What clinical manifestations of RA did the patient exhibit? Explain the pathophysiologic basis

Ignatavicius: Medical-Surgical Nursing, 9th EditionChapter 18: Care of Patients with Arthritis and Other Connective Tissue DiseasesQUESTION 1Case StudyThe Patient with Rheumatoid Arthritis
A 58-year-old patient comes to the clinic with symptoms of fatigue and hand and wrist pain for 3
months. The patient reports that the fatigue has started to interfere with sleep, and NSAIDs have
provided minimal pain relief. The nurse assesses that the proximal interphalangeal (PIP) and
metacarpophalangeal (MCP) joints of both hands are warm, swollen, and painful to touch with
limited ROM. Diagnostic tests reveal a positive rheumatoid factor, elevated antinuclear antibody
(ANA), and ESR of 32 mm/hr. The patient is diagnosed with rheumatoid arthritis (RA), and the
health care provider prescribes a regimen of prednisone 10 mg orally daily, methotrexate 15 mg
orally weekly, and folate once per day.
for these clinical manifestations.2. Document the discharge teaching instructions provided to the patient for prednisone,
methotrexate, and folate therapy.3. What are four minimum interventions the nurse can suggest to manage the patients fatigue?QUESTION 2After reading the scenario below answer each question and also give the rationale for your answer.Mr. Busch, a 68-year-old man, comes to the ED with severe pain of his left great toe. The toe and surrounding area is red, hot and tender to touch, and edematous. Mr. Busch is unable to wear a shoe or sock; he states It hurts too much to put something on my foot! He rates his pain as a 9 on a scale of 0 to 10, and states that he is unable to perform his daily routine because of the pain.1. What laboratory value results should the nurse expect for Mr. Busch?Answer:
Rationale: 2. Mr. Busch lab results have returned with slight elevations in the ESR and uric acid levels. The provider wants to be sure of the diagnosis before prescribing treatment.3. What procedure may the patient require to confirm a diagnosis of gout?Answer:
Rationale: 4. Mr. Busch asks the nurse, My doctor said I have gout and it is something I need to control with diet or my kidneys could go bad. What do I need to know about my diet?How should the nurse respond to Mr. Busch question?Answer:
Rationale: 5. Mr. Busch tells the nurse that he wants to watch his diet, but he has trouble cooking for himself since his wife of 40 years recently passed away. With whom on the interprofessional health care team should the nurse collaborate to help Mr. Busch meet his dietary needs? Answer:
Rationale: QUESTION 3Identify 10 things you as a nurse would educate a sickle cell patient and family to do in preventing a sickle cell crisis. Elaborate on the top 3.

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