissue damage and needs extensive examination.

2. Give analgesics as needed and evaluate its success.

Rational: Analgesic block the path of pain, thereby reducing pain.

3. Giving antibiotics. Create a variety of drink preparations, including fresh water. Provision of water to 2400 ml / day.

Rational: As a result of urine output makes it easy to urinate often and help flush urinary tract. 

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Ineffective Airway Clearance Nursing Care Plan for Tetanus

Tetanus is caused by gram positive, obligate anaerobic bacteria: Clostridium tetani which affects skeletal muscles."Gram positive" means that the bacteria has a thick cell wall, while "obligate anaerobe" means that the bacteria can't survive in the presence of oxygen and survive using anaerobic respiration (without oxygen).

Causes:
Bacterium Clostridium tetani.
Contamination of a puncture wound, e.g.: a piercing.
Ear infections as bacteria may enter through ear.
Using unsterile equipment in surgery or other similarly invasive procedures such as tattooing and body piercing.

Ineffective Airway Clearance related to the accumulation of sputum in the trachea and the respiratory muscles spame

Characterized by:
Ronchi,
Cyanosis,
Dyspneu,
Ineffective cough accompanied by sputum or phlegm, lab test results, Abnormal Blood Gas Analysis (respiratory acidosis)

Objective: Airway clearance is effective

Criteria:

- Clients are not congested, mucus, or none sleam
- Respiratory 16 -18 x / minute
- No breathing nostril
- No additional respiratory muscle
- The results of laboratory examination of blood: Blood Gas Analysis in the normal range (pH = 7.35 to 7.45; PCO2 = 35-45 mmHg, pO 2 = 80-100 mmHg)

Nursing Interventions Ineffective Airway Clearance Nursing Care Plan for Tetanus:

1. Clear the airway by adjusting the position of head extension
Rational: The anatomy of the head position of the extension is a way to align the respiratory cavity so that the process of respiration remains smooth to get rid of airway obstruction.

2. Physical examination by auscultation listening to breath sounds (there Ronchi) every 2-4 hours.
Rational: Ronchi indicate a problem caused by upper respiratory fluids or secretions that covered most of the respiratory tract that is necessary to issue, to optimize the airway.

3. Clean the mouth and airways of secretions and mucus by suction
Rational: Suction is an act of assistance to remove secretions, thus simplifying the process of respiration.

4. oxygenation
Rationale: The provision of oxygen in adequat can supply and provide backup oxygen, thus preventing the occurrence of hypoxia.

5. Observation of vital signs every 2 hours
Rational: Dyspneu, cyanosis is a sign of breathing disorder which is accompanied by decreased cardiac work and capilary tachycardia arising refill time prolonged / long.

6. Observation of the onset of respiratory failure.
Rational: The inability of the body in the process of respiration required critical interventions using tools breathing (mechanical ventilation)

7. Collaboration in drug delivery thinning secretions
Rational: Drug-thinning secretions could dilute the thick secretions that facilitate spending and prevent viscosity.

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