Arthritis nursing rounds record

Currently, priority is given to adjusting non-drug intervention programs + optimizing pain management pathways. The original dosing regimen of 10 mg of methotrexate per week as a slow-acting antirheumatic drug will not be adjusted for the time being. Special one-on-one education is needed to address three misunderstandings in home care for patients and their families.

Just after the ward rounds, the whiteboard at the nurse station still recorded the aunt's VAS pain scores for the past three days: 4, 5.5, 4.5, which has dropped a lot from the 7 points when she was admitted to the hospital, but it was still stuck on the moderate pain line. Morning stiffness lasted for about 30 minutes in the morning. The aunt always said that when she first got up, her knees were as hard as if she had poured cold paste, and she had to clench her fists and rub them for a long time before she could move.

The first thing discussed was the issue of family members continuing to apply hot compresses to the affected area. This happened to be a controversial point in the industry: Colleagues in the rehabilitation team often mentioned that warm compresses can relax muscles and relieve stiffness during the stable phase of chronic arthritis. Why can't they be used now? The attending doctor Liu Lei pointed to the joint ultrasound report that had just come out. There was 1.2cm of fluid in the suprapatellar bursa, and the skin temperature of the affected limb was 0.8 degrees higher than that of the unaffected side. It belonged to the acute attack stage of synovitis. According to the consensus of the sports medicine group, cold compress can reduce leakage and relieve swelling and pain at this stage. The two views are not contradictory. , but the application scenario is not correct - if there is no effusion and only joint stiffness and coldness, hot compress is absolutely fine. We are even encouraged to wear thin cotton knee pads every day to keep warm. However, hot compress is not helpful in the acute stage. Yesterday, the family secretly applied a hot water bottle for half an hour. Today, the swelling is 2mm higher than yesterday.

The pain management plan has also been fine-tuned. Previously, celecoxib was only given when the pain was above 5 points. Patients were always afraid that taking medicine would hurt their stomach, so they would not take it until they couldn't help it. On the contrary, the pain made it difficult to sleep and affected their recovery. This time it was changed to regular administration. Take half a pill of celecoxib after breakfast, and apply it with topical ketoprofen gel 3 times a day. When applying, massage until it is completely absorbed. Don't just apply a layer of it and it's done. Li Min, the responsible nurse, interjected. Another aunt I took care of last month also always found it troublesome to apply medicine. She only remembered to apply it when it hurt, and the effect was at least 30% worse. There is no need to pursue complete painlessness here. The pain can be stabilized below 3 points and does not affect eating and sleeping. Taking too much medicine will easily cause gastrointestinal reactions, which is not worth the loss.

The silent squat training previously arranged for my aunt has also been stopped. She is always afraid that she will not be able to do it properly. She will squat with her knees past her toes, which will put extra burden on the joints. Now she has switched to more gentle ankle pumps and straight leg raises, 15 times each, 3 groups a day. Sister Wang, the nurse in charge, specifically mentioned that last year there was a 70-year-old patient who heard from a square dance partner that "the more the joints hurt, the more they have to be worn. Just grind the bone spurs away." She walked 5,000 steps a day, and the cartilage peeled off in half a month. Finally, she had a joint surgery. I have to clean my mirror, but I have suffered an old crime. This time I have to break the widespread rumors and tell them clearly - don't climb stairs, don't squat, don't walk with a heavy load, and leave tasks such as shopping for groceries and walking to family members for the time being. If you really want to move, wait until the pain subsides.

Auntie usually likes to use Tik Tok, and the missionary education does not use the previous method of reading manuals. Instead, she found a short home care video in dialect produced by our department. The printed manual was specially changed into large fonts, and the key contents were circled in red pen. The family members were also taught: Don’t buy online Those amazing magnetic therapy knee pads are so tight that they constrict the legs and affect blood circulation. Just buy ordinary cotton knee pads, which are enough to keep warm. Wear soft-soled shoes with a heel of about 2cm. Don't wear slippers all day long. Don't let the cold wind blow directly on your knees when the air conditioner is turned on in summer.

Her VAS score and joint mobility will be re-evaluated after 3 days. If the pain drops below 3, the duration of morning stiffness is less than 15 minutes, and the erythrocyte sedimentation rate is stable at the current level, discharge can be arranged. After discharge, she will be followed up by phone once a week for 1 month. If there are any problems, she can come to the outpatient clinic to adjust the plan at any time. Before leaving, the aunt asked Dr. Liu if he could do a slow-paced square dance. Dr. Liu smiled and said that of course he could wait until the pain subsides, but just don’t do that jumping dance.