Arthritis nursing rounds record

The original twice-daily medium-frequency electrotherapy intervention was suspended and changed to once a day, fixed in the afternoon when the inflammation level was relatively stable.； Added care measures to raise the lower 1/3 of the calf 15° during sleep at night ； The original general arthritis health education list was replaced with personalized contraindication guidelines for the active stage of rheumatoid arthritis, and the remaining care paths (supervision of oral medication compliance, guidance of quadriceps isometric training) remained unchanged.

When she pushed the ward door open, Aunt Zhang was frowning and rubbing her knees. Her pajama sleeves were rolled up to her elbows, and her knuckles were a little swollen. Her first words when she saw us were, "I finished the electrotherapy yesterday morning. When I woke up this morning, my legs were as hard as frozen pipes. It took me a long time to put on my socks."

Responsible nurse Xiao Zhou was stunned for a moment. The 7 patients with simple knee osteoarthritis she had previously used the twice-daily medium-frequency regimen. Most reported that the pain was less severe. This time, the special situation of the patients with active rheumatoid disease was not taken into account. The blood test results just came out yesterday showed CRP42mg/L, 6 times higher than the upper limit of normal. The duration of morning stiffness was stable at about 70 minutes, indicating that they were in the stage of high inflammation.

Rheumatology specialist nurse Sister Li took out her nursing notes at this time and turned to a similar case from last year: "There was a patient in the previous two beds who had exactly the same situation as hers. She was also in the active stage of osteoarthritis combined with rheumatoid arthritis. When she first came here, we followed the usual osteoarthritis care routine of doing medium frequency twice a day. After 3 days, her knees were so swollen that she could not bend 30 degrees. Later, she changed to doing it once a day at around 3 pm. At that time, after most of the day's activities, the local inflammation was not as severe as in the morning. In addition, she was given ice for 10 minutes after the exercise. Half of the swelling disappeared in 3 days, and the morning stiffness was shortened. ”

The intern nurse who was following the ward round suddenly interrupted and said that during the rotation in the orthopedics department, the teacher said that patients with arthritis should not rest their legs casually, for fear of causing flexion contracture of the knee joint in the long run. After hearing this, the head nurse smiled, waved her hand, and pulled out the patient's knee X-ray: "The patient you are talking about is a patient with advanced osteoarthritis who already has flexion deformity. It is true that he cannot put anything under the popliteal fossa for a long time. But now Aunt Zhang suffers from severe swelling during active periods and poor venous return. Putting a pillow on the middle and lower third of the calf, not the popliteal fossa, can not only help eliminate edema, but also urge her to do knee joint straightening training three times a day for 10 minutes each time during the day, and there will be no contracture problem at all. After adding this care to the patient I managed last year, his morning stiffness was shortened by an average of 20 minutes, and the effect was more obvious than applying Voltaren once more. ”

Speaking of the issue of health education, Aunt Zhang’s son happened to come in with a thermos bucket. He heard what we were talking about and answered the question, saying that he had just bought two boxes of heating knee warmers for his aunt a few days ago and planned to let her wear them when she goes to bed at night. We quickly stopped him. In the health education list adjusted this time, the taboos during the activity period were specially marked with red pen: Do not soak your legs in water above 40 degrees Celsius for a long time, do not apply heating plasters, do not deliberately walk more and exercise more, and slowly increase the amount of activity after the inflammation is under control. We have encountered a confused patient before who walked 10,000 steps every day during the active period. The inflammation that could have been suppressed in a week did not subside for a month, and he ended up staying in the hospital for half a month longer.

We tried the height of the pillow for Aunt Zhang on the spot, and used an ordinary ward cotton pillow to put it under her calf. She shook her leg and said, "It's really more comfortable than before, and it's not so bloated." Xiao Zhou wrote down the adjusted nursing measures on the nursing record sheet on the spot, and also specially marked the time of electrotherapy with a red pen, so as not to forget it when he was busy.

When he was walking to the nurse's station after the ward rounds, Xiao Zhou was still flipping through the rheumatism nursing specialist manual, saying that he had not mastered the key points of nursing for comorbidities in detail before. Oh, by the way, we also specially added a daily monitoring item to Aunt Zhang's care sheet, recording her morning stiffness duration and pain VAS score every morning, and reassessing her after 3 days. If the effect is not good, she will need to adjust again. After all, there are no hard-and-fast standards in nursing care. It is only useful to follow the actual situation of the patient.