Ankylosing Spondylitis AND Celebrex-Clinical Workbook pg 76 PDF

Preview

Summary

A casestudy on how to treat ankylosing spondylitis and celebrex...

Description

Mendoza 1 Samantha Mendoza Professor Debra Marotta Nursing 110 Clinical February 4, 2020 Ankylosing Spondylitis and Celebrex Assessment Subjective- “I have been experiencing a lot of back pain and stiffness. I don’t know if this medication is even working.” “I don’t take Celebrex daily, but every other day because the medication has become too expensive on my limited income.” ➔ Allergies- Patient states they have “no known allergies.” Objective- Pt slouches to reduce discomfort; grimaces upon encouragement to stand upright. ➔ Neurologic- Pt is alert and slightly lethargic due to fatigue→ alert to time, person, and place; promptly follows commands and answers questions -

Sensation intact→ sensitive to light touch

-

Deep tendon reflexes are 1+

-

Slow movement due to pain

-

Extremity strength are equal

➔ Musculoskeletal- Core, upper and lower back muscle tone slightly atrophic as evidenced by moderate kyphosis; ROM is limited due to pain  ➔ Skin- Skin is color is normal, elasticity adequate, warm and moist; no existing skin ulcers/lesions ➔ GI- Oral mucosa is normal; normal bowel sounds; no significant weight change; last BM 2/4/2020 ➔ Lab Tests - Genetic testing: e.g., HLA-B27 to see if client is carrying the gene after finding out their family history and to find out their likelihood of developing the disease - Erythrocyte sedimentation rate: indicates the presence and level of inflammation if elevated - C-reactive protein: indicate presence of inflammation (usually elevated in ankylosing spondylitis) - Rheumatoid factor and anti-nuclear antibodies: usually negative for those with ankylosing spondylitis

Mendoza 2 Nursing Diagnosis ● Ineffective management of therapeutic regimen R/T deficient knowledge as manifested by noncompliance with taking medication as prescribed ● Risk for activity intolerance R/T chronic pain ● Difficulty falling asleep R/T impaired comfort ● Acute pain R/T psychological stress as manifested by moderate flare-ups and patient not complying to therapeutic regimen due to “limited income” ● Risk for ineffective breathing pattern R/T limited lung expansion as manifested by moderate kyphosis and bent-forward posturing Implementation 1. Watch a video on how to do basic Pilates and Tai Chi exercises and execute them with patient during video demonstration. 2. Have patient slowly fix posture from bent forward to slightly upright while sitting and standing. 3. Monitor patient’s pain tolerance during nonpharmacological interventions by watching their body language. 4. Teach patient relaxation and stress management techniques for flare-up prophylaxis. 5. Have patients communicate pain intolerance during implementation of activities. 6. Apply warm compresses as needed. 7. Administer Celebrex as prescribed by primary care provider. 8.Provide further comfort measures to reduce pain via positioning, environmental control. 9. Refer patient to case manager to help patient obtain medication for free or for a discounted amount. 10. Have patient repeat the importance of complying with therapeutic regimen, when to take the medication, and to follow up with the physician a few days after discharge after patient teaching. 11. Monitor ESR and CRP levels. 12. Speak with admitting healthcare provider and refer patient to physical therapy. Evaluation- Patient is able to demonstrate basic light exercises as they were taught; patient is able to fix posture; patient’s pain and stress is slightly relieved through nonpharmacological interventions; patient’s pain is moderately relieved after Celebrex administration; patient is able to obtain medications from their local pharmacy for a greatly discounted amount after speaking with a case manager; and patient’s ESR and CPR levels are decreased indicating responsiveness to Celebrex.  Teaching

Mendoza 3

1. Teach patient how to do exercises for ankylosing spondylitis. 2. Teach patient about how serious their condition is and how important it is to stick to their therapeutic regimen to slow down the progression of their disease. 3. Teach patient about what their medication does- it decreases back pain and stiffness, and inflammation by inhibiting the COX-2 enzyme (which causes inflammation), as well as maintaining flexibility and posture. 4. Teach patient to get in touch with primary care provider and case manager if problems ensue in regards to them obtaining their medication. 5. Tell patient to have someone or an alarm remind them when to take their medications and to only take the prescribed dosage. Do not double dose when you miss one! 6. Tell patient to establish a clutter-free environment and implement safety measures if CNS or visual disturbances occur. 7. Stop taking Celebrex if sore throat, rash, itching, weight gain, swelling in ankles or fingers, vision changes, chest pain, SOB, and/or slurred speech occur.  Critical Thinking 1. Understanding the pathophysiology of ankylosing spondylitis and how this drug works. How can the nurse explain the importance of taking the medication as prescribed? What key points should the nurse include in teaching?  Firstly, I would explain the urgency of taking his medication in a timely manner by telling him that ankylosing spondylitis is a chronic condition where the bones the axial skeleton such as the spine and sacroiliac joints fuse (due to bone tissue growth), causing progressive and worsening spinal stiffness. In addition, the damages caused by the disease are irreversible once they occur. Failure to comply with the medical regimen will simply allow the condition to progress faster. Not only will not taking the drug as prescribed cause the disease to progress faster, but it may even cause drug resistance. In turn, the efficacy of the drug decreases due to the patient developing a resistance to it. Furthermore, Celebrex is a non-opioid analgesic that helps with the maintenance of flexibility and posture. By not taking Celebrex as prescribed (for the relief of pain and stiffness and the delay of spinal deformity), the non-compliant client may suffer from debilitating pain, causing his range of motion to diminish, leading to physical disability. As a final

Mendoza 4 point, ankylosing spondylitis may affect his breathing adversely due to the condition causing limited lung expansion. 2. Why do you think A.D. 's condition is worsening? 

Aside from A.D. 's condition worsening as a result of not sticking to his drug regimen, the

financial stressors and other factors such as a lack of sleep may play a role in his condition. As a matter of fact, external factors that lead to psychological stress can increase the chances of suffering from a flare-up. His positional preference of slouching when sitting or standing also seems to contribute to his discomfort. Other possible factors exacerbating his condition(e.g., diet, exercise, weight, and age) are things that the RN would have to take into consideration and assess during the nurse-client interview. 3. What interventions do you as a nurse see should be implemented to cope with the disease and for A.D. to maintain the appropriate drug regimen? As an RN, I would encourage the patient to engage in exercises that strengthen the core muscles and maintain flexibility like pilates or light exercises such as Tai Chi. In addition, I would advise them to sit upright and stand tall to decrease spinal strain and discomfort. Heat application to relax the joints and muscles will probably help as well. As for helping A.D. stick to the drug regimen, I would refer him to a case manager to help him obtain a discount for medications or for free. I would also do nurse-patient teaching, then have him repeat all the key points in regards to the nonpharmacological therapies and drug regimen back to me to see if he would be able to execute everything on his own. If he has additional questions, I would give him the facility’s number to call me and advise him to follow up with his primary healthcare provider.

...