A public health nurse working in a rural area is developing a program to improve health for the local population. Which of the following actions should the nurse plan to take?

Potential Condition: Osteoarthritis

Actions to take:

Instruct the client to apply topical analgesics

Instruct the client to apply heat and cold

Parameters to monitor

Joint deformities

ESR

Rationale:

• Condition: 1. Osteoarthritis
  Rationale:

  • Gradual onset of joint pain over 2 years, affecting weight-bearing (knee) and commonly used joints (wrist).Crepitus noted in affected joints. No systemic symptoms (no rashes, no fever).ANA negative, ESR normal, uric acid mildly elevated but within normal limits, less consistent with gout or SLE. Family history is not strongly suggestive of autoimmune disease.

• Nursing actions to take: 3. Instruct the client to apply topical analgesics, 5. Instruct the client to apply heat and cold
  Rationale:

  • Topical analgesics help relieve localized joint pain.

  • Heat and cold therapy help reduce pain and stiffness.

  • Dietary restrictions (purines) and vaccine precautions are not priorities for osteoarthritis.

• Parameters to monitor: 1. Joint deformities, 4. ESR
  Rationale:

  • Joint deformities: Monitor progression of structural joint changes.

  • ESR: Although typically normal in OA, it can help distinguish from inflammatory arthritis if changes occur.

Rationale:

Anticipated:

Administer betamethasone: The client is 33 weeks gestation with signs of preterm labor (back pain, contractions, cervical dilation). Betamethasone is given to enhance fetal lung maturity and reduce complications if preterm birth occurs.

Administer terbutaline: Terbutaline is a tocolytic (uterine relaxant) used to delay preterm labor and allow time for betamethasone to take effect. Since the client is not yet in active labor, terbutaline may be used to temporarily suppress contractions.

Maintain bed rest with bathroom privileges: Activity restrictions are recommended to reduce uterine stimulation and preterm labor progression. However, strict bed rest is not typically recommended due to risks (e.g., venous thromboembolism).

Unanticipated:

Administer oxytocin: Oxytocin stimulates labor contractions, which is contraindicated since the goal is to delay preterm birth. Instead, tocolytics (e.g., terbutaline) should be used to suppress contractions.

Place client in supine position: The supine position can cause supine hypotensive syndrome by compressing the vena cava, reducing blood flow to the fetus. The left lateral position is preferred to optimize placental perfusion.

Limit fluid intake to 1000 mL/day: Hydration is important for preventing contractions, as dehydration can trigger uterine irritability. Unless there is a specific medical reason (e.g., preeclampsia, heart failure), fluid restriction is unnecessary.