Arthritis Nursing Process

Question 1

Assessment

Answer 1

• Pain assessment - PQRST including location, frequency, and duration of client’s joint pain and stiffness
• Joints affected - asymmetric (OA) vs symmetric (RA)
• Morning stiffness usually resolved in 30 minutes (OA) vs stiffness greater than 30 minutes (RA)
• The extent to which symptoms affect client’s ability to perform ADLs
• Pain-relieving practices - medications and non-pharmacological strategies
• Support system
• Physical examination of affected joint or joints includes assessment of tenderness, swelling, limitation of movement (ROM), and crepitation
• Any deformities - Herberden’s nodes, Bouchard’s nodes (OA) vs ulnar drift, boutonniere, swan neck (RA)
• An involved joint should be compared with the contralateral joint
• Extra-articular manifestations (RA)

Question 2

Diagnosis

Answer 2

• Joint pain and stiffness related to joint inflammation
• Chronic pain related to ineffective pain control and/or comfort measures
• Impaired physical mobility related to joint pain, stiffness, and/or deformity
• Self-care deficits related to joint deformity and pain with activity
• Potential for altered nutritional intake related to pain
• Disturbed body image related to deformity
• Chronic low self-esteem related to inability to perform usual

Question 3

Goal

Answer 3

• Control symptoms and manage pain with hopes of satisfactory relief
• Maintain/improve joint function with minimal loss of functional ability of the affected joints
• Maintain a positive self-image
• Perform self-care to the maximum amount possible
• Participate in planning and carrying out the therapeutic regimen
• Participate in family, social and leisure activities

Question 4

Rest

Answer 4

• Alternate scheduled rest periods with activity.
• The affected joint should be rested during periods of acute inflammation.
• Total bed rest is rarely necessary and should be avoided to prevent stiffness and immobility. Lying prone for half an hour twice daily can be recommended.
• Good body alignment while resting can be maintained through use of a firm mattress.
• To decrease the risk of joint contractures, pillows should never be placed under the knees. A small, flat pillow may be used under the head and shoulders.
• Positions of extension should be encouraged, and positions of flexion should be avoided
• Modify usual activities to decrease stress on affected joints. For example, the client with knee OA should avoid prolonged periods of standing, kneeling, or squatting.
• Splints and braces to rest the inflamed joints, maintain proper alignment and prevent deformity from muscle spasms and contractures.
• Tasks should also be spread throughout

Question 5

Joint Protection

Answer 5

Client’s independence may be increased by:

• Using assistive devices that help simplify tasks, such as built-up utensils, lightweight plastic dishes, electric can opener, raised toilet seats.
• Wearing shoes with Velcro fasteners and clothing with buttons or a zipper down the front instead of the back makes dressing easier.
• A cane or a walker offers support and relief of pain when walking.
• A platform-wheeled walker further minimizes strain on the small joints of the hands and wrists.
• See slide - patient teaching on joint protection

Question 6

Cold and Heat Applications

Answer 6

Cold applications

• Cold reduces inflammation and pain.
• Application of ice is especially beneficial during periods of disease exacerbation.
• Plastic bag of frozen vegetables (peas or corn), which can easily mould around the shoulder, wrists, or knees, are an easy home treatment.

Heat applications

• Heat reduces stiffness and pain.
• Heat therapy - moist hot packs, paraffin baths, whirlpool baths, warm baths or showers.
• Heat and cold can be used as often as desired; however, the heat application should not exceed twenty minutes at one time, and the cold application should not exceed ten to fifteen minutes at one time.

Question 7

Nutrition

Answer 7

• Balanced nutrition is important.
• Fatigue, pain, depression, limited endurance, and mobility deficits may cause a loss of appetite or interfere with the client’s ability to shop for and prepare food. Weight loss may result.
• Corticosteroid therapy or immobility secondary to pain may result in unwanted weight gain.
• If the client is overweight, a weight-reduction program is a critical part of the total treatment plan to reduce stress on joints.

Help the client evaluate the current diet to make appropriate

Question 8

Excercise

Answer 8

• A therapeutic exercise program is usually developed by a physiotherapist and includes exercises to improve flexibility, strength, and endurance.
• Client should practice the exercises with supervision and ensure that the exercises are being done correctly.
• Inadequate joint movement can result in progressive joint immobility and muscle weakness, and overaggressive exercise can result in increased pain, inflammation, and joint damage.

Examples: gentle ROM

Question 9

Complimentary

Answer 9

• Acupuncture, for example, has been found to be a safe and effective method for arthritis pain management.
• Relaxation i.e. meditation
• Other therapies include the use of yoga, Tai Chi, massage, guided imagery, and therapeutic touch.
• Studies on the use of nutritional supplements such as glucosamine for relieving arthritis pain and improving joint mobility are inconclusive

Question 10

Patient Teaching

Answer 10

Patient Teaching - (OA & RA)

• Explain the chronic nature of their disease
• Provide teaching on non-pharmacological pain management i.e. relaxation techniques, heat/cold applications
• Provide teaching on drug therapy i.e. correct administration, reporting of side effects, and frequent medical and laboratory follow-up visits
• Promote a healthy body weight to reduce strain on joints through appropriate diet and exercise

Patient teaching - Joint Protection

Maintain joint in neutral position to minimize deformity.

• Press water from sponge instead of wringing.

Use strongest joint available for any task.

• When rising from chair, push with palms rather than fingers.
• Carry laundry basket in both arms rather than with fingers.

Distribute weight over many joints instead of stressing a few.

• Slide objects instead of lifting them.
• Hold packages close to body for support.

Change positions frequently.

• Do not hold book or grip steering wheel for long periods without resting.
• Avoid grasping pencil or cutting vegetables with knife for extended periods.

Avoid repetitious movements.

• Do not knit for long periods.
• Rest between rooms when vacuuming.

Modify home environment to include faucets and door-knobs that are pushed rather than turned.

Modify chores to avoid stress on joints.

• Avoid heavy tasks.
• Sit on stool instead of standing during meal preparation.