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HESI Case Study Meet the Client: Terry Bames Terry Barnes a 35-year-old mother | Rheumatoid Arthritis with Joint Arthroplasty : Terry Barnes (complete solution guide answered by expert tutors) Latest 2020/2021$17.49
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HESI Case Study Meet the Client: Terry Bames Terry Barnes a 35-year-old mother | Rheumatoid Arthritis with Joint Arthroplasty : Terry Barnes (complete solution guide answered by expert tutors) Latest 2020/2021
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Course
NURS 111 (NURS111)
Institution
Rasmussen College
Rheumatoid Arthritis with Joint Arthroplasty Instructions Meet the Client: Terry Barnes Terry Barnes, a 35-year-old mother of three young children, visits the healthcare clinic. She reports experiencing increasing bilateral joint pain, especially in her hands, wrists, and knees. She also reports in...
Terry Barnes, a 35-year-old mother of three young children, visits the
healthcare clinic. She reports experiencing increasing bilateral joint pain,
especially in her hands, wrists, and knees. She also reports increasing
fatigue and a weight loss of 5 pounds over the last 2 months. She states
she has been taking a couple of aspirins a day, but the joint pain is
increasing, and she is hesitant to take more medication without a medical
evaluation. She appears tense and anxious, and states that she is upset
because it is becoming increasingly more difficult to do all the little things
necessary to care for her three children. She states, "I'm too young to have
arthritis. That's something you get when you're old." Terry's initial medical
diagnosis is rheumatoid arthritis, and she is scheduled for diagnostic
evaluation.
Diagnostic Evaluation
Terry is scheduled for a CBC (complete blood count), RF (rheumatoid factor), ESR
(erythrocyte sedimentation rate), joint x-rays, and a bone scan. Additional diagnostic tests,
which may be performed to help diagnose rheumatoid arthritis, include MRI and synovial
fluid analysis, or synovial biopsy.
1.
Which nursing intervention related to the scheduled bone scan is most important to
implement?
A) Ask the client if she has any internal metal devices.
INCORRECT
This is an important measure prior to an MRI, because the magnetic force may cause
movement of internal metal devices.
B) Assess the joint puncture site for signs of inflammation.
INCORRECT
This is an important intervention after synovial joint fluid analysis. Joint fluid for analysis is
obtained using sterile procedure, but the client should be monitored carefully after the
procedure for any signs of bleeding or infection at the site of the needle insertion.
, C) Advise the client that the test requires lying still in an enclosed cylinder.
INCORRECT
This is an important intervention prior to an enclosed MRI, since clients with claustrophobia
may have difficulty in an enclosed space.
D) Instruct Terry to increase fluid intake after the test.
CORRECT
Increasing fluid intake after a bone scan will help with elimination of the injected
radioisotope. Terry should also be instructed that because the dose of radioisotope is
minimal, no special precautions are necessary.
Etiology/Risk Factors
Terry's test results confirm the diagnosis of rheumatoid arthritis. Her CBC shows
normochromic anemia, her RF is positive, and her ESR is elevated. The x-rays and bone
scan show evidence of rheumatoid arthritis.
Terry is told of her diagnosis of rheumatoid arthritis (RA). She expresses confusion, and
states, "How did I get this? What is it? How long will I be like this?"
The nurse provides the following explanation:
Rheumatoid arthritis is an autoimmune disease affecting not only joints, but organ systems
as well. The symptoms of this inflammatory disease can often be controlled, but the disease
itself cannot be cured. It is a chronic, progressive disease that seems to affect women more
often than men.
2.
Which etiologic factor is related to the onset of rheumatoid arthritis?
A) Increasing age.
INCORRECT
The onset of rheumatoid arthritis (RA) occurs primarily between the ages of 35-45, although
it can occur at any age.
B) Genetic predisposition.
CORRECT
Because the incidence of RA in persons with a positive family history is significantly greater
than for the general population, genetic predisposition is probably a significant etiologic
factor. In addition, increased stress has been linked to RA, and viral infections are believed
to be a trigger for the onset of this autoimmune disease.
, C) Environmental exposure to carcinogens.
INCORRECT
Although environmental factors may be involved, there is no clear evidence to link specific
exposure to carcinogens to the onset of RA.
D) History of osteoarthritis.
INCORRECT
Osteoarthritis is a degenerative joint disease, and although it is not related to RA as an
etiologic factor, persons with RA may develop secondary degenerative joint disease.
Clinical Manifestations
The nurse completes an assessment of Terry.
3.
In addition to the bilateral swollen tender joints, weight loss, and fatigue, what additional
manifestation(s) of RA might Terry exhibit? (Select all that apply.)
A) Finger tophi.
INCORRECT
Finger tophi are typically seen in the client with gout.
B) Joint deformities.
CORRECT
Joint deformities and subcutaneous nodules are common in advanced RA.
C) Butterfly rash.
INCORRECT
A butterfly rash on the face is a classic manifestation of systemic lupus erythematosus (SLE)
rather than RA.
D) Fever.
CORRECT
A persistent low-grade fever is a common early manifestation of this inflammatory disease.
Remember, RA is both a local and systemic inflammatory disease with many generalized
symptoms such as fever, fatigue, and weakness, along with multiple lung, cardiac, and
renal manifestations.
E) Drooling.
INCORRECT
In fact, the client with RA is likely to experience dry mouth, which along with dry eyes, are
the hallmark symptoms. In addition, Sjogren’s syndrome may cause skin, nose, and vaginal
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