Arthritis nursing rounds record

1. Suspension of the currently used mugwort Chinese medicine hot compress care regimen and replaces it with hypoallergenic hydrogel alternating hot and cold compress care regimen.； 2. The original "timing and quantitative unified standard" functional exercise program was adjusted to a "pain-adapted time-phased step-by-step" program. The intervention goals in the subsequent 7 days are to reduce the resting VAS pain score to less than 3 points, increase the active flexion and extension range of the knee joint to 110°, and stabilize fasting blood sugar in the 6-7mmol/L range.

The ward round was done at 8:30 this morning at the bedside. When we entered, Aunt Zhang was secretly rubbing her knees. Her trouser legs were rolled up to the top of her thighs. There was a small light red rash on the inside of her knees. She said she had been itching for most of the night. The nurse did not dare to ring the call bell for fear of trouble. The bed nurse Xiao Zhou discovered it first when she was changing the sheets. She just had an arthroscopic joint debridement last Tuesday. On the fifth day after the operation, she was in so much pain that she couldn't sleep the night before. She secretly added half a tablet of celecoxib. In the morning, her fasting blood sugar was measured at 7.8mmol/L, which was 1.2 higher than the day before. She was still talking about how the herbal pack given by her neighbor at home worked well, but why she felt uncomfortable after applying the hot compress pack in the hospital.

When it came to stopping the hot compress pack, there was some debate at the scene. Nurse Wang, who has been working in traditional Chinese medicine for 20 years, looked at the formula of the hot compress pack for a long time and said that we have been using this formula for five or six years. Mugwort leaves, Euphorbia sinensis, and Muscle herb are all mild medicinal herbs for unblocking collaterals. Usually, there are very few people with allergies. The problem this time is most likely due to a weak skin barrier caused by diabetes, not a problem with the plan itself. Xiao Li, a young nurse who had just returned from a rotation in the rehabilitation department, did not give in. She took out her mobile phone and took out a screenshot of the "2024 Clinical Nursing Guidelines for Osteoarthritis" that she had saved. She said that the latest regulations clearly mentioned that diabetic patients with peripheral neuropathy and poor skin tolerance are originally relative contraindications for traditional Chinese medicine hot compresses. The inflammatory reaction has not disappeared a week after the operation. Hot compresses will increase inflammatory infiltration by dilating blood vessels, which not only aggravates pain but also easily induces contact dermatitis. This is not called care, but a disservice. The two argued for half a minute, and finally the bedside doctor pulled out the allergen report from the time of admission - Aunt Zhang was mildly allergic to mugwort, which had been omitted when entering the case, so they decided to switch to a hypoallergenic hydrogel: cold compress at 4°C for 15 minutes when it hurts, and warm compress at 37°C if it doesn't hurt, as it will not irritate the skin.

As for the change of functional training to stepped exercises, to put it bluntly, the previous plan was too dead. Previously, I was required to do 3 sets of straight leg raises in the morning, noon and evening every day, each set of 20. Aunt Zhang was originally afraid of pain. She grimaced in pain every time she did the tenth, so she secretly reduced the amount, but she couldn't practice properly. I went to the provincial nursing society meeting last month, and a rehabilitation nursing teacher from a tertiary hospital said that there is no longer a "one-size-fits-all" exercise amount, and it is based on the patient's current VAS pain score: if it is less than 3 points, use the standard amount, if it is 3-5 points, it will be halved. If it is more than 5 points, relieve the pain first before practicing. If you practice hard, it will easily cause secondary damage to the patellar tendon and cartilage. We tested Aunt Zhang on the spot. She found that the resting state pain was 4 points, and when she bent her legs, it was 6 points. We adjusted the plan for her on the spot: when she woke up in the morning, the pain was light, do 2 sets of 15 straight leg raises and 5 passive knee joint flexion and extensions. Aunt Zhang laughed on the spot and said that before, she was always afraid of being criticized for not completing the task, but now she felt much more at ease.

Oh, by the way, I almost forgot to mention blood sugar. The nurse who came to the endocrinology department for consultation said that her recent fluctuation in blood sugar was directly related to her poor sleep. She gave priority to pain relief first. Once she sleeps, her blood sugar will naturally be stabilized. There is no need to rush to increase the amount of hypoglycemic medication. She just needs to replace the white rice porridge with multigrain porridge in her usual nutritious meal. Aunt Zhang usually likes to drink thin food. She was afraid of raising blood sugar before and was afraid to drink it. Now she is happy. We used to manage a 70-year-old man who also had knee surgery. He endured the pain and practiced according to the standard. In the end, he injured his patellar tendon and spent half a month in the hospital. It was not worth the loss. So now we have learned well. Instead of telling patients "how many exercises must be done", we just say "if you feel pain, stop and let's take your time." On the contrary, recovery will be faster.

After the ward check, we were sorting out the records at the nurse station. Xiao Zhou was still feeling emotional. Before, I always thought that there was nothing wrong with following the standards. Now I realize that standards are dead, but people are alive, especially nursing care. Only by adjusting according to the actual situation of the patient can we really treat the patient well. Oh, yes, I have to give health education to Aunt Zhang in the afternoon. I have to remind her not to use hot compresses with mugwort at home. This time, I have found a hidden allergen, which is also a good thing. Uncle Li, who has the same disease as her in the next bed, came over and asked if he could also use this ladder exercise program. We said we would wait until we check his joint range of motion tomorrow and see if he has any underlying diseases. There is no general good program that can be used only if it suits him.